Sunscreen and Skin Cancer

May is Melanoma Awareness Month, and as such we want to bring awareness to three different skin cancers, as well as how proper skincare can help prevent and protect your skin from skin cancer. Skin cancer is the most commonly diagnosed cancer in America, with 1 in 5 Americans developing skin cancer sometime during their lifetime. Although frequently diagnosed, skin cancer is preventable. The majority of skin cancer comes from prolonged and unprotected exposure to ultraviolet radiation (UV rays), which can be blocked from entering the skin and damaging underlying skin processes.

Being based in Oregon, we are obviously partial to knowing the United States rates of skin cancer; however, we think Spencer Tunick’s 2022 photography project is a fantastic visual to show how many people are affected by skin cancer each year. In Australia alone, 2500 adults are diagnosed with skin cancer each year - for context, in 2022 about 3.8 million Americans were given the same diagnosis. In order to raise awareness of the importance for yearly skin check ups, internationally renowned artist Spencer Tunick gathered 2500 adults to Australia’s famous Bondi Beach (a famous location for tanning) for a nude photo-op. At first, the stunning display of nude bodies suggests a fun afternoon of frivolous enjoyment. Upon further reflection, you begin to realize the overwhelming presence that skin cancer has in our lives. Today, we will be covering the three most common types of skin cancer:

• Basal Cell: Mutation of the basal cells in the skin
• Squamous Cell: Mutation of the squamous cells in the skin
• Melanoma: Mutation of the melanocytes in the skin

Together, Squamous Cell, Basal Cell, and Melanoma are the 3 types of cells found in the epidermis and the 3 most commonly found in skin cancer patients. There are some other uncommon skin cancers that make up less than 1% of skin cancer patients, such as:

• Merkel cell carcinoma (mutation of merkel cells - neuroendocrine cells, similar to nerve endings)
• Kaposi sarcoma (cancer of the cells that line lymph or blood vessels)
• Cutaneous (skin) lymphoma (non-Hodgkin lymphoma that starts in the skin)
• Skin adnexal tumors (tumores that start in hair follicles or skin glands) 
• Other various types of sarcomas (cancers that develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels)

Each one of these conditions has different warning signs and implementations, and if you suspect any marking on your body may be cancer, we strongly urge you to seek the advice of a dermatologist. With that being said, let’s start breaking down skin cancer.

Actinic Keratosis

What is Actinic Keratosis? 

You can help differentiate if a flaky patch is AK or a skin condition by asking:

• Have you added anything into your skincare routine recently?
• Have you stopped using a skincare product recently?
• Have you changed any medication?
• How long have you noticed this flakiness? Does it appear consistently or only after certain events (such as cleansing your face)?

Sometimes your skin microbiome can get out of balance as a result of medications affecting your hormones. Switching up your skincare, if not using the proper products, can result in your skin getting out of balance, as well. While there are a variety of reasons why your skin might be flaky, if it is persistent and unchanging, you may want to seek a skin specialist to take a closer look. The annoying appearance of AK’s may lead people to trying to fix the topical issue while a bigger one can be brewing within. This is why monthly at-home skin checks followed by a yearly one by a professional are crucial in skin cancer prevention, as well as proper protection from UV rays. 

UV rays damage the skin, there is no way around that fact. That is why we always stress the importance of not only using a proper sunscreen, but also of using a SkinCeuticals vitamin c. SkinCeuticals is the only brand that is FDA approved to say that their vitamin c’s go deep into the skin, down to the cellular layer, and begin to prevent and reverse sun damage. Other vitamin c’s are great for topical use of lightening pigmentation, but only SkinCeuticals actually protects your skin from skin cancer.

One benefit of seeing a skincare professional several times a year is that we are closely monitoring your skin for any changes. While our facialists at Bellini’s are looking at your skin under a magnifying lamp, they see oil trapped beneath the surface, clogged pores, and even minute dark spots. Because we are working together to achieve a skin goal of yours, we know every inch of your face. We are often able to notice something on a client before they even are. At Bellini’s, we are also trained by Impact Melanoma in order to spot skin cancer, like the image to the left. We have a special device that allows us to zoom in extremely closely to determine if the spot is worthy of concern. 

