The document discusses the anatomy and functions of the skin, types of skin cancer including melanoma and risk factors, proper use of sunscreen, and the importance of nutrition and antioxidants in both preventing skin damage from UV rays and potentially skin cancers. It also notes the controversy around sunscreen blocking vitamin D production from sunlight.

1. The Skinny on Skin
A Wellness Perspective
to Skin Health and Education
Brandon Fletcher
The Christ Hospital Research

2. Our Skin
 Protects our body from heat, injury, infection,
water loss and sunlight
 Regulates body temp
 Storage (H2O, fat, Vit D)
 Consists of three layers
 Epidermis (outermost layer)
 Dermis (beneath the epidermis)
 Hypodermis (deepest layer)

3. Skin Anatomy
EPIDERMIS
DERMIS
HYPO-DERMIS

4. Skin Anatomy: Epidermis
 The Epidermis is the thin outer layer of the skin. The
epidermis itself is made up of three sub-layers:
– stratum corneum (horny layer)
This layer contains continually shedding, dead keratinocytes (the
primary cell type of the epidermis). Keratin is a protein formed
from the dead cells which protects the skin
– keratinocytes (squamous cells)
This layer contains living keratinocytes (squamous cells)
– basal layer
The basal layer is the lower layer of the epidermis containing
basal cells. Basal cells continually form new keratinocytes and
replace the old ones that are shed from the skin's surface
– The epidermis also contains melanocytes, which are cells that
produce melanin (skin pigment).

5. Skin Anatomy (Cont.)
The Dermis
contains connective tissue, nerves, vessels,
glands, and hair follicles
held together by a protein called collagen
The Hypodermis (Subcutis)
Contains a network of collagen and fat cells which
help conserve the body's heat and protects other
organs from injury by acting as a "shock absorber

6. About Skin Cancer
 Skin cancer is the most common cancer and is
increasing at by 4% a year, which is faster than any other
type of cancer
 There Are Two Types of Skin Cancer:
– Non-Melanoma (97% of all skin cancers): the most
common are:
• Basal cell cancer: (shiny or pearly surface)
• Squamous cell cancer: (reddish and scaly)
– Malignant Melanoma (3% of all skin cancers)

7. Basal Cell Carcinoma
Least malignant and most common skin
cancer
Stratum basale cells proliferate and invade
the dermis and hypodermis
Slow growing and do not often metastasize
Can be cured by surgical excision in 99%
of the cases

8. Squamous Cell Carcinoma
Arises from keratinocytes
Arise most often on scalp, ears, and lower
lip
Grows rapidly and metastasizes if not
removed
Prognosis is good if treated by radiation
therapy or removed surgically

9. About Melanoma
Currently, the lifetime risk of developing
invasive melanoma (US) is 1 in 62
Melanoma is the most common cancer in
young adults (25-29 yrs) and the 2nd most
common cancer in adolescents and young
adults (15-29 yrs)

10. About Melanoma
 Over 75% of skin cancer deaths are from
melanoma
 One American dies from melanoma every hour
 The causes of melanoma are complex and
involve interactions between genetic and
environmental factors
 If detected in the early stages before it reaches
the lymph nodes, melanoma has a 99% five-year
survival rate

11. Melanoma
 Melanoma skin cancer starts in the melanocyte
cells of the skin
 Cancer of melanocytes is the most dangerous
type of skin cancer because it is:
– Highly metastatic
– Resistant to chemotherapy
 There are 4 main types, depending on their
location, shape and whether they grow outward
or downward into the dermis

12. The Four Types of Melanoma
 Superficial, spreading or flat: grows outwards
in an irregular pattern with an uneven colour
 Nodular: lumpy and often blue-black in colour
may grow faster and spread downwards
 Acral melanomas: occur on the palms of the
hand, soles of the feet or nailbeds
 Lentigo maligna: usually on the faces of elderly

13. Sites of Melanoma Occurrence

14. Important to Know
Melanoma is not limited to the skin you
can see
Melanoma can also start in the mucous
membranes of the mouth, anus and vagina,
in the eye or other places in the body
where melanocytes are found

