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Skin Cancer: How to Protect Yourself and Minimize Risk

This topic is dear to me as a fellowship-trained Mohs surgeon who literally sees patients in the office every day with a skin cancer diagnosis.  First, I want to get the message out that skin cancer can be and should be highly curable.  However, this requires you to be looking at your skin and assessing for worrisome spots or changes.  Also, it requires you to get a skin examination once a year to make sure that a qualified expert is also looking at your skin. If you are good about both those things your likelihood of dying from skin cancer is almost zero. So the most important thing is being proactive. 

In a nutshell, the sun emits UV radiation. That radiation hits our bodies and causes damage to DNA.  In response, our body creates a pigment called melanin to try to protect itself from further UV damage.  Melanin is also what gives our body a tanned appearance, and it is good at absorbing UV radiation.  Our body also has ways to try to go back and repair the DNA damage that occurred from the UV radiation. Unfortunately, sometimes the DNA damage occurs in such a way that the body is not able to repair the damage, and a mutation in the DNA occurs that leads to a cancer developing. 

If I could stress anything here it would be DON’T GET SUNBURNED, but really you should avoid tanning in general.  Do not go to a tanning salon unless it's for a spray tan.  I’m not trying to ruin the fun of the sun for people, but when it comes to your skin there is never a good reason to lay in the sun or in a tanning bed. Get outside and be active by all means, but always remember your sunscreen, sunglasses, and a hat. Stay away from sunlamps and tanning beds at all costs.  There are no specific foods that are evidence based to offer skin cancer prevention, but foods high in antioxidants (berries, nuts, seeds), omega 3 fatty acids (fish, chia & flax seeds), polyphenols (dark chocolate, tea), vitamin D (fortified milk, fatty fish), and lycopene (tomatoes, watermelon, pink grapefruit) all may offer some benefit. 

Avoid long term direct sun, particularly during the most powerful hours of the day, which is usually 11:00 AM until 4:00 PM (the typical peak UV index hours).  Be extra careful around water, snow and sand as it can reflect UV to increase your exposure. You want to avoid when the sun is the strongest with the most UV getting through the atmosphere. This happens when the sun is the highest in the sky. 

The UV index is a rating scale used to quantify how much UV radiation is getting through the atmosphere. The higher the number, the more powerful and harmful the UV exposure. It ranges from 0-11+.  On the lower end of the scale, you can spend a lot more time outdoors and still have minimal risk of UV damage or sunburn. Conversely, at the high end you have to be extra careful.  Here is a great tool where you can enter your zip code and get a risk assessment.

I have a few blogs that really go into the nuances of this here.  Generally speaking, you want to apply early and often with something over SPF15 rating or higher.  If you're sweating or in the water, apply more often.  If it is very sunny, apply more often like every 2 hours or even more.  Mineral vs chemical sunscreen is another thing to consider, which I elaborate on here.  It is important to know that they work in different ways and should be applied with specific consideration.

I have a whole blog and youtube video dedicated to this here.  If this happens, you need to first get out of the sun immediately and go indoors.  Stay out of the sun until the redness is gone.  This means that if you go outside you need long sleeves and pants, SPF 15 or greater, a huge hat, and probably some sort of scarf to protect your face and neck.  

I recommend my patients take ibuprofen or Aleve to decrease the inflammation that goes along with the sunburn.  Drink lots of water.  You need to flush all the toxins your body is making out of your system.  Plus, you’ll likely already be dehydrated. Take as cold of a shower or bath as you can tolerate, and use ice packs over the areas to calm inflammation.  Many people use aloe vera gel to try to get some relief.  If blisters pop up, try to keep them intact as it offers a natural bandage and decreases risk of infection.  My Day Preventive Treatment will calm a lot of redness as well, in part due to the Vitamin C.  Moisturize frequently to try to keep the skin barrier intact.  Make sure to pick a moisturizer that is really formulated for sensitive skin, as you don’t want any additional irritants adding fuel to the fire.  My Body Cream would be excellent for this. 

Unfortunately, you’ve just increased your chance of getting skin cancer as well.  It doesn’t mean that you are automatically going to get skin cancer or, if you do end up with one, when that will happen.  It certainly won’t be days, weeks or even months.  

More than 1 million cases of skin cancer are diagnosed in the United States every year.  The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma.  There are numerous other more rare types of skin cancers (ex. Merkel cell, spindle cell, apocrine, etc).   

For most skin cancers, we do a skin excisions where tumor with about .5cm margin of normal skin is removed, sent to pathology for further review but the patient is stitched up immediately. Mohs Micrographic Surgery is a very specialized method of surgery for basal cell and squamous cell carcinomas. Here the dermatologic surgeon removes the skin cancer and typically a smaller margin of normal skin. Then while the patient waits this piece of tissue is frozen, cut and stained and made into microscope slides.  The dermatologic surgeon reviews these slides to ensure complete clearance of the tumor before the reconstruction takes place. This method is used for high risk tumor or tumors in cosmetically important areas like face and hands. Training to perform Mohs surgery, reading pathology and the reconstruction is a fellowship that can be done after completing your dermatology residency. I completed my dermatology residency and fellowship in Mohs surgery at Columbia University Medical Center in NYC. 

These recommendations are not sponsored. They are the result of Dr. Heather D. Rogers, MD evidence-based research and extensive clinical experience. 

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