Sun Exposure and Skin Cancer Prevention David J. Leffell, MD Professor of Dermatology & Surgery Chief, Dermatologic Surgery & Cutaneous Oncology Yale School of Medicine Author, TOTAL SKIN, Hyperion © David J. Leffell, MD

Skin Cancer Non-melanoma skin cancer: Melanoma: the most common cancers in humans Basal cell cancer Squamous cell Cancer Actinic keratoses 80% to 90% caused by UVR overexposure Melanoma: severity related to stage at diagnosis Melanoma in situ ( also called lentigo maligna) Malignant melanoma Precursor: atypical moles in some cases 60% caused by UVR overexposure © David J. Leffell, MD

HIGHEST CURE RATE EARLY MELANOMA POTENTIALLY DEADLY HIGHEST CURE RATE EARLY 100% CURE 96% CURE >90% CURE © David J. Leffell, MD

Signs of Melanoma WARNING SIGNS A new mole An irregular mole Changing color Changing shape Bleeds or itches Or, Just Doesn’t Seem Right © David J. Leffell, MD

Melanoma and Skin Cancer Can Be Prevented and Diagnosed Early CAUSE EARLY DIAGNOSIS Lung cancer Smoking; other unknown ? Colon cancer ? Diet colonoscopy Breast cancer mammogram Prostate PSA Melanoma and skin cancer Ultraviolet radiation from the sun Regular skin exams © David J. Leffell, MD

Sun and Skin Cancer Copyright David J. Leffell, MD

Sun and Skin Cancer Ultraviolet radiation from the sun is the only environmentally proven cancer causing agent Ultraviolet radiation cannot be seen, smelled, tested or felt Ultraviolet radiation is the single most important factor in causing skin cancer including many melanomas © t David J. Leffell, MD

© David J. Leffell, MD

© David J. Leffell, MD

Proof That Sun Causes Skin Cancer The Australian experience Animal studies DNA studies Human correlation studies © David J. Leffell, MD

Other Effects of Ultraviolet Radiation Premature aging of the skin Wrinkles Pigmentation Splotches Immune suppression Irregular skin texture © David J. Leffell, MD

Minute Survey Do you use sunscreen on a daily basis? Do you wear a brimmed hat? Do you avoid the sun during peak hours from 10 am to 4 pm? Have you ever used a tanning booth? Do you have an annual full body skin exam by a dermatologist? Do you see a dermatologist when you develop a mark or spot that concerns you? © David J. Leffell, MD

Risk Factors Fair skin Blue, green or grey eyes Blonde or red hair Family history of skin cancer Copyright David J. Leffell, MD

Risk Factors A single blistering sunburn in childhood can double your risk of melanoma Most sun exposure is acquired by age 18 Individuals with outdoor occupations have a higher incidence of skin cancer Lifeguards Construction workers Individuals with extensive recreational sun exposure Golfers Tennis players Boaters © David J. Leffell, MD

Sunscreen Facts THIS IS ONLY A ROUGH GUIDE UVB protection: Sun Protection Factor This number tells you, on average how long you can stay in the sun before developing a burn Calculation: If you turn red after 10 minutes in the sun, a sunscreen with an SPF of 30 will THEORETICALLY protect you for: 30 x 10 minutes =300 minutes THIS IS ONLY A ROUGH GUIDE Copyright David J. Leffell, MD

Does Higher SPF Provide More Protection? © David J. Leffell, MD

Does Clothing Protect Against UV? © David J. Leffell, MD

UVA Protection UVA protection: not yet rated; undergoing review Ingredients to look for: Parsol 1789 also known as avobenzone Mexoryl ( in non-U.S. sunscreen but available in daily moisturizer Zinc oxide Titanium dioxide © David J. Leffell, MD

© David J. Leffell, MD

© David J. Leffell, MD

Sun Protection: Youth Attitudes & Behavior Routine sun-protection behavior: Sunglasses: 32% Long pants: 21% Staying in the shade: 22% Applying suncreen: 31% Effective sun protection is practiced by less than 1/3 of U.S. youth © David J. Leffell, MD

Sun Protection Myths The higher the Sun Protection Factor (SPF), the more protection you are getting Sunscreen use increases skin cancer rates Use of sunscreen results in Vitamin D deficiency Ultraviolet radiation from a tanning booth is safer than UVR from the sun © David J. Leffell, MD

© David J. Leffell, MD

SUN PROTECTION Use a daily moisturizer with SPF of 30 Use a broad spectrum sunscreen with an SPF of 30 or higher while outdoors and reapply every couple of hours while active Wear a brimmed hat Wear sun protective clothing (e.g. Solumbra) Avoid the sun during 10 am to 4 pm Wear UV protective sunglasses Become familiar with the UV Index © David J. Leffell, MD