Australians aren’t strangers to messaging around skin health. We know the “slip, slop, slap” mantra and that “tanning is skin cells in trauma”, yet skin cancer cases in this country are still overwhelmingly caused by excess ultraviolet radiation (a carcinogen) from the sun.
2 out of 3 Australians will be diagnosed with skin cancer by age 70.
To break it down further, skin cancer can be divided into melanoma and non melanoma skin cancer. The latter includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and by far the most deadly skin cancer is melanoma.
Skin cancer does not discriminate according to age and melanoma is the leading cancer affecting younger people (15-39 years).
Some skin cancers, including melanoma, are linked to sun exposure incurred in the first 10-20 years of life, while others are due to cumulative lifetime sun exposure.
The good news is, that the majority of melanomas are preventable and minimising UV exposure is the key preventative factor. Regardless of what stage you are at in your life – start and commit to daily sun protection. Ideally the earlier these habits are instilled, the more enduring the benefits.
Make these 5 elements your friends all year round, especially over summer – SASSS!
Sunscreen, A broad brimmed hat, Sunglasses, Sun protective clothing, Shade (and avoiding sun during the peak UV periods, i.e. in the middle of the day).
We all know it and it sounds simple, but very rarely do we do all of the above.
Using the full complement of sun protective measures (5 elements) offers you the best chance of protection. Using one of these methods isn’t good enough!
The best sun protection means the best chance of reducing your skin cancer risk. Remember whenever the UV index is greater than 3, some form of sun protection is needed. In Sydney, except for the depths of winter, rarely is the UV index less than 3. You can download the SunSmart app on your phone for free which details the UV index across the day.
The best sunscreen is the one you will use
Choose a sunscreen you like and will wear – make sure it’s SPF 50+, has Broad Spectrum (UVA+UVB) protection and that you apply the appropriate quantity (one teaspoon for each limb/front and back trunk/face and reapply every 2 hours), according to your body exposure and activity. There is good evidence to show sunscreen use reduces the risk of most skin cancers.
Underapplication of sunscreen effectively reduces the SPF by up to half, if not applied in the right amount.
Beware of sunscreen sprays! It is difficult with a spray to achieve the desired thickness of application and therefore lack of protection is a concern.
I encourage my patients to incorporate sunscreen daily into their morning skin care routine. Do not rely on makeup to have the appropriate SPF or broad-spectrum protection. It is always best to wear sunscreen under makeup.
Don’t forget your eyes and sites where the sun don’t shine
When choosing sunglasses, ensure they meet the Australian Standard for eye protection, choose category 2 or higher and look for an Eye Protection Factor (EPF), ratings of 9 or 10 provide excellent protection.
Your eyes, like your skin are sensitive to UV damage. While ocular (eye) melanoma is rare, it certainly can occur in addition to skin cancers involving the eyelids/skin around the eye.
Do not forget concealed sites. Mucosal melanomas and non melanoma skin cancers are rare but it is important to know that the mucosa (moist lining) of the mouth, eyes and genitals can be a site for skin cancer as can the scalp. Be on the lookout for lumps and bumps on the scalp when washing your hair, ask a partner, family member, even your hairdresser to look at hard to see places like the scalp.
Tanned skin is essentially a sign of distressed skin
Tanned skin signals DNA damage to the skin cells which can serve as a precursor to skin cancer. Fake tan offers an SPF of around 2 (negligible), don’t be lulled into a false sense of security that your tan (real or fake) is offering sun protection. Studies indicate having a tan makes us feel a little more invincible when it comes to the sun and the need for sun protection.
Don’t forget that excessive UV radiation, that results in tanning, not only contributes to skin cancer risk but also contributes to premature ageing of the skin, due to the oxidative stress it creates. In other words, it’s a fast track to wrinkles, pigmentation and lacklustre skin
Know the skin you are in
Regularly survey your skin (around once a month), be on the lookout for anything new or changing and get anything of concern seen to promptly by a trained medical professional.
Remember the ABCDE rule for pigmented lesions: A for asymmetry, B for border irregularity, C for colour variegation, D for diameter (>6mm, but melanomas can be any size), E is for evolution. It is important to note that melanomas can be pigmented (brown/black) and up to 20 percent may be amelanotic (pink/red/lacking in pigment). The latter tend to be more aggressive and late to diagnosis and require prompt review.
Formal skin surveillance for most adult Australians should take place annually. The frequency of clinical review very much depends on one’s risk factor profile. Early detection of melanoma is key as early stage disease has a much better chance of cure. Good sun protective practice reduces skin cancer risk and is easy to implement at any stage in life.
I encourage my patients young and old to sun-protect to reduce their skin cancer risk as well as to lead by example, that is to be the change they want to see. For parents and grandparents, little eyes are constantly watching your every move. For teenagers and young adults, your peers are impressionable. Lead the way.
Skin cancer, in particular melanoma, is primarily preventable. It is one of the few cancers that is and we know the primary causative factor- excessive UVR from the sun. It’s a no brainer. Know and protect the skin you are in and spread the message.