Plus 7 crucial steps to stopping skin cancer before it starts
I’m an unapologetic sunseeker. And my favorite time of the year is upon us!
Summer is the season I dream about during all the others. And as the weather starts warming up, I can’t help but think about the beach. When will I get there—and how many trips can I swing?
I admit it—I’m addicted to the sun and sand. And I know I’m in good company…
But as a doctor, I also know that this penchant poses a unique catch-22. On the one hand, sunshine is your best natural source of lifesaving vitamin D. (As I’ve reported many times, it’s key in preventing—and even reversing—numerous debilitating conditions such as Alzheimer’s, diabetes, heart disease, and cancer—just to name a few.)
On the other hand, well, you know the drill… Hysteria over skin cancer risk has long dominated the mainstream conversation about sun exposure. And it’s not that there isn’t a grain of truth there. Skin cancer can be deadly—and excessive sun exposure is the No. 1 cause.
Still, as well-intentioned as the call to stay in the shade may be, that advice can also shield you from some essential health benefits. And the consequences could prove just as deadly.
So let’s shed some light on the topic at hand by first weighing some of the sun’s risks and benefits. I’ll tell you how you can protect yourself without missing out on one of the most powerful forms of natural disease prevention you have.
Sunshine saves lives, in more ways than one
First, let’s cut straight to the facts: “Too much” sun actually has its advantages. And they’re not exactly small ones, either.
Consider the results of the following study, published in the Journal of Internal Medicine in 2016: Researchers observed nearly 30,000 Swedish women for more than 20 years. And ultimately, they found that when it comes to your health and your mortality risk, hiding yourself away from the sun is just as dangerous as smoking.
Women who smoked and soaked up a lot of sun enjoyed lifespans on par with non-smoking women who avoided the rays. And overall, the women with the highest sun exposure had a life expectancy up to two years longer than women who avoided sunshine.1
But that’s not all. In this study, sun-seeking women were also at lower risk of heart disease, diabetes, and multiple sclerosis than their sun-avoiding counterparts.
The best part is that these results were dose-dependent—meaning the benefits of sunshine increased with greater exposure.
Researchers, however, did find a higher rate of skin cancer in the women who got the most sun. No surprises there. But overall, these cases were actually less aggressive—and carried better prognoses—than the cases of cancer among women without as much sun exposure.
To be clear, I’m not suggesting that we all slather ourselves in baby oil and lay out with a makeshift tin foil reflector (as many of us did when we were young). Considering the fact that the American Cancer Society reported 76,000 new melanoma cases in 2016, it’s safe to say that skin cancer is still a serious concern.
But there’s a right—and a wrong—way to go about preventing it…
Sunscreen isn’t a magic bullet against melanoma
Let’s start with what doesn’t work (at least, not as well as we’ve all been led to believe): sunscreen.
Another recent study, presented at the American Public Health Association 2016 Annual Meeting, enrolled 499 white children. The researchers categorized the children’s skin tone as lighter or darker.
Every year, they examined the children for new moles (an indicator of melanoma risk). The children’s parents also completed an annual survey detailing the frequency of sunscreen use when kids were outside for more than 15 minutes, thickness of sunscreen application, which parts of the body were protected, and other sun-protection measures.
What they found turns the idea of recommending sunscreen for everyone on its head. Only the high-risk kids—who had the lightest skin tones and experienced at least three sunburns between ages 12 and 14—benefited from sunscreen. Of the kids in that group, those who used sunscreen had significantly fewer moles than those who did not. But for other kids, sunscreen didn’t offer protection against developing moles.2
Now, this study only observed the children until they turned 15, and moles can take much longer than that to start appearing. But as it stands, this is the longest mole study ever conducted. And if the evidence holds true, we need to rethink our sunscreen recommendations.
The notion that sunscreen protects against skin cancer is so widely accepted that it’s practically second nature to some. But, as this evidence suggests, the protection benefits might not be as reliable as one might think…
How UV rays can help or harm
One of the reasons sunscreen isn’t as protective as expected is that many popular products are only effective at blocking ultraviolet B (UVB)—or “short wave”—rays. Until recently, we thought UVB rays were the only ones linked to melanoma.
But we now know that ultraviolet A (UVA)—or “long wave”—rays play a role too. We also know that they penetrate deeper into the skin… all the way down to the dermis (the second deepest) layer.
Additionally, UVA exposure is more or less constant throughout the day. So although the sunburn danger wanes when the sun is low in the sky, risk for UVA exposure can remain.
In fact, the damage to your skin can continue for up to four hours after you go inside.3 Even if you’re sitting in total darkness.
But fear not—researchers have found that applying a lotion containing vitamin E after you’ve been in the sun can help offset—and potentially repair—some of the damage done by the UV rays. Just be sure to look for a vitamin E product that uses all-natural ingredients (as is the case when choosing a sunscreen, which I cover in the sidebar on page 4).
