Skin Cancer: The Basics Mary E. E Maloney MD Umass Medical School Division of Dermatology

Skin cancer

Squamous cell carcinoma Melanoma

Basal cell carcinoma

Outline • Ultraviolet light – Immediate and long term effects – Ozone

• Tanning • How to protect your skin – Sunscreen for adults and kids

• S Sunless l tanners • Vitamin D

Things that damage skin • Ultraviolet light • Smoking – Increases wrinkling and fine line – Increases risk for Squamous cell carcinoma

Ultraviolet (UV) light • Sources of Ultraviolet light – Natural sunlight

– Artificial A tifi i l light li ht • (tanning booths, phototherapy booths)

Sunlight • Sunlight consists of visible light (the light we see) and ultraviolet light (we can’t see) • Ultraviolet light is what causes – Sunburns – Suntans—a markk off damage d to the h skin ki – Other skin damage

Ultraviolet light g is divided into 3 parts

• UVA • UVB • UVC

The atmosphere blocks some UV

O Ozone llayer ddamage  increasing i i UV gets t to t Earth E th

– UVA Photoaging Ph i / wrinkles i kl and tan Skin cancer sunburn,  b tan, and d – UVB skin cancer

– UVC

 Filtered by ozone layer

Short-term affects of UV • Sunburn • Tanning • Polymorphous light eruption (“sun allergy ) allergy”) • Flare of cold sores (herpes infection)

Sunburn • Intense UV exposure p causes burn of the skin • Caused by UVB • Severe cases can involve blisters • Melanoma risk doubles with 5 or more sunburns b

Tanning… skin’s skin s self defense • UV light causes damage to the DNA in our cells • Pigment (melanin) is made by the skin to help protect the DNA from further damage • Increased melanin in the skin  TAN • Tan skin is not healthier, it is a direct result of skin damage

Chronic sun damage • Wrinkles • Pigment changes – Brown spots (freckles (freckles, lentigenes lentigenes, melasma) – White spots

• Blackheads • Telangiectasias

Photoaging and wrinkles • Caused by UVA light • UVA penetrates regular window glass

Skin cancer UV light exposure

Damage to DNA in skin cells

Growing cells develop mutations

Cells become malignant (cancer)

Who gets skin cancer • Most at risk – – – – –

Fair skin Burns easily History of lots of sun exposure F il history Family hi t off melanoma l Risk increases as you get older

• Rates are increasing in young people

Tanning booths • P Provide id an artificial ifi i l source off UV light li h for the purpose of tanning • Give UVA and UVB exposure – Levels of UV radiation are NOT regulated

• Use of tanning booths continues to increase in adolescents

Tanning misconceptions • Tanning booths are safe • Tanning in a booth is safer than outdoors • Getting a base tan will protect my skin • A tan is healthy y for the skin

Tanning booths • Tanning causes damage to the skin, just like burning • Risk of skin cancer increased – 15 percent higher risk of melanoma if ever used a tanningg booth * – 2.5x greater squamous cell carcinoma – 1.5x 1 5x greater basal cell carcinoma

• Accelerated skin aging * The Association of Use of Sunbeds with Cutaneous Malignant Melanoma and Other Skin Cancers: A Systematic Review," International Journal of Cancer 120, no. 5 (2006): 1116 - 1122).

Sun protection • Sun avoidance • Sun protective clothing • Sunscreen

Playing safe in the sun • Peak UV times are 10 am to 4 pm, with the greatest risk from 12 to 2pm • Try to plan outdoor activities for early morning or late afternoon if possible • Seek k shade h d • Wear a hat with a broad brim, made of dense weave material • Wear W UV protected t t d sunglasses l

Sunscreen • Something applied to the skin to help protect it from UV light • Come in gels gels, lotions lotions, creams, creams sprays, sprays sticks • Added to chapstick and makeup

Important sunscreen info • SPF • Ingredients – does it block UVB and UVA?

