Ask a Doc Skin Cancer

June 7, 2017
Dr Michael Jordan

Skin cancer seems to occur in more people and not just in older adults. Each year, there are more new cases of skin cancer than the combined total of new cases of breast, prostate, colon and lung cancer. Sunburn will increase risk dramatically, having experienced just 5 sunburns can double ones risk for malignant melanoma. 90 percent of all non-melanoma skin cancers are caused by ultraviolet radiation from the sun and in the US the annual cost of treating skin cancer is over $8 billion dollars!

I know most parents want to do whatever they can to protect their children from harm, yet in the office we see too many young children with sunburns. I really don’t think those well-meaning parents truly understand the risk associated with sunburn in children. Those sun burns significantly increase the risk of skin cancer; sadly nearly 10,000 people in the US will die in 2017 from malignant melanoma.

Our knowledge and tools for skin cancer prevention are better than ever but those practices must start early in life. For infants 0-6 months it is best to keep them out of the sun and the delicate newborn skin lacks the pigment melanin which makes them very susceptible to the UV damage from the sun. They should be dressed in clothing that covers their arms and legs and shielded with a wide brimmed bonnet or hat when outside and use a stroller with a sun-protective cover. For babies 6 months to 1 year apply a broad spectrum sunscreen but keep exposed skin to a minimum and apply 30 minutes before going outside and reapply after 2 hours or after swimming.

Prevention of sun damage has come a long way in the past 20 years, with very effective, non-allergenic compounds that really work. A “broad spectrum” sunscreen implies that the compounds block both the damaging UVA radiation and the burn and cancer causing UVB rays. Sun screens also prevent the aging effect of wrinkling and leathering of the skin. Sunscreens are marketed with different SPF levels. SPF stands for Sun Protective Factor and is a rough estimate of the duration of the protective properties of the sunscreen. Simply put, SPF 15 would increase the duration before burn 15 times above using no block. It’s a “rough” estimate because individual children have very different skin types and some will burn sooner than others. It’s also a crude measurement because SPF numbers are not always reliable. Consumer Reports magazine recently tested 58 sunscreens and found that “20 tested at less than half their labeled SPF number”.

Most people don’t use enough sunscreen. For example, it is recommended by the Skin Cancer Foundation that to be effect during a long day a person should use nearly ½ of an 8 oz bottle of sunscreen, or at least a shot glass full with each application and it should be reapply after swimming. Sunscreen should even be used on cloudy days as up to 40 % of the UV rays reach the earth on a completely cloudy day. The American Academy of Dermatology recommends a sunscreen of at least 30 SPF. A head to head comparison of sunscreens was published in the July 2017 Consumer Reports Magazine. They looked at the level of UVA, UVB protection, the cost and the variation from the labeled SPF. The highest rated sunscreen was very expensive at almost $ 26.00 for a tube but the second best of all the comparisons was the Equate brand at Walmart for just $5.00.

Sun protection is not limited to sunscreens as more outdoor clothing is marketed with an “UPF” value, a UPF of 30 is said to protect against 97 % of the UV rays. Look for these qualities in children’s outdoor clothing as recent reports have indicated that radiation caused skin cancer have occurred through the ultraviolet penetration of clothing.

Our vigilance is in reducing injury and illness risk with car seats, vaccines and medicines have made great progress. We should also view ultraviolet protection with the same importance. Prevention is truly the best option to avoid skin cancer and cancer prevention must start in infancy to be most effective. 

Michael Jordan, MD, MS-HQSM, CPE, FAAP
Medical Director Rochester Regional Health
Chief Pediatrician, Newark Wayne Community Hospital

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