Why Does Actinic Keratosis Occur?

Although the skin heals, extended exposure to UV leaves damage hidden within your cells. There are numerous risk factors associated with the growth of AK’s, Some of those are:

• Increased age (Simply being over 50 years old means you’ve had more time to be in the sun)
• Male gender
• Fitzpatrick Type 1-3, (less melanin in the skin tend to burn easily)
• Geographic location (closer to the equator more intense UV rays)
• Immunosuppression (chemotherapy, diabetes, organ transplant recipient, AIDS)
• History of AK or other Skin Cancers
• Excessive exposure to sun (e.g. construction, farming, outdoor activities, tanning beds)

What Does Actinic Keratosis Look Like?

Actinic Keratosis can be any range of colors from red, tan, white, pink or even flesh toned. In people of color these spots look more like flat, scaly, age-spots.

They are easier to feel on the skin versus seeing sometimes because of the change to skin texture. These spots are mostly found on points of the body that received the most sun and least protection - cheek bones, nose, back of hands, neck, forehead and scalp. When found on the body, they are usually more raised than on the face/neck, where they are more flat or concave. These lesions can become rough, itchy,  sensitive, bleed, or look like a persistent rash/breakout. They may also appear on the lips, called actinic cheilitis, which can cause a white patches on the lip, loss of lip color, dry, scaly lips that never heal. 

Treatment for Actinic Keratosis? 

There are multiple treatment options for AK’s once identified. From surgical procedures such as, 

• Chemical peels (MD grade peel, removing top layers of skin, multiple week downtime, not at salon or at home)
• Cryosurgery (freezing of the tissue to allow new growth)
• Curettage and desiccation, (scapres or shaves off lesion, then uses heat or chemical to kill remaining cells)
• Laser surgery (vaporize lesions)

To topical treatments like creams, gels and solutions prescribed to patients as well. Speak with your doctor or dermatologist about the best treatment for your condition. 

Basal Cells and Squamous Cells 

What is Basal Cell Cancer? 

The most common form of skin cancer is called Basal Cell cancer, with 8 out of 10 skin cancer patients likely to have basal cell cancer (cite). This cancer forms in the bottom layer of the epidermis and typically forms in sun-exposed areas especially the face, neck and head. You can identify it by the flesh or pink colored, pearly papules with overlaying ulceration or telangiectatic vessels. As with all skin cancer, this form of cancer is the result of damaging prolonged, unprotected exposure to UVA and UVB rays. Damaging UVB rays destroy our bodies DNA and RNA, whereas UVA is absorbed by melanin in our skin, and thus indirectly damages DNA via free-radicals.

It is rare for this cancer to spread from the affected areas, but if left untreated it can grow into other areas and invade bone or other tissues beneath the skin. Removal of tumors like this can leave the patient with a changed appearance. There are more than 26 different subtypes of BCC that show up throughout studies. The more common, distinctive types include: nodular, micronodular, superficial, morpheaform, infiltrative and fibroepithelial. 

Here are some warning signs of BCCs:

• Pink of reddish growth that dips in the center
• Growth or scaly patch of skin on or near the ear
• A sore that doesn’t heal (or does then returns) and might bleed, ooze, or crust
• Scaly, slightly raised patch of irritated skin
• Round growth that may be pink, red, brown, black, tan or flesh colored
• Spot that feels scaly or looks like an age spot
• Scar like mark on your skin that may be white, yellow or skin-colored + waxy
• May look shiny and the surrounding skin often feels tight

Patients have expressed feelings of numbness, pins-and-needle sensation, extreme sensitivity and itching in the affected area. BCCs can be tricky, in some people they can resemble psoriasis or eczema and in people of color the BCCs are pigmented. 