15. About Moles
Malignant melanoma almost always starts
as a mole, so get to know your skin
– A normal mole is round or oval, usually flesh-
coloured, pink, tan or brown and is flat or
dome-shaped
– The signs and symptoms of malignant
melanoma are changes in the characteristics of
a mole

16. Know what to Look For
How Do You Know Which One is Malignant?

17. Melanoma Detection
 Melanomas have the following characteristics
(ABCDE’S rule)
– A: Asymmetry; the two sides of the pigmented area
do not match
– B: Border is irregular and exhibits indentations
– C: Color (pigmented area) is black, brown, tan, and
sometimes red or blue
– D: Diameter is larger than 6 mm (size of a pencil
eraser)
– E: Elevation/Enlargement
– S: Surface (raised,scaly,eroded)/Sensation (tender)

18. Using the ABCD’s of Melanoma
Asymmetry: sides don’t match Border: uneven
Color: many shades Diameter: Larger than a pencil eraser

19. Melanoma Detection (Cont.)
So, Pay Attention to:
– Any new growth or non-healing sores
on the skin
– Any change to your skin such as in
shape, color, size or surface of a mole or
birthmark
– Use the ABCDE’S of melanoma
– See a dermatologist to be sure

20. The Rate of Skin Cancer is
Significantly Increasing. Why?
Poor Health
Greater UV exposure
– Changes in ozone layer
– Involvement in outdoor activities
– Wearing skimpy clothing
– Pursuit of a tan
• Tanning bed use

21. The Skinny on Skin Cancer and
the Sun
 UV light causes skin cancer through the
combined effect of immune system suppression
and DNA damage
 90% of non-melanoma skin cancer is thought to
be related to UV radiation exposure (sun!)
 65% of malignant melanoma skin cancer is
thought to be related to UV radiation exposure

22. About the Sun
 The sun produces 3 types of light: Ultraviolet
(UV), Visible and Infrared
 The shorter the wavelength, the higher the
energy, and the more damaging to DNA

23. About the Sun (Cont.)
There are 3 types of UV light
UVA:
– UVA rays make up most of the sun’s natural
light. They can penetrate deep into the skin
causing wrinkles and aging, and are strongly
absorbed by the melanocytes
– UVA rays also have a depressing effect on
the immune system

24. About the Sun…UV Rays (Cont.)
UVB:
– Ultraviolet B rays (UVB) are the most visually
damaging to our skin
– They are the main cause of sunburns as they
are nearly 1000 times stronger than UVA rays
UVC:
– (short-wave radiation) rarely reach the earth’s
surface because the atmosphere filters them
out

25. About the Sun…UV Rays (Cont.)
UV rays can get through clouds, fog and
haze. Water, sand, concrete and especially
snow can reflect, and even increase, the
sun's burning rays
UVA Rays penetrate glass and most
sunscreens
UVB Rays are blocked by glass and most
sunscreens

26. The Sun: The Bright Side
Summer Enjoyment: flowers, trees,
beaches
Outdoor Sport and Recreation
Food Production: fruits and vegetables
Vitamin D synthesis
– Most of the body's vitamin D supply, about
75% of it, is generated by the skin's exposure
to UVB rays

27. The Sun: The Dark Side
DNA Damage
– Skin Cancer
Eye Damage
Weakening of the Immune System
Premature Aging of the Skin

28. Skin Cancer Risk Factors
 Sensitivity and Exposure to UV radiation (sun)
– Chronic better than intermittent
 Lots of moles
 Family history of melanoma
 Blond or red hair
 Fair or freckled complexion
 Severe and/or chronic childhood sunburn
– Before age of 20/ 5 burns=2x risk

29. Skin Cancer Risk Factors
(Cont.)
 Previous history of melanoma
 Age
– People over the age of 50 have a greater chance of
getting skin cancer (why?)
 Many people develop skin cancer without any
of these risk factors

30. Things You Cannot Change
Fair skin that tans poorly or burns
Blonde, red or light brown hair
Light coloured eyes - blue, grey, or green
Freckle easily
Large number of moles
Family history of skin cancer

