Our skin, the largest organ in our body, shields us against the elements — especially the sun. But many years of exposure to its harsh rays can take a toll.
While we may not like the resulting sunspots and leathery texture, the greater danger is skin cancer.
"The ultraviolet radiation from the sun is a carcinogen," says UCI Health dermatologist Natasha Mesinkovska, MD, PhD. "We need to treat it as such and take precautions.”
That’s especially true in sunny Southern California, she says.
"I can almost always tell when a patient is from this area or is a transplant by the condition of their skin. There is just no escaping the sun here. While it's the very reason many move out here to begin with, it also brings with it higher risks."
Recognizing skin cancer
Skin cancer is the most common cancer in the United States, says the American Academy of Dermatology, and one in five Americans will develop it in their lifetime.
There are three predominant types of skin cancer:
- Melanoma, the most dangerous form of skin cancer, accounts for less than 5% of U.S. skin cancer cases but the majority of all skin cancer deaths. It begins when the DNA in a mole or other pigmented tissue is damaged by overexposure to the sun. It develops most frequently on the torso in men and on the legs in women. If caught early, it is very treatable. Left untreated, it can invade other parts of the body and be fatal.
- Squamous cell carcinoma is the second most common form of skin cancer. It often appears as a firm red bump, an abnormal patch of skin, or a sore that bleeds and does not heal. It occurs most commonly on sun-exposed areas such as the back of the hand, scalp, lip and upper portion of the ear. It is highly treatable, but it can metastasize (spread elsewhere in the body).
- Basal cell carcinoma is the most common form of skin cancer, making up about 75% of all U.S. skin cancer cases. Rarely life threatening, it can be disfiguring if allowed to grow unchecked. Basal cell cancer primarily occurs on the face and neck and is characterized by pimples that don’t heal, unyielding red bumps and red, scaly areas that are usually smaller than a pencil eraser. Basal cell carcinoma has a very low rate of metastasis but should be surgically removed.
Prevention is the best protection
Fortunately, there are ways to reduce your risk of getting skin cancer, says Mesinkovska, who also serves as vice chair for clinical research in the UCI School of Medicine's Department of Dermatology. Here are her top three prevention tips:
Get a yearly skin check-up with a dermatologist. “This should be as commonplace as a mammogram, prostate exam or pap smear,” says Mesinkovska. Don't hesitate to have a mole or suspicious spot looked at when it doesn't heal, bleeds for no reason, has irregular borders, is growing or has multiple colors.
"Changing skin spots warrant a closer look,” she says. “Some people are almost apologetic when they come in but I tell them that there is no such thing as a silly question about a changing spot. I can't tell you how many lives are saved because people come in for a 'silly' reason."
Family members should give each other periodic skin inspections. "I often say — wives save lives,” says Mesinkovska. “In my experience, your partner is most likely to notice skin lesions. You should listen when they insist on getting something checked out." Use the American Academy of Dermatology guidelines to help identify dangerous spots.
If you have dark skin, don’t assume you are immune from skin cancer. Melanomas can appear on the bottom of the foot or other places where skin pigment and sun exposure are low.
"We classify skin types into six categories, from the freckled complexion of redheaded people with light eyes, to the deepest dark skin tones," Mesinkovska explains. “We see the most skin cancers in type 1 and 2 (light skin), but the risk is still there across the board.”
Don’t wait if you have a suspicious lesion. “Time is of the essence with certain kinds of cancers, so see a dermatologist right away,” Mesinkovska says. “If the appointment scheduler gives you an appointment weeks or months away, explain that you have a suspicious lesion and you need to be on the cancellation list or squeezed in sooner.”
Shield your skin
"Of course, we want to enjoy the beauty of California including surfing, swimming and playing outdoors,” says Mesinkovska. “The key is to try to avoid the sun during peak hours (10 a.m. to 4 p.m.) as much as possible and go out with the right protection."
Here are her best recommendations for safer sun exposure:
- Cover up. It may not be what people want to hear, but particularly if you have fair skin and fair eyes, wearing clothing that covers the skin — long sleeves, long loose pants, a brimmed hat and sunglasses that filter both ultraviolet A and B (UVA and UVB) rays — is the single best thing you can do.
- Wear protective fabrics. Special fabrics that filter out UVA rays are best, but can be expensive. One solution is to choose garments with ultraviolet protection factor (UPF) labels, which assess factors such as fabric weave (tighter is better) to rate how effectively a piece of clothing shields against the sun.
- Use water-resistant sunscreen with a sun protection factor (SPF) of 30 or higher. Apply and reapply frequently, particularly during the peak hours of intense sunshine. Look for the American Academy of Dermatology seal to ensure the SPF and other claims are valid. In September 2021, the U.S. Food and Drug Administration (FDA) stated that paba-aminobenzoic acid (PABA) and trolamine salicylate are no longer recognized as safe and effective for use in sunscreens. Baby formulations are often a good choice because they tend to be free of PABA and less irritating to sensitive skin.
- Protect yourself whether you see the sun or not. Any unprotected exposure adds to your skin cancer risk. Contrary to many people's assumptions, overcast skies and car windows don't protect you from UVA rays. Cover your face and hands with sunscreen when you dress in the morning. Ideally, reapply to your hands after washing them.
With regular skin checks, some advance planning and the right protection, you can reduce your risk of skin cancer while enjoying life in Southern California.