What is Squamous Cell Skin Cancer?

The second most common skin cancer is Squamous Cell Skin Cancer (SCC), and it develops in the squamous cells that make up the outer layer of the skin (epidermis), as opposed to the bottom layers like Basal Cell cancer does. It is averaged that 1 out of every 5 people will experience squamous cell skin cancer in their lifetime (cite). SCC of the skin is also known as cutaneous squamous cell carcinoma (cSCC). Squamous Cell Skin Cancer is usually not life-threatening, but it can be aggressive. cSCC tends to grow slowly, but deeply. This can injure nerves, blood vessels and eventually a large tumor can form. Certain groups of people are more likely to experience SCC, such as:

• Men
• Fair skinned people (Fitz 1-3)
• Immunocompromised individuals

In people of color, cSCC develops in areas that get little or no sun, such as mouth, genitals and anus. These instances of squamous cell skin cancer are believed to be caused by an injury or HPV, as opposed to typical prolonged sun exposure. Chronic exposure to UV radiation is a common factor for cSCC, but long-term exposure to cancer-causing chemicals, such as tar in cigarettes, can also lead to cSCC. This cancer can vary in appearance, but often appears as one of the following:

• Scaly, red patch often with irregular raised borders
• Brown spots similar to an age spot, elevated growth with a depression in the center, rapidly grows in size
• Wart like growth that crusts and occasionally bleeds
• Tiny rhino shaped horn coming off the skin
• Sore that bleeds or crusts and persists for weeks, disappearing nail (usually happens from HPV but can turn into squamous cell carcinoma). 
• Occasionally be tender and painful, indicating some nerve invasion. 

Squamous Cell Skin Cancer Treatment

Both Squamous Cell and Basal Cell skin cancers are treatable. After a mandatory skin biopsy, your doctor(s) will help you decide which of the following treatments is best for you:

• Excisional surgery (taking the entire tumor with a safety margin of surrounding normal tissue)
• MOH’s surgery (color coding each layer of skin and checking layer by layer for cancerous cells)
• Curettage and electrosurgery (for most small, superficial or minimally invasive cSCC’s & BCCs)
• Cryosurgery (patients with bleeding disorders, implantable cardiac devices)
• Laser surgery
• Radiation (hard to treat surgically tumors)
• Photodynamic therapy (PDT)
• Topical medications (5-FU, imiquimod)

As with many things in life, the best treatment is prevention. If you do not currently use sunscreen, we highly recommend starting to find your favorite. We have a blog going into the different types of sunscreen (chemical and mineral, as well as serum, powder, and cream) we have and which is best (in our opinion) for each Fitzpatrick type (read more here). Many people do not want to explore the world of sunscreen because they think all sunscreen will leave them with a white or gray cast, be thick or sticky and take a long time to sink in, or smell or feel weird on the skin. That is thankfully no longer the case. Sunscreen has come a long way in recent years, and with a more skincare-type finish, you may find yourself changing your mind about sunscreen. 

Sunscreen Alone Is Not Enough

Without a doubt, sunscreen will help protect you from UV damage! Sunscreen use has been shown to decrease the formation of actinic keratosis, which are linked to squamous cell carcinomas. It is one part of the equation though. Having a high dose of constant antioxidants will help to rebuild or minimize the damage from UV rays and their damage. SkinCeuticals clinical studies has found that using their vitamin c and an spf gives you 8x more environmental protection against UVA/UVB rays than if using nothing at all, and 56x more protection when combining SPF and SkinCeuticals vitamin c. In different terms, sunscreen alone protects you against 55% of UV rays, whereas SPF and vitamin c protect you from almost 100%.

Sunscreen creates a physical or chemical barrier to reflect the harmful radiation from penetrating the skin.

• Physical sunscreens create a shield and deflect the radiation (think of a mirror). 
• Chemical sunscreens have ingredients that catch the radiation from UV rays before it enters the skin. 

