12 things you really need to know about sun exposure
Learn to protect your skin and your health this summer, and all year-round, writes consultant plastic surgeon Eilis Fitzgerald.
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 Northern Ireland. As we bask in 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 impacts on our health and our skin is key to developing healthy habits.
1. 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 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 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 in loss of function or significant scarring. In addition to malignant cancers, sun 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.
2. Realise that you are at risk of skin cancer and examine yourself regularly
Non-melanoma skin cancer is the most common cancer in Northern Ireland. Most cases are caused by UV exposure. 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.
Do not forget to part your hair and examine your scalp skin. Using a hand mirror while standing in front of a long mirror 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 changes that occur over time. Make sure these photographs are in focus and in natural light. Ask a relative or friend to check any areas which you cannot see clearly. If you notice anything unusual, or something that does not go away after three to four weeks, have it checked by your GP.
3. 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 tells you what to look out 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 6mm and keep growing.
E: Evolving: melanoma moles often change or evolve.
If you notice any of these signs, or have a mole that is tingling, inflamed, oozing, crusting or bleeding, contact your GP without delay. It’s also advisable 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 moles to develop during childhood and teenage years. If in doubt, see your GP.
4. There is no such thing as a ‘healthy tan’
I commonly come across the belief that a tan 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 tan 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.
5. Avoid sunbeds 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. I would advocate strongly for a sun bed ban.
6. Do not wait for holidays or a heatwave to protect your skin
In Northern Ireland, most people will need to protect the skin between the months of April and September. 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 the Met office
7. Choose a broad spectrum sunscreen
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. 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.
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 think you are going to be sweating profusely or exposed to water.
8. Use a separate SPF on your face
As a rule, the level of protection afforded by the SPF in your moisturiser or make-up is not sufficient. Use 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 their eyes making them sting, or gives an unpleasant, greasy appearance to the skin.
I therefore recommend using a specific SPF for the face. This should be applied after moisturiser has had a chance to absorb. It should be allowed to settle into the skin before make-up is applied.
9. Do not rely on sunscreen alone
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 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 11am and 3pm.
10. Know the truth about vitamin D
I commonly hear that people do not protect the skin sufficiently in the sun, as they are worried about developing low vitamin D levels. For most people, following the World Health Organisation’s guidance to get five to 15 minutes’ casual sun exposure to exposed areas such as hands and face two to three 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.
Maintaining a healthy balanced diet and discussing with your GP as to whether a dietary supplement is appropriate, is the best approach.
11. Never let an unqualified person treat a lesion
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.
12. Do not believe the myths
There are many myths around sun protection, which are disproven and/or dangerous. 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.
Eilis Fitzgerald is Consultant Plastic Reconstructive & Aesthetic Surgeon at Beacon Consultants Clinic, Dublin