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12 things to know about sun exposure

I was recently asked to write a piece for the Irish Independent about staying safe in the sun – and here it is, in today’s Irish Independent. Have a read and hopefully pick up a few tips.

Full text below:

Despite increased awareness of the dangers of sun exposure, the rate of skin cancer, and in particular of melanoma skin cancer is on the rise in Ireland. As Ireland basks in glorious sunshine, many people’s minds are turning to how best to enjoy this weather, while still protecting their skin and their health. Understanding how sun exposure impact on our health and our skin is key to developing healthy habits.

Understand how the sun affects your skin

Ultraviolet energy, also known as UV radiation, from the sun is absorbed by our skin. There are different types of UV radiation, UVA, UVB, and UVC rays. There is no such thing as safe UV radiation. UVA rays damage the DNA of skin cells, and cause skin ageing. These rays cause lines and wrinkles, and contribute to the formation of cancers within the skin. Sunbeds give off a lot of UVA radiation. UVB rays have slightly more energy than UVA rays, and cause sunburn and redness. They too damage DNA, and are thought to cause the majority of skin cancers. UVC rays have more energy than UVA or UVB, but are not generally part of sunlight, and do not tend to get through our atmosphere.

DNA damage builds up over time in skin cells, and ultimately can cause a mutation in previously normal skin cells, which stops them behaving normally, and causes them to become cancerous. With cancer, cells do not behave normally, but keep growing even when there is no need. Melanoma skin cancer is particularly linked to sunburn, and sunbed use, and can be fatal. Non-melanoma skin cancer is such as basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are linked to chronic exposure to the sun. These type of skin cancers are much less likely to spread to other parts of the body, but can cause  significant problems, require extensive surgery, and result loss of function or significant scarring. In addition to malignant cancers, son exposure can also result in a number of benign skin lesions, some of which may be unsightly or uncomfortable, and which may require surgery or other treatment.

The texture, tone, and colour of skin is also altered by sun exposure, and age spots, laxity, rough texture, loss of elasticity, lines and wrinkles. Prevention is much better than cure for these types of concerns.

Realise that you are at risk of skin cancer, and examine yourself regularly

Non-melanoma skin cancer is the most common cancer in Ireland, and the number of cases is rising. Most cases are caused by UV exposure. The rate of melanoma is also on the rise.

In the majority of cases, skin cancers do not cause any symptoms, particularly at first. I commonly see patients who have ignored a lesion on the basis that it was not painful. Also, it’s not only “sun worshippers” who are affected by skin cancer;  we are all at risk.

You should examine yourself from head to toe every month, including parts of your body not usually exposed to UV radiation, like the soles of your feet and the groin area. Develop a routine, which you use every time: it is not important the order in which you examine yourself, but merely that you check every inch of your skin. Many people will check all of the front of the body followed by the back, and both arms before they move on to the legs for example. Do not forget to part your hair and examine your scalp skin. Using a hand mirror while standing in front of a long, is probably the easiest way to do your self examination routine.

Learn what is normal for you, and if you find it helpful, take photographs of your skin and compare for any changes that occur over time. Make sure these photographs are in focus, and if possible taken in natural light. Ask a relative or friend to check your back or any areas which you cannot see clearly. If you notice anything unusual, or something that the does not go away after 3 to 4 weeks, have it checked by your GP.

Know what you are looking for

Non-melanoma skin cancers vary in appearance, and can appear as any of the following: a small lump, an ulcerated area that will not heal, flat red spot, a scaly or flaky patch, a firm red or white lump, or a tender spot or lump.

Melanoma skin cancers present as a mole that suddenly gets bigger, or new mole on the skin. The ABCDE list, which is contained in the Irish Cancer Society’s “melanoma skin cancer : what you need to know” leaflet  is a useful reminder of what to look for:

A: Asymmetrical moles: a change in shape: one half is unlike the other

B: Border of a mole: a change in the edges: they look blurred or jagged

C: Colour of a mole: a change in the colour or differences within the mole – shades of tan, brown, black or even white, red or blue

D: Diameter (width): any change in size: most melanomas are larger than 6 mm (the size of the top of the pencil) and keep growing

E: Evolving: melanoma moles often change or evolve

The Irish Cancer Society advises that if you notice any of these signs, or have a mole that is tingling, inflamed, losing, crusting or bleeding, contact your GP without delay. They also advised to look out for dark patches under your nails, not caused by injury. They point out that these symptoms can be caused by other things, and that it is normal for moulds to grow and develop during childhood and teenage years. It is however better to be safe than sorry, and if in doubt you should see your GP.

There is no such thing as a “healthy tan”

I commonly come across the belief that a town which is developed slowly and gradually, and in the presence of sunscreen application, or without peeling redness, is a healthy tan. This is a myth. Tanned skin is damaged skin, no matter how slowly or gradually the town has developed. Continued exposure of the skin to UV radiation, increases the risk of skin cancer. Squamous cell carcinoma in particular is associated with chronic low-level exposure to the sun.

