Summers in New England are a thing to be cherished, and are a time to soak up the sun!  While we love the summer sun and the warmth and joy that it brings, it is also important to remember that too much sun exposure can be dangerous and that we must play safe in the sun.

The most negative result of direct sun exposure is the risk of developing skin cancer.  Melanoma is a very serious type of skin cancer.  Generally thought of as the “mole” cancer, it can be found anywhere on the skin, even skin not exposed to the sun, as its development is linked to genes as well as to sun exposure.  Early detection and intervention is critical for melanoma, which, if left untreated, can spread inside the body and can be deadly.

Basal cell cancers and squamous cell cancers (known together as “non-melanoma skin cancers”) are more common types of skin cancer.  Both are found on parts of the skin exposed to the sun, especially the head and neck, and both are related to how much time a person spends in the sun.  These skin cancers, while less likely than melanoma to be fatal, should still be treated as soon as they are detected.  If left untreated, they can grow and impact other body tissue, causing scars and even loss of function in some parts of the body. 

If you notice any unusually-shaped or colored moles or other changes to your skin, you should promptly see your regular doctor or a dermatologist.

To help you greatly reduce if not eliminate your risk for any kind of skin cancer, The American Cancer Society reminds us to “Slip! Slop! Slap! and Wrap!”  That is, slip on a shirt, slop on sunscreen, slap on a hat and wrap on sunglasses to protect your eyes and the skin around them.  Here is some additional information on how you can get the most from using these different types of skin protection.

Sunscreen

When it comes to sunscreen, there are many different products available, but not all sunscreen is the same.  The  American Academy of Dermatology (AAD) recommends using products with a sun protection factor (SPF) of 30 or higher.  The SPF number represents the level of protection against UVB (ultraviolet b) rays provided by the sunscreen.  A high number means stronger protection; however, no sunscreen will completely protect you. 

Physical blockers, which contain zinc oxide and titanium dioxide, act as a barrier to the sun’s rays. They begin to work as soon as they are applied to the skin. They are a bit more “chalky white,” although micronized and tinted versions make these more appealing to wear.  Chemical blockers must be absorbed into the skin, and need to be applied 30 minutes prior to sun exposure.  In very hot sun, you can burn in those 30 minutes, even though you think you are protected.  As a reminder, the AAD recommends that babies under 6 months old be kept out of the sun’s rays. After 6 months, sunscreens may be applied.  I personally recommend the physical blockers for children as they protect them right away. 

Waterproof and water-resistant sunscreens are also different.  Waterproof may provide protection for up to 80 minutes while water-resistant may protect for only 40 minutes.  In either case, it is important to reapply sun screen throughout the day.  When not in the water, it is recommend to reapply sunscreen at least every 2 hours.

Don’t forget: you can get sunburn while driving in your car, sitting near a window at work, or flying on an airplane. And no matter what others have told you, you can absolutely burn under a tree or on cloudy days. So make sure to bring sunscreen with you, and reapply before going out for lunch or for a lunchtime drive. Here is a fun test: Blue Lizard® sunscreen is a white sunscreen, but the bottle turns pink when exposed to UV rays. Take a bottle out on a cloudy summer day, or under your favorite tree, where you “think” you’re safe in the shade, and watch it turn pink.  You’ll be amazed!

It’s also important to remember to apply a generous amount of sunscreen to your skin, especially to your face, ears, nose, hands, arms and other places not covered by clothing.  If you are going to wear makeup or insect repellent, be sure to apply sunscreen first.  

Photoprotective Clothing

For many reasons – not liking the feel of sunscreen or not wanting to pollute the environment with globs of sunscreen –  some people are choosing to wear photoprotective clothing, either in addition to or instead of sunscreens.  There are many companies now offering SPF 50+ hats, shirts, pants and bathing suits.  Although I’m not recommending one over another, we often point patients toward Coolibar® and Solumbra®…do an internet search for the websites or just search for “photoprotective clothing” and see.  There are also products such as  SunGuard^TM, which can be put into a load of laundry and add SPF 30+ to your own clothes for several washes. However you choose to protect yourself, be sun safe!

Hats

Baseball is a great summer pastime.  We talk about it, play it and watch it.  A baseball cap, however, only partially protects you from the sun.  While it does cover your head and face, your ears and neck are still exposed.  The ears are one of the most common places to develop skin cancer in men. Ideally, a hat with a 4 inch brim all around is recommended because it protects the ears, eyes, forehead, nose, and scalp.  A shade cap (which looks like a baseball cap with about 7 inches of fabric draping down the sides and back) is also good, and will provide more protection for the neck. And while we’re talking of risky places to develop skin cancers, lips are right up there. Squamous cell carcinomas on the ears and lips have a much higher risk of spreading inside the body and potentially doing significant harm, so cover those ears AND wear SPF lip balm!

Sunglasses

You should be sure your sunglasses block at least 99 percent of UV rays, screen out 75 to 90 percent of visible light, allow for proper color recognition, and are free of distortion.

Tanning beds and sun lamps

Avoid these!  Tanning beds and lamps may cause long-term skin damage and can cause skin cancer.  Those tanning rays, just like the sun’s rays, are also CAUSING YOU TO WRINKLE…yes you heard that right: tanning booths, just like the sun, will cause you to WRINKLE much sooner than you normally would.   If you must have the color, tanning sprays and bronzers can provide that, but remember that they do NOT provide sunscreen protection from UV damage, which in turn causes those skin cancers and wrinkling. If you are going to use bronzers, remember your sunscreen as well.

With these helpful tips, go outside and enjoy those sunny days knowing that you are protecting your skin.  Have fun this summer and always remember to be sun safe!

Dr. J. Suzanne Mosher, a board-certified dermatologist, performs Mohs surgery at the Harvard Vanguard Medical Associates’ Watertown location on Mondays, Wednesdays, Thursdays and Fridays. Dr. Frederic Mohs developed the technique of Mohs surgery in the 1930s, and it became a popular way to treat skin cancer throughout the last two decades, as rates of non-melanoma skin cancer have been on the rise. Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate. The cure rate with Mohs surgery cited by most studies is between 97 percent and 99.8 percent for primary basal cell carcinoma. When not operating, you can find Dr. Mosher spending time with her small children, who can recite in their sleep, “My mom is a skin cancer doctor. Wear sunscreen so you don’t get sunburn, which could give you a skin cancer.” You can also spot them a mile away as the palest ones on the block….the sun block, of course!