The document discusses skin cancer types, risk factors, and options for sun protection. It describes the three main types of skin cancer - basal cell carcinoma, squamous cell carcinoma, and melanoma - and their causes and characteristics. Statistics on skin cancer incidence and risk factors like sun exposure and skin type are provided. The document reviews sun protection options like sunscreen, protective clothing, and avoidance of midday sun. It describes FDA regulations for sunscreen labeling and the UV index scale.

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