Sunscreen makes the biggest impact with diligent reapplication. Making sure you reapply your sunscreen every 90 minutes to 2 hours is pertinent for making sure you’re maintaining your protection during the day, especially the most intense hours of 10am - 4pm. 

Even if you’re not the best at reapplying sunscreen, if you use a SkinCeuticals vitamin c daily you are ensuring a higher level of protection than with sunscreen alone. If you’re not consistently reapplying sunscreen, do yourself a favor and get a SkinCeuticals vitamin c.

Why SkinCeuticals Vitamin C Is the Gold Standard

So, why can’t you use just any regular vitamin c? Afterall, many brands such as The Ordinary, Drunk Elephant, and Kiehls have a vitamin c for the same if not less cost. The difference with a SkinCeuticals vitamin c is that it is the only vitamin c approved by the FDA to go into the skin and prevent, and reverse, sun damage. All other vitamin c serums are only working on the top layers of the skin, and do not reverse the UV damage done within your DNA. 

So, how exactly does ultraviolet radiation cause skin cancer? One of the byproducts of UV radiation is a creation (photolesion) called thymine dimers, which creates a lesion within a DNA structure - thus resulting in a mutation. The DNA molecule is created from the bases adenine (A), cytosine (C), guanine (G), and thymine (T). A thymine dimer is a connection specifically between two thymine bases, which otherwise would never happen naturally. Cancer is thought to be the result of damage or mutations to your DNA, so it is reasonable to assume that the creation of thymine dimers is not ideal for your overall health.

Melanoma

Melanoma is much less common than other types of skin cancer, but it is more dangerous because of its tendency to spread to other organs of the body if not treated early on. Everyone, regardless of Fitzpatrick type, is capable of developing Melanoma. Bob Marly passed away because of Melanoma, so it is clear that even darker Fitzpatrick can be affected. Melanoma is a cancer that begins in the melanocytes of the skin (read more here), which are the cells responsible for the pigment of our skin. This explains why Melanomas are usually a dark brown or black, since they are affecting the melanin-producing cells in the skin. In contrast, a Basal Cell cancer is a pearly, viscous build up of cells. Melanomas can develop anywhere on your body, even places not usually in the sun, such as the soles of your feel, palms of your hands, or under fingernails. These hidden melanomas are more common in people with darker skin. 

How Can I Tell If My Skin Cancer Is Melanoma?

Because of the uniqueness of Melanoma skin cancer, you can follow these “ABCDE's" when examining your moles at home:

• A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves.
• B is for irregular borders. Look for moles with irregular, notched or scalloped borders — characteristics of melanomas.
• C is for changes in color. Look for growths that have many colors or an uneven distribution of color.
• D is for diameter. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters or the size of a pencil eraser).
• E is for evolving. Look for changes over time, such as a mole that grows in size or that changes color or shape. Moles may also evolve to develop new signs and symptoms, such as new itchiness or bleeding.

When in doubt get it checked out!

Ask us to take a photo of any suspicious mole or lesion at your next appointment with our microscope at Bellini’s to take a photo to send to your doctor if you are unsure.

Treatment For Melanoma 

Melanoma is curable when caught early. Treatment starts with a skin examination, followed by a skin biopsy to remove all or part of the spot on your skin. Once biopsied it will be sent to the lab to look for cancer cells. If they are present, your report will include what type of melanoma it is, how deep the tumor has grown and how fast it is growing. There are 5 stages of melanoma that vary in severity, such as only occurring in the top layers of your skin to affecting lymph nodes and other internal organs (American Academy of Dermatology).

From this information, plus your overall health, doctors will decide which course of treatment is best for this melanoma. Some common treatments are surgery such as excision or Mohs surgery. Another surgery for more severe cases is a lymphadenectomy which is a removal of lymph nodes. They can also use different drug therapies such as chemotherapy, radiation therapy, targeted therapy, immunotherapy. Other treatments they might recommend would be a clinical trial, adoptive t-cell therapy, or palliative care. Each person’s chances of beating this cancer all depends on early detection and early prevention.