31. Things You CAN Change
 Make Health and Wellness a Priority
 Nutrition
– Eat eco-friendly, fresh, local, colorful live foods
– Supplement the rest
 Be Mindful of your mind: make room for good
things by eliminating that which is not
 Sun exposure: minimize

32. Be Proactive Not Radioactive

33. Sunscreen
 SPF stands for Sun Protection Factor
 SPF refers to the ability of the product to protect
the skin from UVB rays only
 Some sunscreens offer protection from some
UVA rays as well. These “Broad-Spectrum”
sunscreens are highly recommended
 Two types:
– Chemical (absorb the rays)
– Physical (reflect the rays, generally metallic)

34. The More SPF the Better…
Right?
No. Not necessarily. An SPF of 15 is
NOT twice as effective as an SPF of 30.
Actually, there is very little difference
between an SPF of 15 (93% protection)
and one with an SPF of 30 (97%
protection)

35. Is Bigger Necessarily Better?
SPF vs. UVB Protection

36. SPF vs. UVB Protection (Cont.)

37. Choosing a Sunscreen
Read the label
Check the ingredients for any allergies
Ensure the sunscreen has an SPF of 15 or
higher
Ensure the sunscreen protects against both
UVA and UVB rays – “Broad Spectrum”
Check the expiration date

38. Choosing a Sunscreen (Cont.)
 Check to see if sunscreen is water proof if you
will be using sunscreen in or near the water
 Follow manufacturer’s instructions and patch
test first for irritation
 Apply sunscreen before insect repellant (as the
repellant may reduce the effectiveness of
sunscreen)
 Apply 20 – 30 min. before exposure

39. Choosing a Sunscreen (Cont.)
Spread liberally on all exposed skin (do
not forget the ears, nose, neck and any bald
spots)
Reapply often and regularly, especially
after swimming, towel drying and heavy
perspiration
Do not forget your SPF > 15 lip balm**

40. Things to Remember About
Sunscreen
No sunscreen offers complete protection
from the sun
Sunscreen is not just for sunny summer
days but also for cloudy days and in winter
Sunscreen is only one part of a
comprehensive approach to skin health and
cancer wellness

41. So, If I Use Sunscreen, I Will
Not Get Skin Cancer…Right?
No Evidence: In fact, there is no evidence
that sunscreens protect you from malignant
melanoma, the deadliest form of skin
cancer, even though sunburns have been
linked with the development of melanoma
Chemicals used are being linked to skin
cancer

42. It Remains Debatable
 Most chemical sunscreens contain from 2 to 5%
of benzophenone or its derivatives as their active
ingredient.
 Benzophenone is one of the most powerful free
radical generators known to man. It is used in
industrial processes to promote cross-linking and
is activated by……….. yes, ultraviolet light.
 My recommendation: physical sunscreen and
benzophenone free chemical sunscreens

43. So What Do We Do?
 Limit time in the sun between 11am-4pm and
when the UV index is 3 or higher
 Make use of the shade
 Clothing (SPF type, loose fitting, tightly
weaved)
 Hat (the wider the brim the better)
 Sunglasses (UVA+UVB protection)
 Wrap around style provides increased protection

44. Is That All?
No. Most importantly, take care
of yourself and your family
– Healthy Diet**
– Make Wellness a Priority

45. Skin Cancer Prevention:
Nutrition and Wellness
Low fat diet <20% of calories from fat
Antioxidant vitamins and certain
minerals (in food or supplements)
– neutralize damaging free-radical molecules
produced as a byproduct of normal
metabolism and by ultraviolet light
– important in protecting against skin cancers

46. Antioxidants…Prevention:
Nutrition and Wellness (Cont.)
 Vitamin C (citrus fruits, bell peppers, broccoli,
leafy greens, cauliflower) internal/external-
~>1000mg-3g/d
 Vitamin A/Beta-carotene (carrots, sweet
potatoes, broccoli) internal/external-~30mg/d
– Caution to smokers
 Vitamin E (vegetable oils, nuts, seeds, olives,
spinach, and asparagus) is shown to reduce the
development of UV light-induced tumors in
animals- internal/external-~400-800IU/d

