Myths and Facts: Skin Cancer

Every year, Americans have 4,380 hours of suntanning opportunity, which is the number of daylight hours.¹ In addition to the sun’s rays, there are almost 20,000 tanning salons in the U.S. in which more than one million people tan each year.² The result is the diagnosis of more than 3.5 million skin cancers in over two million people annually. This translates to more than one in five Americans who develop skin cancer in the course of their lifetime. In fact, over the past three decades, more people have had skin cancer than all other cancers combined.³ Yet, despite these statistics, people still flock to warm climates and tanning salons in pursuit of a suntan. And, many people continue to ignore the warnings to minimize the damage the sun can cause, mainly because of a misunderstanding about how harmful the effects of the sun’s rays are and how to protect against them.

Separating Myth from Fact

MYTH: Skin cancer is a less serious form of cancer.

FACT: Skin cancer is the most common of all cancers. It is a very serious form of cancer causing one death every 57 minutes. Approximately 9,480 people died of melanoma, the most deadly form of skin cancer, in 2013. An estimated 3,900 to 8,800 people died from squamous cell carcinoma, another type of skin cancer, in 2012.³

MYTH: There’s only one type of skin cancer.

FACT: There are many types of skin cancer. The three most common are melanoma, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Melanoma begins in melanocytes (pigment cells).⁴ It is estimated that melanoma will account for more than 76,000 cases of skin cancer in 2014.⁵ It accounts for less than 5 percent of skin cancer cases but the vast majority of skin cancer deaths. One in 50 men and women will be diagnosed with melanoma of the skin during their lifetime. The majority of people diagnosed with melanoma are white men over age 50. And, women age 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer. It is the most common form of cancer for young adults ages 25 to 29 years old and the second most common form of cancer for young people ages 15 to 29. Fortunately, survival with melanoma increased from 49 percent (1950 through 1954) to 92 percent (1996 through 2003).³

BCC begins in the basal cell layer of the skin.⁴ An estimated 2.8 million people in the U.S. are diagnosed annually with BCC. The number of women under age 40 diagnosed with BCC has more than doubled in the last 30 years. And, while it is rarely fatal, it can be highly disfiguring if allowed to grow.³

SCC begins in the squamous cells.⁴ It is the second most common form of skin cancer, with an estimated 700,000 cases of SCC diagnosed each year in the U.S. And, the incidence of squamous cell carcinoma has been rising, with increases up to 200 percent over the past three decades in the U.S.³

Between 40 percent and 50 percent of Americans who live to age 65 will have either BCC or SCC at least once.3

MYTH: Only fair-skinned people are at risk of skin cancer.

FACT: People of all skin types can develop all types of skin cancer. BCC is the most common type of skin cancer for people with fair skin, whereas in people with dark skin, SCC is the most common type of skin cancer. While melanoma is rare in people with dark skin, when it does develop, it is usually found under the fingernails or toenails, on the palms of the hands or on the soles of the feet.³

MYTH: Skin cancer develops only on parts of the body that have gotten too much sun.

FACT: Skin cancer can develop on all parts of the body, even those not exposed to the sun. BCC usually occurs in places that have been in the sun, most commonly the face. In people with fair skin, SCC usually occurs on parts of the skin that have been in the sun such as the head, face, ears and neck. However, in people with dark skin, SCC is usually found in places that are not in the sun such as the legs or feet.⁴ Melanoma can occur on any skin surface. In men, it’s often found on the skin of the head, on the neck or between the shoulders and hips. In women, it’s often found on the skin of the lower legs or between the shoulders and hips. And, melanoma is more likely than other skin cancers to spread throughout the body. SCC can sometimes spread to other parts of the body, but BCC rarely does. When skin cancer cells do spread or metastasize, they break away from the original growth and enter blood vessels or lymph vessels, as well as other tissues, and attach to form new tumors.³

MYTH: Sun exposure is needed for the body to get vitamin D.

FACT: The safest way to get vitamin D is through diet and supplements. The body does produce some vitamin D following exposure to the sun’s ultraviolet B (UVB) radiation. However, after a limited amount of sun exposure (approximately five minutes daily for a Caucasian in New York at 12 p.m. in summer), vitamin D production reaches its maximum.⁶ In fact, most people get enough UV exposure to maintain vitamin D levels through their usual outdoor activities.⁷

MYTH: Only people who don’t use sunscreen and spend too much time in the sun get skin cancer.