On the other hand, UV rays are responsible for some of the sun’s significant health benefits too. And not just as a natural source of vitamin D, either. They help lower your blood pressure by elevating nitric oxide, a vasodilator that widens blood vessels. This allows your blood to flow more freely—a major key in preventing a heart attack or stroke.
So in the end, moles really can’t be prevented with sunscreen. They’re the “cost of doing business,” so to speak. But that doesn’t mean you should ignore them. Quite the contrary… In order to enjoy all the health benefits the sun has to offer, you must be particularly vigilant about its most dangerous risks. More on that in just a moment.
To protect yourself from the sun, you’re safer wearing hats, sunglasses, and protective clothing once you’ve reached your sun quota for the day. (This amount of time varies from person to person, but if your skin looks flushed or feels hot to the touch, you’ve met your quota.)
Nonetheless, sunscreen (while I think is overrated), can still serve a purpose if you have exceptionally fair skin or plan to be outdoors for a prolonged period of time…provided you’re using a quality product with natural ingredients (as is the case with any after-sun lotion, as I mentioned earlier). Refer to the sidebar on page 4 for my sunscreen recommendations.
Skin cancer can kill you—but it doesn’t have to
As I mentioned earlier, skin cancer is hands down the most common form of cancer in the United States—about 5.5 million cases are diagnosed every year. Even the less deadly forms—the most common, basal cell carcinoma (BCC), and the second most common, squamous cell carcinoma (SCC)—have been steadily rising. (More than 4 million Americans are diagnosed annually with BCC and nearly 1 million with SCC.) And yet somehow, there still aren’t any solid, consistent guidelines for skin exams and screening.
As for melanoma—the deadliest form of the disease—rates have been increasing at a disturbingly fast pace among the most vulnerable demographics (white men over 55 years of age and white women 49 and younger). According to the Skin Cancer Foundation’s website, approximately 178,560 cases of melanoma will be diagnosed in the U.S. in 2018. And currently, one person dies from melanoma each hour.11
When you consider the fact that a whopping 88 percent of women say they’ve never talked to their doctor about melanoma—and that only about 30 percent of them conduct their own mole and skin checks—it’s easy to see why this is a pretty major problem.
I tend to ask all of my patients if they routinely see a dermatologist for these things. And luckily, most of them do.
Melanoma is a killer that can spread fast unless it’s caught early enough. A new or different mole or skin spot can be a death sentence if it goes unnoticed or unaddressed. And surely you’ve heard how important it is to “know” your body—for a variety of reasons—and in my opinion, this one certainly tops the list.
Fortunately, there are plenty of ways to be proactive about preventing this disease. Perhaps most effective is keeping close tabs on your moles.
Seven crucial steps to stopping skin cancer before it starts
I’ve mapped out seven crucial preventative measures you can start today to protect yourself from the most common form of cancer among Americans.
1) Visit the dermatologist. (And by that, I mean a practitioner who focuses on medical dermatology, not cosmetic procedures.) As I mentioned above, this is the first and most obvious step—because while your regular doc may inspect your skin, you really need a specialist to give you a closer look. Once again, skin cancer can be deadly. Needless to say, you don’t want to leave your fate in the hands of someone who’s not an expert.
I should also note that people with 50 or more moles are at substantially higher risk than those with fewer. If you fall into this category, have a dermatologist map your skin and make sure you follow up with them at least once a year.
2) Share your personal history of sun exposure. As many as 40 percent of doctors don’t even bother asking about this—and I simply can’t understand why. Severe sunburns you may have had, even as a child, and your own family history of skin cancer matter a lot. So does any history of tanning bed use—studies show “fake baking” can raise your risk of melanoma by 75 percent. And it can double your risk of basal and squamous cell carcinomas. (True story: I was a big tanning bed fan at one point—and had a squamous cell carcinoma removed from the back of my own leg! So believe me when I say that you should always volunteer this information.)
3) Strip down for the exam. It’s a scary fact, but nearly 70 percent of all skin checks don’t include the genital region. Skin cancer in these areas may not be as common—but rest assured, melanomas can develop there. This is not a time to be shy. At the very least, make sure you look for skin changes in these areas and report any findings to your doctor.
4) Don’t forget your scalp. Close to 30 percent of skin exams overlook this area, too. Once again, this isn’t a common spot for melanomas—accounting for only six percent of them in fact. But research shows that patients with melanoma of the scalp or neck are 84 percent more likely to die from it. Likely due to the fact that the cancer had gone unnoticed for so long.
5) Check your hands, feet, and nails. Like the pubic area and the scalp, a good 32 percent of exams don’t include a thorough look between the toes, soles of feet, or along the palms and nail beds. And speaking of nails, make sure they’re polish-free for the exam. Regular manicures that use UV lamps could present higher risk of squamous cell carcinoma—so your doctor will need to get a clear, unobstructed look.
