By Dr. Renata Prado, Board-Certified Dermatologist and Fellowship-Trained Mohs Surgeon
For patients who had one or more skin cancers, it can be frustrating that their rigorous and diligent sun protection will not guarantee that they will never have another skin cancer. It is often disappointing to come to your regular dermatology visit and have treatment of pre-cancers or even a biopsy. I am often asked by my patients, “Why am I still getting new skin cancers if I have not been in the sun for years?”. That is a valid question and I understand the frustration.
We know that ultraviolet (UV) radiation (from the sun or artificial sources such as tanning beds) is the main cause of skin cancers. We now appreciate that the role of UV in the development of nonmelanoma skin cancers is twofold. First, UV radiation causes mutations in the DNA of skin cells. Failure to repair these genetic alterations ultimately leads to unrestrained growth and tumor formation. Second, UV radiation has suppressive effects on the cutaneous immune system, allowing the skin cancer to escape your defense cells.
We also know that sun damage accumulates over the years, and may result in skin cancer many years later. Therefore, you are right to think that the most important way to prevent a future skin cancer is by avoiding exposure to ultraviolet radiation. However, depending on how much sun you had in your past, sun protection may significantly decrease the number of future skin cancers, but it may not bring the chances to zero. It is still the measure of greatest impact in reducing future skin cancers.
The Question is, “Are You Practicing Adequate Sun Protection?”
Most of my patients who had a previous skin cancer become very careful and adequately protect their skin from UV radiation when they are going hiking, playing golf or traveling to a sunny destination. If you are already careful with your prolonged outdoor sun exposure, that is great. But please note that a very large percentage of your total yearly UV exposure actually happens on activities of your day-to-day life. Common activities such as walking the dog, going from your car to the store, bringing in the mail, and even driving. If you have never considered using sunscreen daily, even for these day-to-day activities, it is not too late.
Also, remember that UV radiation is able to penetrate clouds and glass (UVA), and bounce off of snow, water and sand. Therefore, it is recommended that sun protection is practiced all year round, and not only on warm months. Yes, that means applying sunscreen on your face in the morning, even it is cloudy and raining outside.
Finally, and especially important for us living in Colorado, remember that the intensity of the UV radiation increases in higher altitude. Reapplication when you go skiing is crucial.
As important as protecting yourself consistently, is protecting yourself appropriately. If you are out, wear a hat with a brim that covers the ears and shades the nose. If it is comfortable, wear long sleeves and pants. I personally try to cover myself as much as possible with sun protective clothing, leaving sunscreen only for areas such as face, neck and hands.
When you use sunscreen, use it properly. That means, apply enough and re-apply it often enough. Be sure to coat the ears, back of the neck, and exposed skin on the head. Apply the sunscreen at least 20 to 30 minutes before you go out in the open sun. Use a broad-spectrum sunscreen that protects against UVA as well as UVB rays and with an SPF greater than 30. Reapply every hour if you are in the water or sweating heavily. Reapply every two to three hours if not in the water or not sweating. Reapply the sunscreen frequently even if the product you buy is formulated to be sweat- or water-resistant.
Finally, if you had a skin cancer, make sure to visit your dermatologist for a total skin exam. Skin cancers are treatable and curable, and much easier to deal with when caught early.
Dr. Renata Prado is a board-certified Colorado Springs dermatologist and Mohs Surgeon. Dr. Prado specializes in the diagnosis and treatment of skin cancers. She is part of Vanguard’s Colorado Springs dermatology practice in Briargate and Broadmoor.
Vanguard Skin Specialists began as a Colorado Springs dermatology practice and now has additional offices in Canon City, Pueblo, and Woodland Park. Vanguard specializes in the diagnosis and treatment of skin cancer, and also offers general dermatology, plastic surgery, and aesthetic medicine.