FACT: Limiting sun exposure can reduce the risk of getting skin cancer, but the risk is not reduced to zero. Genes also influence the risk of developing skin cancer even for some people who wear sunscreen conscientiously but have a family history of skin cancer.⁸ In fact, a new study provides some understanding of why some people are at greater risk of skin cancer because of their family history. A team led by the Wellcome Trust Sanger Institute in Hinxton, United Kingdom, found that people with mutations in a certain gene were at extremely high risk of melanoma. The mutations switch off a gene known as POT1, which protects against damage to packets of DNA known as chromosomes. According to Dr. David Adams, co-author of the study’s report that appeared in Nature Genetics, “The mutations in this gene result in damage to the end of the chromosomes, and chromosomal damage in general is linked to cancer formation; that’s the pathway for it.”⁹

There also is a high risk of skin cancer for people who improperly use sunscreen. A sunscreen with a sun protection factor (SPF) of 30 or higher should be applied a half hour before sun exposure so it has time to penetrate the skin. And, sunscreen should be reapplied regularly.⁸ A quick way to calculate how long a sunscreen will protect the skin is to multiply SPF by 10 to determine how many minutes after an application it needs to be reapplied.¹⁰ It should be reapplied sooner if swimming or sweating a lot.¹¹

Using a sunscreen that only protects against sunburn can also increase risk of skin cancer. The U.S. Food and Drug Administration (FDA) recently revised its rules for labeling on sunscreen bottles. For a sunscreen label to claim it can prevent sunburn, the product must pass the SPF test, which shows how long a sunscreen protects against UVB rays that cause sunburn. SPF levels range from 2 to more than 70. The higher the number, the longer the protection lasts. For a product to claim it can prevent skin cancer, it must pass the broad-spectrum test to show it can protect skin from both UVB rays and UVA radiation, which contribute to skin cancer and early skin aging.¹¹

Even people who avoid outdoor activities are at risk for skin cancer because they, too, are exposed to UV radiation through routine activities like walking a dog or trying to find a parked car.⁸ And, while glass does block most UVB rays, UVA radiation can get through unless a special window film that blocks most UVA radiation is installed.⁶

MYTH: Using sunscreen and avoiding the sun are the only ways to protect against skin cancer.

FACT: While sunscreen and avoiding the sun are effective ways of protecting against skin cancer, research shows that nutrition and supplements can also play a role. According to Dr. Ronald Moy, a cosmetic dermatologist and a fellow of the American Academy of Cosmetic Surgery, antioxidants are the secret weapon against skin cancer. “Blackberries, blueberries, strawberries, artichokes, beans, prunes, plums and green tea are all high in antioxidants, which can help protect the skin cells from DNA damage caused by the sun,” Moy says.¹²

A recent study published in the journal Cancer Research claims that coffee drinkers may be at a reduced risk of developing BCC. The researchers evaluated data on 113,000 men and women, all of whom drank three or more cups of coffee a day. They discovered that rates of BCC were 20 percent less among this control group compared with those who drank no coffee at all, and the active substance in question appears to be caffeine. “Caffeine may help the body kill off damaged skin cells,” says Dr. Josh Zeichner, an assistant professor of dermatology at Mount Sinai Medical Center in New York. “If you get rid of these cells that are damaged, then they don’t have the opportunity to grow and form cancers.” The findings correlate with a 2011 study at Rutgers University that identified a link between caffeine and skin cancer prevention. That study found that caffeine appears to be an effective topical treatment for protecting skin against damage caused by excessive exposure to the sun’s UV rays.¹³

Other research shows that some supplements may help to protect against skin cancer. Researchers at the University of Manchester in the United Kingdom demonstrated how omega-3 fish oils could help protect against skin cancer. It was the first clinical trial to examine the impact of fish oils on the skin immunity of human volunteers. In the study, 79 volunteers took a daily 4-gram dose of omega-3, equivalent to about one-and-a-half portions of oily fish, and were then exposed to either eight, 15 or 30 minutes of summer midday sun using a special light machine. That group was then compared with a second group taking a placebo. The researchers found that immunosuppression was 50 percent lower in people who took the omega-3 supplement and were exposed to eight and 15 minutes of sun compared with people who did not take the supplement.¹⁴