6) Know what you’re looking for—and when to be concerned. More than half of all melanoma patients caught their cancers themselves. New spots—especially ones that are changing quickly, are itchy and crusty, bleeding or misshapen, or are oddly colored—are huge red flags.
7) Perform monthly self-examinations. You should make a point to look at yourself in the mirror once a month for new skin spots or changes in any moles. It should take no more than 10 minutes. Just follow steps 3 – 6 from above in front of a mirror at home.
For a detailed self-examination guide, visit the Skin Cancer Foundation’s website (www.skincancer.org). Simply click on the “Skin Information Tab” then select “Early Detection and Self Exams.” As they say on their site, “If you can spot it, you can stop it.”
If you do find something, it’s important to know what your next steps should be. So let’s take a moment to talk about that now.
Before you go under the knife…
Given the statistics, your chances of grappling with suspicious moles at some point—or multiple points—in your life are obviously high.
But despite how common it is, the necessity of removing a suspicious skin mole is still pretty subjective unless you’re dealing with something really obvious. Your doctor will be on the lookout for various characteristics, which are typically referred to as the “ABCDE rule.” (You should also use these criteria during your monthly self-examinations.)
A: Asymmetry. The spot isn’t a perfect circle.
B: Border irregularity. Edges of the spot may appear notched or “bumpy” rather than smooth and even.
C: Color. A spot that appears mottled or is more than one single shade. (Also, brown and black aren’t the only colors. Melanoma can be pink, tan, or white.)
D: Diameter. Spots over 1/4 inch.
E: Evolution. The spot has grown larger or changed color over time.
If any of your moles meet this criteria, you may need to have it removed. It really comes down to your doctor’s recommendations. But your doctor’s judgment calls don’t end there. And that’s why I want to leave you with one more recommendation.
According to the latest research, cutting a 2 mm margin from the mole’s border is the most effective way to remove all potentially cancerous cells and prevent the need for additional surgery.4
This is important. Because currently, up to two-thirds of the suspicious moles removed in the U.S. every year—and they number in the hundreds of thousands—end up needing further removal because of cells that were missed on the first attempt.
This may not sound like a big deal to you. But going under the knife for any reason puts you at higher risk of infection and scarring. And nobody wants to waste time or money on visits that could have been prevented in the first place, anyway.
A new study shows that allowing for this 2 mm margin could make a significant difference in this department. Researchers removed 151 suspicious skin moles in 138 men and women. And after a year and a half of close monitoring, they found no further suspicious growths at any of the biopsy sites.
In fact, more than 90 percent of the moles biopsied had been completely taken care of with these larger removal margins. So don’t think twice about bringing up this research—preferably before your doctor raises the scalpel.
Natural sunscreens that won’t cramp your style—or put you at risk
First of all, avoid products that are loaded with chemicals (like the ones you most often see advertised), which can disrupt your endocrine system. Of course, that’s easier said than done. The only totally natural sunscreen is titanium dioxide or zinc oxide—the white paste that lifeguards dollop on their noses. These minerals usually need to be combined with other ingredients to make them spreadable—and transparent—on your skin.
It’s important to choose a product that uses organic or natural ingredients to do that. My personal favorites are sunscreens by Lavera, Aubrey, Earth’s Best, and Soleo.
Some sunscreens may also contain natural botanicals such as licorice, curcumin, aloin, ginsenoside, or epicatechin. Research shows that these ingredients all protect against UV damage. And they have a natural sun protection factor of at least 15.9-10
As with most of my recommendations, all-natural is the way to go, even when it comes to slathering on sunscreen.
1. Lindqvist PG, et al. J Intern Med. 2016 Oct;280(4):375-87.
2. American Public Health Association (APHA) 2016 Annual Meeting: Abstract 363065. Presented November 1, 2016.
3. Premi S, et al. “Chemiexcitation of melanin derivatives induces DNA photoproducts long after UV exposure.” Science2015: 347(6224):842-847.
4. Terushkin V, et al. J Am Acad Dermatol. 2017 Dec;77(6):1096-1099.
5. Shapira N. Nutr Rev 2010; 68(2): 75-86
6. Yoshihisa Y, et al. Exp Dermatol. 2014; 23(3): 178-83
7. Saliou C, et al. Free Radic Biol Med. 2001; 30(2): 154-60.
8. University of Colorado Denver. “Silibinin, found in milk thistle, protects against UV-induced skin cancer.” ScienceDaily, 1/30/13
9. Mukherjee P, et al. Phytomedicine 2011; 19(1):64-73
10. Kühnl J, et al. Experimental Dermatology, 2015; 24 (1): 42.
11. Skin Cancer Foundation. “Skin Cancer Facts and Statistics.” Skin Cancer Foundation, 1/31/18.