What is SPF? • Sun protection factor • Measures how much longer it will take to sunburn than without sunscreen – An SPF of 15 = 15 times longer before a faint sunburn occurs

• It measures only UVB protection (UVB causes sunburns)

• Does not tell you about UVA protection

How does sunsreen work? • Sunscreen can have either: – Physical blockers • Block both UVA and UVB

– Chemical absorbers • Can protect from UVA, UVA UVB or both

• They protect the skin differently

Physical blockers protect the skin by reflecting UV light • Include: I l d – Zinc oxide – Titanium dioxide

• Can give a white appearance • Newer formulas have smaller p particles that are more cosmetically pleasing

Chemical absorbers soak up UV light • Many different types • Can protect against UVB, UVA or both depending on the ingredient

UVA •C Certain i ingredients i di block bl k UVA well ll • Physical blockers – Titanium dioxide – Zinc oxide • Chemical absorbers – Avobenzone (Parsol 1789) – Mexoryl y

Labels can be misleading!

Check the active ingredients

H tto select How l t a goodd sunscreen • SPF off 30 or greater • Broad spectrum p sunscreen that blocks UVA too • Fits Fit with ith your activities ti iti – Waterproof /sweatproof for swimming, athletics

• Oil free for areas prone to breakouts (face) • Formula you like – Gel, lotion, spray, stick

Two common questions… • I use high SPF sunscreen… why do I still burn? • Is it true that anything over SPF 15 doesn’t make a difference?

The true SPF depends on how much you apply •M Mostt people l use less l sunscreen than th needed • Thickness of application affects SPF • You Y need d to apply l 2 mg/cm² / ² – That means that: – An average 150 pound adult needs • 1 oz to cover the entire body • 1/3 teaspoon p to cover the face Stokes R. How well are sunscreen users protected? Photodermatol Photoimmunol Photomed. 1997;13:186-188.

•M Mostt people l gett between b t 20-50% 20 50% of the SPF on the label – SPF 15  SPF 3 to 7.5 – SPF 30  SPF 6 to t 15

• Using g too little sunscreen can ggive a false sense of security – Underprotection and increased exposure are a risk

Use enough

Apply evenly

How to apply sunscreen • Apply 20 – 30 minutes before going outdoors • Apply A l liberally, lib ll rubb in i well ll andd evenly l Re apply • Re-apply – After swimming, toweling dry, sweating – After every 2 hours outdoors

I f t andd the Infants th sun • Babies less than 6 months old should get as little sun as possible • Protect infants with: – – – –

Hat with wide brim or bonnet Longg sleeves and pants p Cover stroller Sit in shady spot or under an umbrella

Sunscreen for infants and children • Sunscreen should be used on infants over 6 months of age • Apply liberally • If a rash develops with 1 sunscreen, try switching to another one or ask your doctor for guidance • You Y can test with i h a small ll amount applied li d to the inside of the arm a few days ahead of time to see if a rash develops

Sunless tanners • Are safe • How they work – DHA, DHA dyes the top layer of skin

• Provides only SPF 2-4 • Some have higher SPF but that only last 2 hours, not duration of color change • Use with sunscreen!

Has the damage been done? • It’s never too late! • You can always prevent additional sun damage • Careful sun protection at any point will d decrease the h risk i k off sun damage d down d the h line and may give the skin a chance to heal

Vitamin D • Controversial topic • Vitamin D and disease prevention • Vitamin D and the sun – How much sun do we need?

• Where should we get our Vitamin D?

Vitamin D production SKIN Pre-Vit D3  Vit D3

GI TRACT CIRCULATION

liver kidneys Active Vit D

FOOD / VITAMINS

Conclusions • UV light can cause immediate and long term damage g to the skin • Skin cancer rates are increasing • Prevention is key! – – – –

Seek the shade, especially between 10 A.M. and 4 P.M. Do not burn Avoid tanning and UV tanning booths Use a sunscreen with an SPF of 15-30 or higher every day. day – Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours h – Cover up with clothing, including a broad-brimmed hat and UV-blocking UV blocking sunglasses – Keep newborns out of the sun. Use sunscreen on babies over the age of six months.

How much sun do we need? • Vitamin D is made in the skin with the help p of UVB • Only a little UVB is needed • A fair-skinned person needs only a few minutes – In Worcester in June, June 5 minutes is all you need

• More exposure only increases UVB damage without ih adding ddi more vitamin i i D • Most p people p gget enough g UV exposure p with normal activities