It’s Saturday afternoon and the sunlight beats down on your face, warming your skin. You are so relaxed, you close your eyes and soak in the moment. You hear kids playing in the background, laughing and splashing in the water. The grill is lit, and the food smells absolutely amazing. As you sip your refreshing drink, you enjoy these moments surrounded by family and friends, wishing they would never end. Summer is in full swing and millions of families all across America, just like you, are enjoying hours upon hours soaking up the sunshine. So often we forget – hiding in those comforting rays is a silent threat – melanoma.
Skin cancer is not really the topic people want to discuss when making plans for their summer. However, it is the most commonly diagnosed cancer in the United States, so it is a discussion we need to have. One out of every 50 Americans will develop invasive melanoma – the deadliest form of skin cancer – during their lifetime, with many suffering lasting physical damage and nearly 10,000 each year paying the ultimate price, their life. The American Cancer Society estimates there will be 73,870 new melanoma of the skin cases in 2015. As pharmacists, we are in a prime health care position to educate the public on the risks of sun exposure and melanoma prevention.
The primary cause of melanoma is exposure to ultraviolet (UV) radiation, UVA and UVB rays, which cause irreversible DNA damage. UVA rays are commonly associated with tanning beds, and play a role in wrinkles and overall aging of the skin. UVB rays are more potent than UVA rays, causing direct damage to the DNA; they are more often associated with sunburns. DNA damage is cumulative over the years of UV exposure. Research has demonstrated that regular use of sunscreen decreases the amount of damage caused by sun exposure, leading to a reduction in the risk of melanoma.
To help us better understand UV risk in relation to location, the National Weather Service and the Environmental Protection Agency have developed the UV index, a calculated risk on a scale from 1 to 11+, provided per zip code – the greater the number the greater the risk. The UV index considers factors such as the time of year, time of day, location in reference to the equator, and altitude. UV radiation is at its strongest in spring and summer months, from 10 am to 4 pm each day, as you move closer towards the equator, and/or towards higher elevations. A UV index is often given in the local forecasts, newspaper and weather apps.
People of all backgrounds and skin colors are susceptible to skin cancer. In order to ensure proper education on skin cancer prevention, it is important to know what traits put some individuals at higher risk than others. Below is a list of risk indicators most commonly associated with skin cancer:
- Personal history of skin cancer or family history of melanoma
- Fairer traits and sensitivity to the sun – including lighter natural skin color that freckles or burns easily, natural red or blonde hair, and blue or green eyes
- History of excessive sun exposure, including sunburns – on average, a person’s risk for melanoma doubles if they have had more than 5 sunburns
- History of tanning, including tanning beds or a lot of time spent outdoors for work or play
- Immunosuppressant therapy or an innate decreased immunity
- Presence of atypical, large, or numerous (more than 50) moles
Symptoms of sunburn, including red tender skin, blistering, and fatigue, can take nearly 4 hours after sun exposure to appear. These symptoms typically worsen over the first 24-36 hours and may take 3 to 5 days to resolve. Symptoms of skin cancer may take decades to appear. Therefore education and prevention is key, starting at a young age. The table below offers tips to follow to provide protection from the sun and reduce chances of getting melanoma in the future.
|Use sunscreen – SPF-15 or higher* with “Broad Spectrum” on the label||Apply liberally, 1 oz. (one shot glass full) or more, 30 minutes prior to sun exposure and then every two hours or immediately after swimming or excessive sweating – regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing melanoma by 50%*Using sunscreen with a SPF over 30|
|Seek the shade||Stay out of the direct sun as much as possible, especially during the hours of 10 am – 4 pm, when UV radiation is at its strongest|
|Avoid tanning||Both indoor tanning booths and laying out in the direct sun cause similar amounts of damage to skin and eyes|
|Dress to protect||Wear clothing that will cover as much skin as possible, preferably clothing made from a tightly woven fabricDark colors typically provide more protection than lightSome clothing has a UV Protection Factor – the higher the UPF, the better the protection from UV rays|
|Cover your head, neck and face||Nearly 80% of skin cancers occur on the head, neck, and face – Wearing a hat, with at least a 2- to 3-inch brim all the way around can provide invaluable protection|
|Protect your eyes||Sunglasses not only protect the delicate skin around the eyes, they also reduce the risk of developing cataracts – look for ones that protect against both UVA and UVB rays|
|Know your local UV index||The local UV index can typically be found in a local forecast, newspaper, or weather apps.|
Sun protection factor (SPF) is a measurement of how well a sunscreen blocks UVB rays from damaging the skin. The amount of protection it provides can be described two different ways, how long skin is protected from UVB radiation, or the percent of UVB rays blocked. How long a person is protected from a sunburn can be determined by multiplying the SPF by the amount of time it would normally take to sunburn if unprotected; so if it normally takes 30 minutes to burn and SPF-15 is applied, then theoretically, one would be protected for 450 minutes (7.5 hours). However, it is important that sunscreen be applied every two hours to ensure maximum protection.
SPF may also be represented in terms of the percent of UVB rays filtered: SPF 15 prevents 93% of UVB rays from damaging the skin, SPF 30 shields from 97%, SPF 50 blocks 98%, and SPF 100 blocks 99%. As you can see, as SPFs increase over 30 they provide very minimal added protection. Therefore, many health professionals do not recommend using a sunscreen above SPF-30. On the other hand, they do recommend using sunscreens labelled as “broad spectrum”. Broad-spectrum protection indicates there is an added component to the sunscreen that also provides protection against UVA radiation. The CDC recommends applying sunscreen SPF-15 or higher – with broad spectrum coverage – liberally, 30 minutes prior to sun exposure and then reapplying it every two hours during sun exposure.
As you enjoy the rest of the summer, remember to advocate for the skin health of the patients you serve. Skin cancer is a very preventable disease, and as a pharmacist, you have the tools to provide the public with invaluable knowledge to know their risk and protect themselves from the most commonly diagnosed cancer in America. Take time out to promote sunscreen and educate on its proper use. Take the steps to ensure your patients are provided with the power to prevent. And remember, sunscreen saves lives, so let’s start saving lives, one blocked ray at a time.
Dea S. Deuser
University of Missouri-Kansas City
Doctorate of Pharmacy Class of 2016
Operation Heart Co-Chair
- Cancer Facts & Figures 2015. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. American Cancer Society. Accessed July 7, 2015.
- Skin Cancer Facts. http://www.skincancer.org/skin-cancer-information/skin-cancer-facts. The Skin Cancer Foundation. Accessed July 7, 2015.
- Skin Cancer Prevention and Early Detection. http://www.cancer.org/cancer/cancercauses/sunanduvexposure/skincancerpreventionandearlydetection/skin-cancer-prevention-and-early-detection-what-is-u-v-radiation. American Cancer Society. Accessed July 8, 2015.
- Sunscreens Explained. http://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-explained. The Skin Cancer Foundation. Accessed July 17, 2015.
- UV Index. http://www2.epa.gov/sunwise/uv-index. United States Environmental Protection Agency. Accessed July 9, 2015.