47. Antioxidants…Prevention:
Nutrition and Wellness (Cont.)
 Selenium (garlic, brown rice, whole grains, eggs,
seafood and Brazil nuts)
internal/external-200microg/d
 In studies in JAMA in 1996, researchers showed
that skin cancer patients who ingested 200
micrograms of selenium per day had:
– 37% fewer malignancies
– 50% reduced risk of death from skin cancer
– 17% decrease in overall mortality

48. Antioxidants…Prevention:
Nutrition and Wellness (Cont.)
Omega-3 FAs/Alpha-Lipoic Acid,
DMAE (oils of nuts, seeds {flax!}, and
cold water, deep sea fish) is powerful
antioxidant, 100xs more potent that either
vitamin C or E
– deactivates the power of free radicals caused
by harmful exposures
– stabilizes the membrane around the outside of
each cell so that assaults from sun damage are
greatly reduced-I/E

49. Antioxidants…Prevention:
Nutrition and Wellness (Cont.)
Other Recommendations: Cabbage,
sprouts (especially broccoli), tea
(black, green, white), naturally
pigmented fruits and vegetables and
turmeric to name just a few

50. So, What is the Controversy with
Sunscreen and Vitamin D?
 Vitamin D is a fat soluble vitamin that is found in
food and can also be made in your body after
exposure to ultraviolet (UV) rays from the sun
 Sunshine is a significant source of vitamin D
because UVB rays from sunlight trigger vitamin
D synthesis in the skin comprising about 75% of
the body’s supply
 A low blood level of vitamin D is known to
increase the risk for the development of breast
and colon cancer and may also accelerate the
growth of melanoma

51. More about Vitamin D
 Active vitamin D functions as a hormone by
sending a message to the intestines to increase
the absorption of calcium and phosphorus
 Vitamin D is needed for healthy bones and
muscles, especially in children and the elderly
 There is growing evidence that vitamin D may
reduce the risk of osteoporosis and some types of
cancer, particularly colorectal, breast and prostate

52. More about Vitamin D
Experts are now concerned that many
people are not getting enough vitamin D
A few minutes a day of unprotected sun
exposure is usually all that is needed for
some people to get enough vitamin D.
You don’t need a tan to get benefits from
the sun

53. Sources of Vitamin D
 Sun
 Fish (Salmon, Cod, Mackerel, Tuna, Sardines):
eco-minded
 Dairy: eco-minded
 Whole-Grain Cereals
 Vitamin D supplements
– Due to a poor average American diet, a Vitamin D
supplement may be needed (talk to your doctor or
nutritionist) 200-1000IU/d

54. Hot Off The Press… Latest News on
Skin Cancer
 Lip Balms and Glosses May Boost Skin Cancer
Risks
– Lips are more susceptible than skin to aging from
chronic sun damage and also more prone to
developing serious cancers
– Shiny lip balms and glosses may attract ultraviolet
rays and increase the risk of skin cancer by increasing
light penetration through the lip surface (Baylor
University Medical Center)
– A 30 SPF Broad Spectrum (metallic) lip balm is
recommended

55. Hot Off The Press… Latest News on
Skin Cancer
 Caffeine protects mice from UV-induced skin cancer
(Reuters Health)
– acts as sunscreen to UVB when given before exposure or
corrects the DNA damage after exposure when applied directly
 Resveratrol (found in red wine and dark grapes) protects
the skin cells from UVB related damages that may lead to
the development of cancer (Ahmad, University of
Wisconsin) (Immunogenic as well)
 Perillyl alcohol (found naturally in tart cherries, mint and
citrus fruits) as well as broccoli sprouts inhibit the growth
of both UVB-induced non-melanoma and melanoma
(ACC, Tuscon)

56. Summary: What to Do
Make Health and Wellness a Priority
Nutrition
Be Mindful of your mind: make room for
good things by eliminating chaotic
thoughts that lead to stress and anxiety
Sun exposure: be wise and minimize

57. Links
SunWise Web site
www.epa.gov/sunwise
UV index listings
https://enviroflash.epa.gov
www.MelanomaKnowMore.com
www.oceansalive.org
www.care2.com