1. Skin Cancer and
Sun Protection
Jonathan Gerber, PharmD, BCPS, BCOP
REX Hospital
October 21st, 2014

2. Objectives
• Discuss skin cancer types,
epidemiology, and risk factors
• Explain options for sun protection
• Describe FDA labeling
requirements for sunscreen

3. Sun Damage
N Engl J Med. 2012 Apr 19;366(16):e25

4. Skin Cancer Types
• Basal Cell Carcinoma (BCC)
o Most common type
o Typically appears on the face
o Rarely spreads
o Caused by sun exposure
• Squamous Cell Carcinoma (SCC)
o Typically appears on the face
o Can spread
o Caused by sun exposure
• Melanoma
o Arises from moles on the skin
o Most deadly
o Caused by intense intermittent sun exposure?
www.aad.org

5. Epidemiology
• Most common form of cancer
o Accounts for 75% of all diagnoses
• Approximately 3.5 million new cases per year in the
United States
o Squamous cell and basal cell are NOT reported
• Approximately 76,100 cases of melanoma will be
diagnosed in 2014
o Accounts for <2% of skin cancer cases, but most deaths
• Incidence has been increasing for at least 30 years
Arch Dermatol. 2010 Mar;146(3):283-7
www.cancer.org

6. Risk Factors
• Sun sensitivity
o Sunburn easily
o Difficulty tanning
o Natural blonde or red hair color
o Fair skin
• Excessive sun exposure
• Ethnicity
• Use of tanning booths
• Immune suppression
• History of skin cancer
www.aad.org

7. Prevention & Screening
• Never use tanning bed or lamp
• Wear an SPF 15 sunscreen every day
• Wear clothes that provide sun protection
• Wear sunglasses
• Avoid the sun between 10AM and 2PM
• Screening recommendations vary and are only
available for melanoma
o Monitor moles for melanoma
www.aad.org

8. UV Radiation
• Causes skin damage by producing genetic
mutations that lead to skin cancer and early aging
• UVA
o Account for 95% of UV Radiation
o Causes tanning and skin aging
o Penetrates skin more deeply than UVB
o Less intense than UVB
• UVB
o Causes reddening and sunburn
o Penetrates more superficial areas
o Does not significantly penetrate glass
• UVA and UVB penetrate clouds!
www.skincancer.org

9. UV Index
• Created by the Environmental Protection Agency
(EPA), National Weather Service, and Centers for
Disease Control and Prevention (CDC)
• Predicts the level of UV radiation and indicates risk
of overexposure
www.who.int

10. UV Index
www.who.int

11. Clothing UPF
• Ultraviolet protection factor (UPF) is a measure of
UVA and UVB protection
• UPF compares the UV light measured without the
protection of the fabric to with protection of the
fabric
• Regulated by the Fair Trade Commission (FTC)
• Maximum allowed UPF is 50+
www.sun-protection-and-products-guide.com

12. Sunscreen SPF
• Sun protection factor (SPF) is primarily a measure of
UVB protection
• SPF compares the time of ultraviolet (UV) radiation
exposure it takes to cause redness when a person is
using a sunscreen in comparison to how much UV
exposure it takes to cause redness when they do
not use a sunscreen
• Absorbs or reflects UV radiation
• Regulated by the FDA
www.fda.gov

13. FDA Regulations
• Regulations passed June 2012 and became
effective December 2012
• Broad spectrum sunscreen protects against UVA
and UVB
• “Waterproof”, “Sweatproof”, and “Sunblock” terms
are not allowed
• Cannot claim more than 2 hours of protection
without reapplication unless data is submitted
o No “instant” or “all day” protection
• Water resistance is limited to 40 and 80 minutes
• Apply 15 minutes before sun exposure
www.fda.gov

14. FDA Regulations
• Not all sunscreens are created equal!
• Some sunscreens are only labeled to prevent
sunburn...
• Non-broad spectrum OR broad spectrum + SPF <15
o “This product has been shown only to help prevent sunburn, not skin
cancer or early skin aging.”
• Some sunscreens are labeled to prevent sunburn,
skin cancer, and skin aging…
• Broad spectrum + SPF >=15
o “Helps prevent sunburn”
o “Decreases the risk of skin cancer and early skin aging caused by the sun”
www.fda.gov

15. FDA Regulations
www.fda.gov

16. FDA Regulations
www.fda.gov

17. How to Apply
• Most people don’t apply enough!
• Apply a nickel sized dollop to the face
• Apply 2 tablespoons to exposed areas of the body
o Approximately 1 shot glass
o Approximately 1 golf ball
www.allure.com
www.skincancer.org

19. References
• Gordon, JR, Brieva, JC. Unilateral Dermatoheliosis,
2012. N Engl J Med; 366e25
• www.aad.org. Accessed October 2014
• Rogers, HW, Weinstock, MA, Harris, AR, et al.
Incidence estimate of nonmelanoma skin cancer in
the United States, 2006. Arch Dermatol 2010;
146(3):283-287
• American Cancer Society. Cancer Facts and
Figures 2014. http://www.cancer.org. Accessed
October 2014.

20. References
• www.skincancer.org. Accessed October 2014
• www.who.itn. Accessed October 2014
• www.sun-protection-and-products-guide.com.
Accessed October 2014
• www.fda.gov. Accessed October 2014
• www.allure.com. Accessed October 2014