The SUN:   The most important cause of all forms of skin cancer is from UV Radiation from the sun.   There are three bandwidths of UV Radiation:  UVA, UVB and UVC.  The Ozone Layer blocks out UVC and part of the UVB band.  UVB is the bandwidth is the primary cause of sunburn.  However, both UVA and UVB cause skin aging (dry, leathery skin) and skin cancer.  Sun exposure for as little as 15 minutes can cause a sunburn.  Other risks include photokeratitis, cataracts, and immune system suppression. 

Avoid the sun between the hours of 10 am to 2 pm.  An hour of exposure at 9 am equals 15 minutes of exposure at 1:00 pm.   Water, sand, snow can reflect the sun and amplify, even double, the UV exposure. 

Skin Cancer:   The three most common skin cancers are basal cell carcinoma, squamous cell carcinoma and melanoma.  The vast majority of basal cell carcinomas and squamous cell carcinomas are related to sun exposure.  A significant number of melanomas are also caused by the sun.   

• Basal Cell Carcinoma - T1 on the cheek, central ulcer with a pearly border. T1: Tumor size less than or equal to 2 cm with less then two risk factors.
• Basal Cell Carcinoma - T1 on the forehead, central ulcer with a pearly border. T1: Tumor size less than or equal to cm with less then two risk factors.
• Basal Cell Carcinoma - T1 on the ear, central ulcer with a pearly border. T1: Tumor size less than or equal to 2 cm with less then two risk factors.
• Basal Cell Carcinoma - T1 on the right lower lip, nodular pearly tumor. T1: Tumor size less than or equal to 2 cm with less then two risk factors.
• Basal Cell Carcinoma - T1 on left upper lip, central ulcer with a pearly border. T1: Tumor size less than or equal to 2 cm with less then two risk factors.
• Basal Cell Carcinoma - T2 on the posterior upper neck. The tumor appears to be raw and easily bleeds. T2: Tumor size greater than 2 cm or more then two risk factors.
• Squamous Cell Carcinoma - T2 on the ear. The tumor appears to be raw and easily bleeds. T1: Tumor size less than or equal to 2 cm with less then two risk factors.
• Squamous Cell Carcinoma - T1 on the ear. The tumor appears to be raw and easily bleeds. T1: Tumor size less than or equal to 2 cm with less then two risk factors.
• Squamous Cell Carcinoma - T2 on the posterior upper neck. The tumor appears to be raw and easily bleeds. T2: Tumor size greater than 2 cm or more then two risk factors.
• Squamous Cell Carcinoma - T3 on the ear. The tumor appears to be raw and easily bleeds. T3: Tumor with invasion of temporal bone, mandible, mxailla or orbit.
• Melanoma on the cheek - T1. The lesion has irregular borders and variegated colors. Note the central ulcer is a biopsy site. T1: Tumor thickness of less than or equal to 1.0 mm.
• Melanoma on the cheek - T1. The lesion has irregular borders and variegated colors. T1: Tumor thickness of less than or equal to 1.0 mm.
• Melanoma on the cheek - T1. The lesion has irregular borders and variegated colors. T1: Tumor thickness of less than or equal to 1.0 mm.
• Melanoma on the cheek - T1. The lesion has irregular borders and variegated colors. T1: Tumor thickness of less than or equal to 1.0 mm.
• Melanoma on the cheek - T1. The lesion has irregular borders and variegated colors. T1: Tumor thickness of less than or equal to 1.0 mm.

Staging of Skin Cancer:   Anyone can get skin cancer, even minorities.  Each year there are over two million cases of skin cancer with over 123,000 cases of melanoma.  Squamous Cell Carcinoma and Basal Cell Carcinoma are staged the same way.  The stages are related to the size of the tumor and spread to adjacent structures.  Melanomas are staged differently, these tumors are staged by the thickness of the tumor.  https://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional/page3    

Melanoma:  This is viewed as a serious and often deadly from of skin cancer.  The treatment of these tumors is often with surgery.  Radiation therapy is often ineffective.  New research and treatment protocols using immunotherapy appear to hold great promise. 

Sentinel lymphnode biopsy has a high false negative rate, when positive it is highly predictive of recurrence.  View Abstract

Prevention:  

Lotions:  Some sunscreens just protect against UVB and sunburn.   These products will not protect against UVA and skin cancer.   Broad Spectrum products that protect against UVA and UVB should be used.   SPF (Sun Protection Factor) is a relative scale.  It does not relate to hours of allowed exposure.  The SPF, prior to the summer of 2012, only applies to UVB or the sunburn band.  After the summer of 2012, a broadband SPF may be specified on products which will apply to both UVA and UVB.    
 
Products with an SPF less than 15 will help to reduce sunburn.  Products with an SPF of 15 or higher can reduce the risk of skin cancer and early aging of the skin.   SPF of 50 or greater will be labeled after 2012 as "50+" since there is little evidence of any difference between these products.    

Sunscreen should be applied 30 minutes before exposure then every two hours.   Sunscreens are not waterproof but may be water resistant.  These products will have to be applied more frequently as specified by the supplier.    

Clothing:  Wide brim hats and sunglasses are a must.  A tee shirt provides an SPF protection of approximately 15.  A wet tee shirt reduces protection.  A dark tee shirt offers more protection.  Fabrics which are thicker and more densely woven will offer more protection against the sun.    Sunglasses should offer UV protection.  A UV coating is also available for regular glasses. 

Vitamin D:

One of the beneficial effects of the sun is the production of Vitamin D.  Use of sunscreens  and avoidance of the sun, helps prevent skin cancer and premature skin aging.  However, this may also cause Vitamin D deficiency.  Thus, one should always take a Vitamin D supplement.  This is very important during the winter months. 

Vitamin D deficiency in children can cause rickets, a bone disease in children.  In adults, deficiency can cause osteoporosis and brittle bone.  There is also some evidence that Vitamin D deficiency can cause heart disease.  High levels of Vitamin D can help prevent cancer and lower the risk of diabetes. 

Too much Vitamin D is toxic and can be even life threatening due to increase in blood calcium levels.

Sun Beds and Tanning Products:

Sun beds are not any safer than the sun.  39% of teenagers believe they are safer but they are wrong.   Pills are also used to darken the skin, however, they are not FDA approved and some may be dangerous.  A spray on tan may be the safest, but one needs to be careful not to get the chemical into the eyes, mouth and nose, and not to inhale the spray. 

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