In another study conducted at the University of Texas Health Science Center in San Antonio, scientists observed that resveratrol (an antioxidant found in grape skins), grape seed extract, D-glucarate (a cellular detoxifier), calcium and ellagic acid work in harmony to protect against skin cancer when administered both orally and topically in mice with skin cancer. Even in low doses, the plant agents exerted maximum therapeutic effects when combined with each other because each compound plays a specific and unique role in the process. When administered individually, however, these compounds were not particularly effective.¹⁵

MYTH: Sun protection is needed only on hot, sunny days.

FACT: Even on cloudy days, the sun’s rays can damage the skin. In fact, 80 percent of the sun’s UV rays can penetrate through clouds and fog.⁶

MYTH: Dark skin protects against skin cancer.

FACT: Naturally darker skin doesn’t prevent skin cancer. While skin cancer is less common among African-American and Hispanic populations than among Caucasian populations, African-Americans and Hispanics who develop melanoma are more likely to die from the disease than are Caucasians.⁸ The overall melanoma survival rate for African-Americans is only 77 percent versus 91 percent for Caucasians.3 It is believed that this difference in patient outcomes is that dark-skinned people are less likely to seek treatment for skin lesions before the disease has reached an advanced stage. For example, acral lentiginous melanoma, the most common melanoma in African- Americans and Asians, often goes unrecognized because it affects parts of the skin where cancer is not expected such as the palms, soles of the feet and nail beds.⁸ The most common form of skin cancer among African-Americans and Asian Indians is SCC. SCC in African-Americans also tends to be more aggressive and is associated with a 20 percent to 40 percent risk of metastasis.³

MYTH: Tans shield the skin from damage.

FACT: A base tan may delay sunburn, but it will not prevent damage from UV radiation. Tanning is the body’s attempt to defend itself against previous exposure to UV radiation by increasing the amount of pigment in the skin, which means the DNA in suntanned skin has already been damaged by UV radiation. And, DNA damage can lead to mutations that cause cancer. In addition, a substantial amount of UV radiation will still penetrate any tan.⁸

MYTH: Tanning beds are safer than tanning in the sun.

FACT: The U.S. Department of Health and Human Services and the World Health Organization’s International Agency of Research on Cancer panel has declared UV radiation from the sun and artificial sources such as tanning beds and sun lamps as known carcinogens. Indoor tanning equipment, which includes all artificial light sources, including beds, lamps, bulbs, booths, etc., emits both UVA and UVB radiation, the amount of which is similar to the sun and, in some cases, might be stronger.¹⁶ One minute in the average indoor tanning machine in England is twice as carcinogenic as one minute in the midday Mediterranean sun. And, frequent tanners using new high-pressure sun lamps may receive as much as 12 times the annual UVA dose compared with the dose they receive from sun exposure.³

Many studies have shown that indoor tanning causes skin cancer. Some studies have found a 59 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning, and the risk increases with each use. Other studies have shown that exposure to radiation from indoor tanning devices is associated with a risk of SCC and BCC. In fact, a recent study estimates that this exposure causes more than 450,000 cases of SCC and BCC, and 10,000 melanoma cases each year in the U.S., Europe and Australia.¹⁶

On May 6, 2013, FDA issued a proposed order for stricter regulations on indoor tanning devices. And, several states have laws that prohibit minors under the age of 17 or 18 from using indoor tanning devices.¹⁶

Dispelling the Myths Now

The American Cancer Institute estimates that 9,710 people will die from melanoma in 2014, a death rate that has remained consistent since 2001. During this same time frame, the incidence of melanoma has continued to climb,¹⁷ which means treatment for this skin cancer has greatly improved. But the cost of treating skin cancer is high. In 2010, the estimated cost of treating melanoma was $2.36 billion. The latest figure available for the cost of treating nonmelanoma skin cancers was $1.4 billion in 2004.³ Yet, despite its risks and the escalating costs of treatment, people still flock to warm climates and to tanning booths in pursuit of a tan. With no end in sight to the allure of a tan and time in the sun, it’s important for individuals to understand the facts about the harmful effects of the sun’s rays and to take the necessary precautions to protect themselves as best they can.