Sun Exposure and Skin Cancer: Know Your ABCDEs Presenters: Chris

Sun Exposure and Skin Cancer: Know Your ABCDEs Presenters: Chris Kuhn, Center Director, Oneonta Job Corps Center John Kulig, MD, MPH, Lead Medical Specialist, Humanitas May 19, 2022

Overview This webinar will provide a review of the different types of skin cancer, recognition of skin cancer and educational resources for skin cancer prevention. A melanoma survivor will discuss his case and offer suggestions for skin cancer prevention in Job Corps.

Learning Objectives Participants will be able to: 1. Recognize the relationship between rising rates of skin cancer and sun exposure. 2. Explain the signs and symptoms of skin cancer and the meaning of the acronym "ABCDE." 3. Describe educational resources and strategies to communicate skin cancer prevention information for Job Corps students.

Factors influencing production of vitamin D in skin Skin color and current tan level Amount of time spent in the sun Weather conditions: cloud cover and pollution, ozone layer, surface reflection Latitude and elevation Season Time of day Use of sunscreen Clothing, hats Adequate vitamin D can be obtained safely through food and dietary supplements

Harmful effects of sun exposure Tanning is the body’s response to skin damage from ultraviolet (UV) radiation from the sun Sunburn – 1st (redness) and 2nd degree (blisters) Dehydration/heat injury/heat stroke Corneal damage to the eyes Drug sensitivity reactions Premature skin aging/wrinkles/age spots Solar urticaria (hives) - rare

Harmful effects of sun exposure Sunburn can occur in less than 15 minutes, but may not appear for another 2 to 4 hours Skin cancer – most common of all cancers – 90% caused by sun exposure “Sustaining 5 or more sunburns in youth increases lifetime melanoma risk by 80%.” [Skin Cancer Foundation]

Types of skin cancer Basal Cell Carcinoma about 8 out of 10 of all skin cancers usually develop on areas exposed to the sun, especially the head and neck Squamous Cell Carcinoma tend to grow slowly usually occur on sun-exposed areas of the body, such as the face, ears, neck, lips, and backs of the hands Melanoma much less common than basal cell and squamous cell skin cancers, but far more dangerous trunk (chest and back) is the most common site in men; legs are the most common site in women; neck and face are other common sites

Basal Cell Carcinoma

Squamous Cell Carcinoma

How common is skin cancer? The National Cancer Institute SEER Program projects there will be 106,110 new cases of skin melanomas and 7,180 deaths in 2021. In 2018, there were an estimated 1.3 million people living with melanoma of the skin in the U.S. About 4.3 million people are treated for basal cell cancer and squamous cell skin cancer in the U.S. every year, according to a report from the Office of the Surgeon General. FDA

Melanoma rates Incidence of melanoma in the U.S. has grown over 320% since 1975 Five year survival 99% with stage I disease, but only 30% with stage IV disease

Skin Cancer in African Americans African Americans are less likely than members of other racial and ethnic groups in the United States to develop skin cancer Melanomas occur mainly on body sites that are not pigmented, such as the palms of the hands, the soles of the feet, and the skin beneath the nails as well as the mucous membranes of the mouth, nasal passages, and genitals Outcome of skin cancer is often poorer in African Americans because the disease is often diagnosed at a more advanced stage

Question Which internationally famous singer, songwriter and musician died at age 36 of malignant melanoma that presented under the nail of a toe?

ABCDE for Melanoma

What about E? Evolution (or Change) evolution of a nevus has become the most important factor to consider when it comes to diagnosing a melanoma Elevation elevation changes are critical because, when the thickness of a melanoma exceeds 1 mm, the chance of internal spread increases

And now F and G! Properties of nodular melanomas E ELEVATED Early elevation above the skin surface F FIRM Firm to the touch, not flabby G GROWING Continues growing more than two to three weeks

Nodular Melanomas Nodular melanomas are typically dome-shaped and lacking in the ABCD properties, making visual diagnosis more difficult http://www.skincheck.org/

The “Ugly Duckling” Sign Based upon the observation that nevi in the same individual tend to resemble one another and that malignant melanoma often deviates from this nevus pattern.

Prevention Melanoma can be prevented by reducing ultraviolet radiation exposure from sunbathing and indoor tanning and increasing the use of sun protection.