A general rule-of-thumb with sunscreen is that it is active for as many minutes as the SPF is high. In other words, a 50 SPF sunscreen will be effective for 50 minutes of sun exposure, and after which you should reapply for optimal sunscreen protection. We love COOLA’s sunscreen sprays for body and face for this reason - because who wants to reapply a cream in the middle of the day? It’s a good habit to get into to cover your naked body in sunscreen cream in the morning, and reapply with a spray throughout the day. 

Sometimes starting a habit is difficult, we get that. If you’re not able to start at this optimal level of coverage, you can try starting with one of these steps:

• Cover your chest, arms, and neck with a sunscreen cream
• Spray your body with a sunscreen spray
• Spray your face with a sunscreen spray

Eventually, these habits will build up and you will be able to cover your whole body in sunscreen various times of the day. It’s about progress, not perfection. 

Overall, there is a clear correlation between excessive, unprotected UVA/UVB exposure and developing skin cancer. There is also a clear correlation between using SkinCeuticals vitamin c serums with your favorite sunscreen and preventing skin cancer.

Trying to live a sun-friendly life is going to keep your skin and body protected longer. So make sure you use sunscreen, hats, sunglasses, sun-protective clothing and reapply if you are going to be out in the sun for long periods of time. Protect that skin, because about 90% of the visible aging we see on the skin is from UV damage to skin. 

It's never too late to make your skin health a priority.

Will Sunscreen Help? What about Vit. C + AOX?

The final piece to the puzzle is antioxidants. How do they fit into all of this? When the UV rays do penetrate the skin they have free radicals that start attacking cells and increase oxidative stress in the skin. That may not sound like much but oxidative stress wreaks havoc on our bodies and is one of the biggest factors on aging in the body. “The detrimental effects of oxidative stress occur through multiple mechanisms that involve alterations to proteins and lipids, induction of inflammation, immunosuppression, DNA damage, and activation of signaling pathways that affect gene transcription, cell cycle, proliferation, and apoptosis.” (Dunaway).  So how do antioxidants help and where do I get some? Antioxidants have the capability to help neutralize the free radicals in the skin caused by the UV rays. Having both the internal help of antioxidants and the external help of sunscreen, we are giving our cells the best chance to have the least amount of damage and regeneration to continue. We receive these ingredients through our diet but making sure we get them directly to the skin cells with a topical product is best since our skin is the last place our diet delivers nutrients. 

Frequently Asked Questions

Can people with dark skin get skin cancer?

Though skin cancer is more common in fair-skinned people it can happen to anyone, even with a dark skin tone. “Naturally darker-skinned people have more eumelanin and naturally fair-skinned people have more pheomelanin. While eumelanin has the ability to protect the skin from sun damage, pheomelanin does not. That’s why people with darker skin are at lower risk for developing skin cancer than fair-skinned people who, due to lack of eumelanin, are more susceptible to sun damage, burning and skin cancer. But, skin cancer can happen to anyone, regardless of skin tone” (The Skin Cancer Foundation).

Can you get skin cancer on unexposed body parts, or does it only appear where the sun hits?

You can get skin cancer on areas that are unexposed to the sun such as the bottoms of your feet or the palms of your hand, throat, fingernail beds. “Experts recommend applying sunscreen to your entire body before you dress for the day. That way your skin will be protected if your clothing shifts or you remove layers" (The Skin Cancer Foundation). Making sure you are using a minimum of SPF 30 for your base layers of sun screen. 

Can you get skin cancer from a tanning bed? 

“People who have ever tanned indoors are 29% more likely to develop BCCs and increase your risk for BCC before age 40 by 69%.”*? The lights in tanning beds have a more powerful UVA output than the sun, roughly 12 times more. This extra damage to the skin will cause mutations to happen sooner in the cells, resulting in cancer. Self tanning is a great alternative to keeping that bronze look without succumbing to harmful UV rays. Check out our blog here to find some tips and tricks on how to keep a true healthy tan that isn’t extra intense exposure to UV rays. A safe alternative to sun tanning is using fake tan, and we have a full article about how to best apply fake tan here. 

