It seems so confusing at times. Medical professionals encourage you to get out and get some sun. They urge you to do outdoor activities and exercise outside. But they also tell you to protect your skin from the sun. Which is more important? Can you both get your daily dose of Vitamin D AND protect your skin from skin cancer? Absolutely! It does take diligence and a healthy dose of sunscreen.
Both tanning and sunburn are the results of damage to the DNA of the skin. Sunburn and suntans are an adaptive response to sun damage, and both can lead to skin cancer and general sun damage to the skin, as well as premature aging of the skin. Skin cancer, of course is the most harmful of the response to excessive sun exposure. There are two basic kinds of skin cancer–melanoma and non-melanoma. The most common forms of non-melanoma cancers are basal cell carcinoma and squamous cell carcinoma.
Melanoma is the deadliest form of skin cancer. It often runs in families, especially in families with lighter skin. While melanoma can be caused by sun damage, it can occur even in hard to see places like the back of the eye or the lining of the mouth as well as frequently sun exposed area of the skin like the face, arms, and legs. Melanoma often looks like a brown mole or birthmark. They will often have a black or bluish appearance, or maybe even reddish brown or scabbed appearance. They are often rapidly changing or growing. While many lesions that are brown are not skin cancer, it is important not to ignore one that might be a melanoma. Melanoma can rapidly spread from the skin to the internal organs of the body and is often not curable in these situations. If you feel you have a suspicious lesion, be sure to ask your physician. Dermatologists are great at checking the skin and mapping lesions, but your primary care doctor should be able to offer you good guidance as well.
Squamous cell carcinoma of the skin accounts for about 20% of all non-melanoma skin cancers. In fair skinned individuals, these skin cancers often occur on the areas of the skin that are most sun exposed. In darker skinned people, they occur more often on areas that are not exposed to the sun. These types of skin cancers often appear as lesions that just won’t heal. They can be pink or red, dry and peeling, scabbed, thick or crusty. They tend to be rough, scaly thick lesions that can be felt by rubbing gently over the skin too. While these types of lesions are not always cancer, they may be. Once again, your doctor can help determine if you may have a squamous cell cancer. Unlike melanoma, there types of cancer rarely spread throughout the body if caught and treated appropriately.
Basal cell carcinomas are the most common type of non-melanoma skin cancers, accounting for almost 80% of all non-melanoma skin cancers. Basal cell cancer doesn’t typically spread to other organs of the body but they are invading locally and become quite large. They are much more common in light skinned individuals. They typically occur most on areas of the skin exposed to the sun. These types of cancers typically grow slowly but they still require treatment to prevent complications. They often appear as red shiny dome shaped lesions. They can be hard (indurated) to the touch and may even be scabbed. They will not go away without treatment. Once again, your regular physician can help determine if your lesions might be basal cell skin cancers.
There are definitely things you can to do prevent skin cancers while still getting adequate Vitamin D. You should avoid prolonged sun exposure during the middle of the day. Wearing sunscreen offers good protection, especially if you reapply it often. Wearing clothing and hats is helpful to keep the sun off the skin. It is important to never use tanning beds. It is probably ok to get 20-30 minutes of sun exposure daily without too much concern, but more time than that without protection could lead to problems. This small amount of direct sun along with some Vitamin D supplementation should lead to adequate Vitamin D levels while protecting the skin from the sun.
It is important to protect the skin from the sun even on cloudy days. UV radiation can pass through clouds to damage the skin and it also passes through water. UV rays can reflect off light colored surfaces as well as the water and snow. Shade is helpful to protect from sun damage, as well as wearing a wide brimmed hat and long-sleeved shirts and pants. Sometimes that is not easy, especially on really hot days. In these situations, sunscreen can be really helpful.
There are sunscreens that provide a physical barrier to the sun’s UV rays such as zinc oxide as well as sunscreens that use chemicals to absorb UV rays. Most sunscreens have a combination of the two methods. Sunscreens need to be reapplied at least every 2 hours, or even more often if you are sweating, rubbing the skin, or swimming. The Sun Protection Factor (SPF) of the sunscreen matters greatly. You should try to use a sunscreen with a rating of 30-50 on exposed areas of skin. To get the degree of protection on the label, you will need to frequently reapply the sunscreen. It is important to use a sunscreen that blocks both UVA and UVB rays. Don’t forget to protect your lips with a lip balm that is at least SPF 15. People with light skin, children and babies are most at risk of sunburn. Since most sunscreens are not recommended for babies under six months, it is very important to protect them from direct sun rays and to keep the skin covered when possible.
What do you do if you didn’t apply your sunscreen or got too much exposure and got a sunburn? It is acceptable to take Tylenol for discomfort. Cool compresses or a cool bath can be helpful. Sometimes I add a little white vinegar to my bath water if I burn and this helps take some of the burn out. There are some aloe vera gels that have a little lidocaine in them to numb the skin. While all these things can ease the discomfort, the damage has already been done and cannot be fixed. It is rare that a sunburn requires medical attention, but don’t be afraid to contact your doctor if you feel you are ill from a sunburn. It is most important to just avoid the sunburns if you can, so be smart! Wear your sunscreen and avoid too much direct sun but get out there and live life with an extra dose of common sense!
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