Sun safety and prevention of skin cancer starts in childhood.

Dubai Desert Safari. (Dr. Noorali Bharwani)
Dubai Desert Safari. (Dr. Noorali Bharwani)

Snow has melted and summer is around the corner. It is about time to get some sun exposure and vitamin D. But we have to be careful. We have to find a right balance. Too much sun exposure allows ultraviolet (UV) rays to reach your inner skin layers that gives you sunburn. Sunburn kills your skin cells and cause cancer. You don’t want that.

UV rays are invisible, and are produced by the sun and tanning lamps. Most often, skin cancer is the result of overexposure to sun. Good news is most cases of skin cancer can be prevented.

There are three types of skin cancers. Basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. The first two are common and have good prognosis but can disfigure your face. Melanoma can be lethal if not treated early. Melanoma is the least common, but most serious type of skin cancer.

Who gets melanoma?

The rate of melanoma has tripled in the last 50 years. Melanoma is the deadliest skin cancer. It accounts for only about one per cent of all cases of skin cancer, but is responsible for the vast majority of skin cancer deaths.

In men, melanoma is most commonly found on the back and other places on the trunk (from the shoulders to the hips) or the head and neck. The most common sites in women are the arms and the legs. People with fair skin, such as those with Scandinavian ancestry, are more prone to sun damage than people with darker skin.

Approximately two per cent of melanomas occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in prepubertal children. Children spend more time outdoors than adults. It is known that high exposure to sunlight during childhood sets the scene for higher rates of melanomas as an adult. Your risk of skin cancer increases with level of total cumulative exposure to the sun and number of sunburns. Melanoma loves overexposed and burnt skin.

What happens after diagnosis?

Your doctor will investigate if the melanoma is at an early stage or advanced stage. Early-stage means the cancer hasn’t grown much and hasn’t spread. Treatment is more likely to be successful.

Advanced-stage melanoma usually means the cancer is bigger and has probably spread. It’s important to know the stage of a cancer. It helps decide on your treatment.

Most early melanomas can be treated with wide surgical excision. But prognosis drops dramatically when the tumor has spread. There is no curative treatment available for advanced melanoma.

While we are waiting for scientific breakthrough in many areas of melanoma, we can try and prevent melanoma by protecting against sun exposure and sun burn. Natural protection (shade) is considered the best protection. And sunscreen (SPF 15 or higher) should be adjunct to natural protection.

Wear sun protective clothing (tightly woven). Wear wide brim hats. And use eyeglasses that block both UVA and UVB light.

Skin is the largest organ in the body. It is a very precious and important organ. It has many important functions. It is important for our survival. Let us protect it well starting from childhood. There is no doubt melanoma risk rises rapidly with increasing exposure to ultraviolet light in childhood. That is where the prevention should start and then continued into adult life.

Have a wonderful safe summer.

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Proper Use of Sunscreen Important to Prevent Skin Cancer

"Trust me, I'm a doctor!" (Dr. Noorali Bharwani)
"Trust me, I'm a doctor!" (Dr. Noorali Bharwani)

Skin cancer is the most common cancer in North America. The benefits of sunscreen outweigh the inconvenience of using it.

First step in the prevention against skin cancer is to avoid sun exposure between 10 a.m. and 2 p.m. whatever the season. These are prime hours for exposure to skin-damaging ultraviolet (UV) radiation from the sun, even on overcast days.

Second step is to wear protective clothing. This includes pants, shirts with long sleeves, sunglasses and a wide-brimmed hat.

Third step is to use sunscreen. Apply sunscreen generously and reapply regularly, says a dermatologist at Mayo Clinic.

There are two types of UV light that can harm your skin – UVA and UVB. A broad-spectrum sunscreen protects you from both.

UVA rays can prematurely age your skin, causing wrinkles. UVB rays can burn your skin. Too much exposure to UVA or UVB rays can cause skin cancer. The best sunscreen offers protection from all UV light.