Resources

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“Actinic Keratosis: Diagnosis and Treatment.” American Academy of Dermatology, www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment. Accessed 23 May 2023.

“Actinic Keratosis Warning Signs and Images.” The Skin Cancer Foundation, 1 May 2023, www.skincancer.org/skin-cancer-information/actinic-keratosis/actinic-keratosis-warning-signs-and-images/.

“Actinic Keratosis.” The Skin Cancer Foundation, 29 June 2022, www.skincancer.org/skin-cancer-information/actinic-keratosis/.
“Antioxidant Science: Skinceuticals.” Skin Ceuticals, www.skinceuticals.com/aox-science.html. Accessed 22 May 2023.

“Basal Cell Carcinoma.” The Skin Cancer Foundation, 1 May 2023, www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/.

Chien, Anna Lien-Lun. “Sunscreen and Your Morning Routine.” Sunscreen and Your Morning Routine | Johns Hopkins Medicine, 20 July 2022, www.hopkinsmedicine.org/health/wellness-and-prevention/sunscreen-and-your-morning-routine.

Cornish, Ruby. “Bondi Beach Goes Nude as Thousands Strip off for Art Project.” ABC News, 26 Nov. 2022, www.abc.net.au/news/2022-11-26/bondi-beach-nude-art-project/101701730.

Dunaway, Spencer et al. “Natural Antioxidants: Multiple Mechanisms to Protect Skin From Solar Radiation.” Frontiers in pharmacology vol. 9 392. 24 Apr. 2018, doi:10.3389/fphar.2018.00392

Haywood, Rachel, et al. “Sunscreens Inadequately Protect against Ultraviolet-a-Induced Free Radicals in Skin: Implications for Skin Aging and Melanoma?” Journal of Investigative Dermatology, vol. 121, no. 4, 2003, pp. 862–868, https://doi.org/10.1046/j.1523-1747.2003.12498.x.

McDaniel B, Badri T, Steele RB. Basal Cell Carcinoma. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482439/

“Melanoma.” Mayo Clinic, 18 June 2022, www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884.

“Melanoma.” The Skin Cancer Foundation, 13 Apr. 2023, www.skincancer.org/skin-cancer-information/melanoma/.

Pinak, Miroslav. “Enzymatic Recognition of Radiation-Produced Oxidative DNA Lesion. Molecular Dynamics Approach.” Modern Methods for Theoretical Physical Chemistry of Biopolymers, 2006, pp. 191–210, https://doi.org/10.1016/b978-044452220-7/50074-5.

Sander, Megan et al. “The efficacy and safety of sunscreen use for the prevention of skin cancer.” CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne vol. 192,50 (2020): E1802-E1808. doi:10.1503/cmaj.201085

“Skin Cancer Types: Basal Cell Carcinoma Causes.” American Academy of Dermatology, www.aad.org/public/diseases/skin-cancer/types/common/bcc/causes. Accessed 23 May 2023.

“Skin Cancer Types: Basal Cell Carcinoma Overview.” American Academy of Dermatology, www.aad.org/public/diseases/skin-cancer/types/common/bcc. Accessed 23 May 2023.

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Thompson, S C et al. “Reduction of solar keratoses by regular sunscreen use.” The New England journal of medicine vol. 329,16 (1993): 1147-51. doi:10.1056/NEJM199310143291602

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“What Is Melanoma Skin Cancer?” What Is Melanoma?, www.cancer.org/cancer/types/melanoma-skin-cancer/about/what-is-melanoma.html. Accessed 23 May 2023.

“What Is a Soft Tissue Sarcoma?” Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin, www.cancer.org/cancer/types/soft-tissue-sarcoma/about/soft-tissue-sarcoma.html. Accessed 23 May 2023.