Avoid sun beds completely

There is an outdated belief that a “base tan”, developed on a sunbed, is a way of protecting the skin prior to further sun exposure, for example going away on holidays. This is untrue. All that using a sunbed will do, is increase your risk of skin cancer, including melanoma skin cancer. This link is so strong that in the great majority of states in Australia, commercial sunbeds are now banned. I would advocate strongly for a similar ban here.

Do not wait for holidays or a heatwave to protect your skin

In Ireland, most people will need to protect the skin between the months of April and September. Many people I meet are quite meticulous about sunscreen while on holidays, but neglect this when in Ireland. The skin should be protected from the sun using sunscreen and other measures, as described below, on any day that the UV index is three or greater. The UV index runs from 0 to 10, and is routinely reported by Met Eireann as part of the weather forecast. If in doubt, protect your skin.

Choose a broad spectrum sunscreen, and use it properly

Sunscreens are labelled with a number that indicates what fraction of the sunburn-causing ultraviolet (UV) sun’s UV energy can reach the skin; so for example a sunscreen with an SPF (sun protection factor) of 30 allows 1/30th of this UV radiation through to your skin. This rating refers only to the protection offered from UVB rays. The star rating system is used for UVA protection: three stars is the lowest rating and five stars the highest – ideally you should select one with a five-star rating.

My advice is to use a minimum of SPF 30, with a four or five-star rating. To make sure that you continue using the product, it is important that you select one that you can afford, that you like the texture of, and which you find pleasant to wear on your skin. It is extremely difficult to continue using a product that gives you spots, makes you appear greasy, or that feels strange on your skin.

When you find your ideal product, make sure that you apply an adequate quantity – for most sunscreens this is a shot glass full to cover the entire body, and a teaspoonful for the face. For most people, this sounds like a very high volume, and is not what they are used to applying. If you use less, however, you will not get the full protection from the product. Remember that higher factor sunscreens do not last any longer than lower factor ones, and all sunscreen should be reapplied every two hours, to maintain its effect. Apply 20 minutes before going out into the sun, and use a waterproof formulation if you were think you are going to be sweating profusely, or exposed to water.

Use a separate SPF for your face

Time and time again, when I ask patients if they wear sunscreen on their face, they tell me that there is SPF in the moisturiser or make-up. As a rule, the level of protection afforded by these products is not sufficientUse a broad spectrum product, and one that is non-comedogenic (does not clog pores), and bring it with you during the day so that you can reapply. I commonly see people discontinuing the use of SPF on the face, because they use a formulation that is not made for this area of the body, and causes spots, gets into the rise making them sting, or given unpleasant greasy appearance to the skin. I therefore recommend using a specific SPF for the face. This should be applied after moisturiser, after the moisturiser has had a chance to absorb. It should be allowed to settle into the skin before make-up is applied.

Do not rely on sunscreen alone

Sunscreen, even if applied properly, does not provide a “coat of armour” to protect you from the sun’s rays, and it certainly can be difficult to reapply the quantities mentioned above, at regular intervals. In order to best protect yourself, make sure that you cover as much of your body as possible with sun protective clothing. Remember that a white cotton T-shirt probably offers approximately SPF 10, and is not adequate without sunscreen on your skin underneath. Choose a wide-brimmed hat, which shades your face, nose and ears. Ensure that your sunglasses have UV protection – many cheaper glasses will not, and UV exposure increases your risk of cataracts. Finally, seek shade at the times of the day when the sun is hottest, usually between 11 AM and 3 PM.

Know the truth about vitamin D

I commonly hear that people do not protect the skin sufficiently the sun, as they are worried about developing low vitamin D levels. For most people, following the World Health Organisation’s guidance to get 5 to 15 minutes casual sun exposure to exposed areas such as hands, and face 2 to 3 times per week, is adequate to prevent deficiency. More time in the sun does not equate to more vitamin D, and your body is only capable of storing this vitamin D for 30 to 60 days, some more time in the sun now, will not equate to more vitamin D3 use in winter months. Maintaining a healthy balanced diet, and discussing with your GP as to whether a dietary supplement is appropriate in your particular case, is the best approach.

Never let an unqualified person treat a lesion on your skin

Like many plastic surgeons, I have come across cases where the diagnosis of skin cancer has been delayed, because a mole or a lesion was treated with laser in a beauty salon. Unfortunately, there is little to no regulation around who can purchase and operate laser machines in this country. Allowing someone with no medical qualification to “zap” a pigmented or brown lesion on your skin is dangerous, and I would strongly advise against this.

Do not believe the myths

There are many myths around sun protection, which are disproven and/or dangerous. Remember that false tan does not protect the skin from the sun. Also bear in mind, that no matter what your skin type, you are at risk of skin cancer. Skin cancers can occur in even the darkest skins, and are usually diagnosed at a later and more dangerous stage when they do occur.

Remember to enjoy the sun

There are huge health benefits to being outdoors, and we certainly should not confine ourselves to the indoors whenever the sun peeps from around a cloud. By making sun awareness part of our daily routine, whether that be by putting the SPF besides the moisturiser on the bathroom shelf, or beside the door so we see it on the way out of the house, getting used to wearing a hat, or choosing a shaded spot to enjoy the sunshine, we can all protect ourselves, without risking cancer and premature skin ageing.