SPF stands for sun protection factor, a measure of how well sunscreen protects against UVB rays. UVA protection isn’t rated. Manufacturers calculate SPF based on how long it takes to sunburn skin that’s been treated with the sunscreen as compared to skin with no sunscreen.

When applied correctly, a sunscreen with an SPF of 30 will provide slightly more protection from UVB rays than does a sunscreen with an SPF of 15. But the SPF 30 product isn’t twice as protective as the SPF 15 product. Sunscreens with SPFs greater than 50 provide only a small increase in UV protection.

Often sunscreen is not applied thoroughly or thickly enough, and it can be washed off during swimming or sweating. As a result, even the best sunscreen might be less effective than the SPF number suggests.

Rather than looking at a sunscreen’s SPF, choose a broad-spectrum sunscreen. A water-resistant sunscreen means the SPF is maintained for up to 40 minutes while swimming or sweating. Very water resistant means the SPF is maintained for 80 minutes.

Is one sunscreen better than others?

Experts at Consumer Report (May 2017) tested 62 lotions, sprays, sticks, and lip balms. Out of these, 23 tested at less than half their labeled SPF number. That doesn’t mean the products aren’t protective, but you may not be getting the degree of protection you think you are.

To compare the full list of sunscreens you will have to go to the Consumer Report. Here are the top five brands mentioned in the Report:

  1. Equate Sport Lotion SPF 50 (Walmart)
  2. Pure Sun Defense Lotion SPF 50
  3. Equate Ultra Protection Lotion SPF 50 (Walmart)
  4. Trader Joes Spray SPF 50+
  5. Equate Sport Continuous Spray SPF 30 (Walmart)

If you cannot find one of the above sunscreens, then choose a chemical sunscreen with an SPF of 40 or higher that will give you a better chance of getting at least SPF 30.

How to use the sunscreen?

  1. Shake it well.
  2. Apply 15 to 30 minutes before going out.
  3. Use at least a teaspoon on each body part.
  4. Reapply every two hours.
  5. Use spray sunscreens carefully so you don’t inhale it, they can also be flammable. Avoid using sprays on children.

Be safe and enjoy the summer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Smart Sunscreen Strategy Needed to Prevent Skin Cancer

Sunset in Hawaii. (Dr. Noorali Bharwani)
Sunset in Hawaii. (Dr. Noorali Bharwani)

There are three types of skin cancers. Basal cell cancer (BCC) and Squamous cell cancer (SCC) are not lethal but can leave you with scars and deformities on your face and other parts of the body. Then there is melanoma. If not detected early and treated melanoma can be lethal.

When exposed to sunrays, some people burn easily and others slowly. Those who burn easily have a higher risk of skin cancer than others. But everybody is at some risk of getting skin cancer. So be smart and prevent skin cancer. Here are some guidelines.

Minimize sun exposure. Avoid the sun or stay in the shade when the sun is the strongest (10 a.m. to 4 p.m.), and dress right for the occasion. Wear a hat and clothing that’s made from tightly woven fabric.

Use appropriate sunscreen. The American Academy of Dermatology (AAD) guidelines recommend people use sunscreens with three important qualities:

  1. Use broad-spectrum sunscreen to protect against ultraviolet A rays and B rays. Ultraviolet A rays make up 95 percent of the UV spectrum and are most associated with wrinkling. Ultraviolet B rays, cause sunburn and are stronger at midday and in the summer. Both types of rays can cause skin cancer.
  2. Use water resistant sunscreen – no sunscreen is “water proof” but water resistant means you can go up to 80 minutes in the water before you need to reapply.
  3. Use sunscreen with SPF of at least 30.

To understand what sunscreens people actually use compared to what they need to prevent burning, the researchers looked at the most popular sunscreens on Amazon – the top one per cent, or 65 products.

