If you read the news these days, things can get you down. There is so much turmoil, sickness and sadness. It breaks many a heart.
I am sad to say that what is ALSO troublesome these days is the continued burden of preventable skin cancer. In the US, it is estimated that 95% of skin cancers are due to modifiable risk factors. That means, if we were better at getting the information out, if we were better at targeting these risk factors, fewer people would suffer.
I'd like to keep getting better. Prevention is the word of the year.
According to cancer.net, it is estimated that almost 100,000 adults in the US will be diagnosed with melanoma in 2022. Thousands will die from this condition unless we can change our ways. Thousands of Americans also may die of the more common, but less aggressive squamous cell carcinoma this year.
So what do we do?
Dermatologists recommend a tiered approach.
Of course, sun/UV protection is the first line of protection. Start early. I remember reading a study once that indicated that most people get the majority of their sun exposure in childhood. Learn how to better protect yourself and your kids. We all need to get outside, breathe fresh air, explore our wonderful planet, but do it with sun protection.
We know that one of the most preventable and highest risk factors for skin cancer is exposure to ultraviolet light, whether on the beach or in a tanning bed.
Play in the shade! Look for shade structures when outside. Incorporate them into your outdoor spaces and plan activities when the intensity of UV isn't at its peak.
Shade seeking and clothing leads to fewer sunburns compared to sunscreen.
Use physical non-micronized sunblocks for areas that can't be covered. I use this on my kids and I just love the scent.
Stay away from the tanning beds. Every time you step into the tanning bed you increase your risk for skin cancer. Just say no. As of 2022, tanning is illegal for minors in 23 states due to the known risk factors for skin cancer.
Intense INTERMITTENT exposure seems to be particularly dangerous. Be careful with change of seasons and WHEN ON VACATION!
Don't forget protection for your eyes. Yellow/orange filters are thought to be superior to other lenses in your sunglasses. How cool are these! My little guy could probably loan you a pair of his...
But what about Vitamin D?
Many people think that they need to spend quite a bit of time in the sun in order make Vitamin D. But actually, this isn't really the case.
For instance, even at the very northern latitude of Oslo, Norway, studies suggest that just 30 minutes fully in the summer sun will make 10,000-20,000 IU of Vitamin D. That is WAY beyond the necessary recommended daily allowance, and often lower than the threshold where many will get a sunburn.
My rule of thumb I share with my patients is that generally speaking, for fair skin populations, “10 minutes a day, 10 percent (skin) exposure” is generally sufficient to make your Vitamin D.
Now if you have darker skin, you may need a few extra minutes. More melanin means it takes a little longer to synthesize Vitamin D. Similarly, if you are older than 50, you may also need a few extra minutes. This is because over time we have less dehydrocholesterol in the top layer of our skin. This is one of the compounds that starts the process.
I generally recommend that my adult patients take the RDA of Vitamin D, which is 600IU. They even have them in gummies!
Supplements and Medications
What about other measures? Are there other things we can take to reduce our risk of skin cancer? This is complicated, and we don't have all the information yet. But to make a long story short, the answer is probably so.
There is some evidence that eating a healthy diet rich in naturally occurring compounds may be helpful as part of an overall risk reduction strategy. Antioxidants (which target DNA damage from dangerous reactive oxygen species) that occur NATURALLY in plant foods may play a role.
But (and this is a big but) this may not necessarily be true for supplements, where the data is controversial and even at times, concerning.
Similarly, high citrus consumption even in natural forms prior to high outdoor exposure may prove to be dangerous! It may be sensitizing to the dangerous UV effects!
For people who have made at least one skin cancer, most importantly squamous cell carcinoma, who have a fair amount of sun damage, I encourage them to speak to their doctors about NIACINAMIDE (also known as nicotinamide). I do not recommend this for everyone. However. it is essentially a form of Vitamin B3 that has been studied extensively as part of an overall risk reduction strategy. It is not recommended for lower risk populations, but again for high risk populations, this may be helpful. Definitely, speak with your health care providers about this!
Niacinamide
Interferes with carcinogenesis by augmenting DNA repair
Inhibits inflammation in irradiated keratinocytes
Restores the skin barrier
Effects diminish after six months post intervention.
Usually prescribed as 500 mg by mouth twice daily.
For people who have had a solid organ transplant and a skin cancer, you may also want to speak with your physicians about a medication known as acitretin. This has some more side effects but for people with solid organ transplants who are at high risk for skin cancer, it is definitely worth the conversation with your doctor!
Also, if you are a person who has had precancers and you have been treated with that liquid nitrogen spray to destroy them, speak with your doctor about field treatments to see whether you are a candidate. These come in a few forms, but generally the most commonly used is a topical prescription medication.
Some medications for other conditions may increase risk for skin cancer. If you are on medications for an organ transplant, high blood pressure, high cholesterol or other conditions, AND YOU ARE HIGH RISK for skin cancer, ask your health care provider whether there are alternatives that might be safer. Many times, the answer is yes.
Screening and Education
I recommend a periodic skin cancer screening for every adult in the US. To clarify, of course this does NOT have to be done by a board certified dermatologist! But it should be done by your physician or health care provider from time to time, more often of course if you are higher risk.
More importantly, for my patients with multiple moles, I always recommend GETTING TO KNOW YOUR MOLES AND BIRTHMARKS! For some people, who have very few, this might not take much time. However, for my patients with 20 or more moles, I generally recommend that they look at their moles at least once a month. That way, if something changes, they know right away! This is critical since we know that the faster you detect a skin cancer, the better your overall chances of survival and decreased morbidity.
Don't know how to do this? Take a smartphone photo! Use this as your baseline, and repeat as needed.
We also need to start screening and education early. Skin cancer often shows up later in life, but the damage that often leads to it many times happens very early in life. If we educate our kids on the risks, and keep REMINDING them, we stand a better chance.
Skin of Color
What about if you have skin of color? Are you still at risk for skin cancer? The answer is a definite YES!
Skin comes in many beautiful shades. Some are more predisposed to skin cancer from UV rays. Some have a little more protection from that form. However, the sad truth about skin cancer is that not all skin cancers are sun induced. Many happen from other alterations in DNA that were not caused by UV, but by other factors, such as genetic risks or other pathways.
Also, when people THINK of a sunburn, they often imagine bright red or blistering skin. But people with darker skin may not experience a sunburn that way. It may just be tingling or irritated skin. But the damage is still happening.
So yes, even if you have skin of color, get to know your skin, and pay attention to anything changing or evolving. Pay particular attention to the palms, soles and nail beds which are occasionally the sites of melanoma in people with darker skin.
These are only a few of the steps we can take to reduce our risks. My hope is that with more information, we can reduce these risks and the burden of skin cancer over time.
It's my mission.
So what can you do?
Take Action!
Invest in sun protection, and make it a habit.
Advocate for safe outdoor spaces for kids in your community. Your school can apply for a grant for a shade structure through the American Academy of Dermatology. Learn more about it here.
Find sun protective clothing, hats and sun block that you like and you will wear. If you have one, go put it by the front door now so it will be ready for you the next sunny day you head outside.
Ask your doctor if you are a candidate for niacinamide. If you have an organ transplant and you have already had a skin cancer, ask your doctor about acitretin.
If you are on medications and you have a high risk for skin cancer, speak with your health care provider about risk benefit and alternatives if available.
Go take a good look at your skin! Repeat this periodically. Get to know your skin so that if it ever changes, you are more likely to catch the change right away.
This is how we do it. Let's do it together. My very best to you...