Ask Dr. Mark – July Newsletter

Dr. Mark: Skin cancer is the most common type of cancer in the U.S. and one in five American’s will develop skin cancer in their lifetimes. In fact, more people are diagnosed with skin cancer each year than all other cancers combined! The situation is also getting worse with the rates for melanoma, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) all increasing at alarming rates over the last 20 years.

 

DM: While skin cancer can affect anyone, regardless of skin color, it is more common in people with lighter natural skin color, and skin that burns, freckles, reddens easily. Blue or green eyes and having blond or red hair are also risk factors, as is, having a family or personal history of skin cancer. Even one blistering sunburn during childhood or adolescence can nearly double a person’s chance of developing melanoma and exposure to tanning beds increases the risk of melanoma, especially in women 45 and younger.

 

DM: Most skin cancer deaths are from melanoma and it is estimated that 7,230 people will die from melanoma and another 4,420 deaths from other types of skin cancer in 2019. Detection of skin cancer early is critical as survival rates for patients whose melanoma that is detected early is about 98%. The survival rate falls to 64% when the disease reaches the lymph nodes and only 23% when the disease metastasizes (spreads) to distant organs. Survival for most non-melanoma skin cancers is excellent. The 5-year survival for BCC is close to 100% and for SCC it is slightly less at 95%. Early detection is critical!

 

DM: A recent Jama study did show that there were measurable levels of some of the chemicals used in sunscreens in the blood of study participants. The levels were low but greater than 0.5ng/L, the FDA cutoff, but just because something gets into your body doesn’t mean it’s bad for you. By way of comparison, the average blood level of caffeine after a cup of coffee is 50 times higher than the peak concentration of oxybenzone seen in this study. The fact that you can measure something in the blood doesn’t tell you anything about whether it is bad for you. We simply don’t know what the risk is, and the FDA have asked for more studies to be completed. The risks of UV damage to the skin are known, cumulative and significant, while these drugs have been used for decades and there have been no strong epidemiologic signals of harm. I would therefore have no concerns about sunscreens continuing to be used, however it is worth remembering that sunscreens lotions are not the only option. Clothing and hats provide excellent sun protection and there is the option of staying in the shade!

 

Regarding ‘tanning pills’ these offer no protection and generally consist of a coloring agent which is being used in an unapproved way. The FDA have issued a warning against their use. While we are on the subject of what not to use, sun beds are also a complete no-no, they just cause skin aging and increase risks of melanomas.

 

DM: If employers have employees who work outside then they have a duty of care to provide protection for those employees. They can also provide awareness education on the risks of UV radiation, a great time to do this is leading up to the summer months, and/or linking it to a national or global sun awareness initiative. Some employers do offer on-site skin screening clinics, however it should be noted that the USPSTF concluded that there is insufficient evidence to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults. Therefore, if such screenings are offered it would be prudent to just offer screenings to employees that are at higher risk.