The researchers found 40 percent – 26 of 65 – of the products did not meet AAD requirements. Most products that failed to meet the standards, 72 percent, did so because they were not water resistant.

A Consumer Reports study (May 2016) found only the following five met the AAD criteria:

  1. Hawaiian Tropic Sunscreen Silk Hydration SPF 30
  2. Neutrogena Age Shield Face Lotion Sunscreen SPF 110
  3. EltaMD UV Physical SPF 41
  4. Neutrogena Ultra Sheer Dry – Touch Sunscreen SPF 55
  5. Neutrogena Sunscreen Ultra Sheer Stick SPF 7

Make sure you use enough sunscreen. Apply sunscreen 15 to 30 minutes before you go outside. For lotions, a good rule of thumb is a teaspoon per body part or area.

For sprays, apply as much as can be rubbed in, then repeat. Regardless of which kind you use, reapply every two hours and after swimming or sweating. Use spray sunscreens carefully. Sprays are flammable; so let it dry before going near an open flame.

Consumer Reports article concludes by saying, “Tests over the past four years indicate that choosing a chemical sunscreen with an SPF of 40 or higher will give you a better chance of getting at least an SPF 30. Using any sunscreen is better than using none, but it’s just one part of a smart sun protection strategy.”

Take care and enjoy the summer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Making a Mountain out of a Molehill to Prevent Skin Cancer

A boat sailing on River Nile in Aswan, Egypt. (Dr. Noorali Bharwani)
A boat sailing on River Nile in Aswan, Egypt. (Dr. Noorali Bharwani)

The other day a gentleman asked me, “Doctor B, I have a mole. Do you think I have melanoma?” I didn’t think he had a mole. I thought it was a skin tag. He said, “OK doc, tell me what does a mole look like and when should I worry about it.”

Defining a mole is not easy. People use the word very loosely to describe any blemish on the skin as a mole.

The majority of moles appear during the first two decades of a person’s life, with about one in every 100 babies being born with moles. Acquired moles are a form of benign new growths, while congenital moles, or congenital nevi, are considered a minor malformation and may be at a higher risk for melanoma. Moles are also known as nevi. Most of them have no malignant potential. But real moles and sunburns have a potential to become cancerous.

Real moles are skin growths that are usually brown or black. During sun exposure, teenage years and pregnancy, these cells multiply and become darker. They can be anywhere on the skin, alone or in clusters. Most moles appear in early childhood and by the age of 20, one can have anywhere between 10 to 50 or more moles. Some moles may appear later in life.

Most moles are benign. The only moles that are of medical concern are those that look different than other existing moles or those that first appear after age 20. If you notice changes in a mole’s colour, height, size or shape, you should have these moles checked. If the moles bleed, ooze, itch, appear scaly or become tender or painful then it is time to have them removed and checked for cancer.

The following ABCDEs are important signs of moles that could be cancerous:

  • Asymmetry – one half of the mole does not match the other half.
  • Border – the border or edges of the mole are ragged, blurred or irregular.
  • Colour – the colour of the mole is not the same throughout or has shades of tan, brown, black, blue, white or red.
  • Diameter – the diameter of a mole is six millimetres or larger.
  • Evolution – are the moles changing over time?

Melanoma is one of the three common skin cancers. The other two are basal cell carcinoma and squamous cell carcinoma. Melanoma is the most serious form of skin cancer. If diagnosed and removed early then the cure rate can be excellent. Once the cancer advances and spreads to other parts of the body, it is hard to treat.

Does melanoma occur in children? Yes, approximately two per cent of melanomas occur in patients under the age of 20 years and about 0.4 per cent of melanomas occur in pre-pubertal children.

We can reduce the risk of skin cancer by protecting against sun exposure and sunburn. Natural protection (shade) is considered the best protection. And sunscreen (SPF 15 or higher) should be adjunct to natural protection. Wear sun protective clothing. Wear wide brim hats. And use eyeglasses that block both UVA and UVB light.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!