1. 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

2. 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

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

4. 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

5. 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

6. Sun and Skin Cancer
Copyright David J. Leffell, MD

7. 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

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9. © David J. Leffell, MD

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

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

12. 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

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

14. 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

15. 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

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

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

18. 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

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20. © David J. Leffell, MD

21. 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

22. 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

23. © David J. Leffell, MD

24. 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