Summary of USPSTF Recommendations and Evidence Population Recommendation Children, Adolescents, and The U.S. Preventive Young Adults aged 10 to Services Task Force 24, Fair Skinned (USPSTF) recommends counseling children, adolescents, and young adults aged 10 to 24 years who have fair skin about minimizing their exposure to ultraviolet radiation to reduce risk for skin cancer. Grade B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

CDC Recommendations Stay in the shade, especially during midday hours from 10 am to 4 pm DST. Wear clothing that covers your arms and legs. Wear a hat with a wide brim to shade your face, head, ears, and neck. Wear sunglasses that wrap around and block both UVA and UVB rays. Use broad-spectrum sunscreen with sun protection factor (SPF) 15 or higher, and both UVA and UVB protection. Avoid indoor tanning. http://www.cdc.gov/cancer/skin/basic info/prevention.htm

Sunscreens Sun protection factor (SPF) degree of protection against the ultraviolet B (UVB) rays that cause sunburn SPF 15 filters out 94% of the sun’s UVB rays. SPF 30 protects the skin from 97% of the UVB rays – no need for SPF 30 must apply at least every 2-3 hours

Simple rules to prevent sunburns When possible, dress in cool, comfortable clothing that covers the body, such as lightweight cotton pants, long-sleeved shirts, and hats. Select clothes made with a tight weave; they protect better than clothes with a looser weave. If you're not sure how tight a fabric's weave is, hold it up to see how much light shines through. The less light, the better. Or you can look for protective clothing labeled with an Ultraviolet Protection Factor (UPF). Wear a hat with an all-around 3-inch brim to shield the face, ears, and back of the neck. Limit your sun exposure between 10:00 am and 4:00 pm when UV rays are strongest. Wear sunglasses with at least 99% UV protection. Use sunscreen.

Sunscreens

How to choose a sunscreen Sunscreen can help protect the skin from sunburn and some skin cancers but only if used correctly. Keep in mind that sunscreen should be used for sun protection, not as a reason to stay in the sun longer. Use a sunscreen that says "broad-spectrum" on the label; that means it will screen out both UVB and UVA rays. Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 (up to SPF 50). An SPF of 15-30 should be fine for most people. If possible, avoid the sunscreen ingredient oxybenzone because of concerns about mild hormonal properties. Remember, though, that it's important to take steps to prevent sunburn, so using any sunscreen is better than not using sunscreen at all. For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and shoulders, choose a sunscreen with zinc oxide or titanium dioxide. These products may stay visible on the skin even after you rub them in, and some come in colors.

How to apply sunscreen Use enough sunscreen to cover all exposed areas, especially the face, nose, ears, feet, hands, and even backs of the knees. Rub it in well. Put sunscreen on 15 to 30 minutes before going outdoors. It needs time to absorb into the skin. Use sunscreen any time you spend time outdoors. Remember that you can get sunburn even on cloudy days because up to 80% of the sun's UV rays can get through the clouds. Also, UV rays can bounce back from water, sand, snow, and concrete, so make sure you're protected. Reapply sunscreen every 2 hours and after swimming, sweating, or drying off with a towel. Because most people use too little sunscreen, make sure to apply a generous amount.

Slip! Slop! Slap! Wrap! Slip on a shirt Slop on sunscreen with SPF 15 or higher Slap on a wide-brimmed hat Wrap on sunglasses

Tanning Beds

Risks of Indoor Tanning Classified as a Class I human carcinogen by WHO in 2009 400,000 cases of skin cancer may be related to indoor tanning in the United States each year: 245,000 basal cell carcinomas, 168,000 squamous cell carcinomas, and 6,000 melanomas (2014) Tanning at younger ages appears to be more strongly related to lifetime skin cancer risk

Early Detection Self-examination once a month Annual dermatology visit if high risk: Fair skin, freckling, red or blonde hair Family history of melanoma Atypical moles/dysplastic nevi Frequent sunburns/indoor tanning Weakened immune system Greater risk in women age 45 years Greater risk in men age 45 years

Prevention on Job Corps Centers May Is Skin Cancer Awareness Month Educational presentations, pamphlets, posters Sunscreen with SPF 30 available at no cost from the Wellness Center Schedule outdoor vocational and recreational activities to minimize direct sun exposure Hydration to prevent heat injury

Resources http://www.skincancer.org/ http://www.skincheck.org/ http://www.cdc.gov/cancer/skin/basic info/sun-safety.htm http://www.cdc.gov/cancer/skin/call to action/index.htm http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm04 9090.htm#Slop