FAQs links between sun, skin cancer and ageing

When it comes to the links between sun, skin cancer and ageing, there’s so much confusion and misinformation that the temptation is to hide our heads in the sand (while leaving the rest of the body to fry). Below is a list of frequently asked questions about the sun’s impact on skin, answered not by cosmetic companies or tanning parlour owners, but five leading medical experts in this field, all from the United Kingdom.

We hear UVA and UVB rays mentioned a lot by suncare companies – what do these terms actually mean?
Dr Rogers: ‘It’s all sunshine, but bright sunlight has different kinds of ultraviolet radiation – UVA and UVB. The easy way to remember what they do is that UVB causes burning – UVBurn – and UVA may be linked with ageing – UVAgeing. It’s very important to have protection from both kinds of rays.’

So, what’s my best protection against skin cancer?
Professor Smith: ‘A lifestyle of safe sun avoidance. I’m not a killjoy: it doesn’t mean you can’t enjoy being outdoors – but it means adopting a more ‘Mediterranean’ lifestyle. If you go to the Med, the locals all have a snooze at lunch time and avoid the peak “danger” hours in the middle of the day.’

But if I wear a sun cream, I’m safe, aren’t I?
Dr Simmons: ‘No. The worry with sun screens is that they can lull you into a false sense of security, making you feel that you can stay out much longer than you should. In the old days, when you stayed too long in the sun, you just went red – and that was a sign to head indoors. These days, because sun screens allow people to stay out in the sun much longer, there is a concern that they may be exposing them to higher levels of UVA radiation. Remember, sun screens are not total blocks: they still allow some UV through.’
Professor Brown: ‘Tanning lotions are protecting you from burning, but not from the dangerous genetic changes in the skin that occur after sun exposure. And many sun screens won’t do much to protect you against ageing. So you have to practice “safe sun” in other ways, as well.’

Why are certain skin colours more vulnerable?
Professor Brown: ‘The paler your skin is naturally, the less melanin there is in it. Melanin is your natural protection against the damage caused by sunlight. The less of it you have, the more careful you have to be.’
Professor Smith: ‘But if you have a Mediterranean skin that tans easily, you can still get skin cancer. If you have black skin, though, you won’t.’

Are some parts of the body more at risk?
Professor Brown: ‘For men, the neck and back are usually a problem. For women, it’s often the legs. For non-melanoma skin cancer, the lower lip can be vulnerable, so a protective lip sun screen is a must. If you have moles, it’s important to keep an eye on them.’
Dr Newton-Bishop: ‘Or ask other people around you to keep an eye on areas that you can’t see easily, such as the back or the back of your legs. You can ask a beautician or chiropodist to be on the alert for anything unusual; if malignant melanoma is caught early, it’s highly curable. But if it’s ignored – or goes undiscovered – it can be fatal.’

When choosing a sun screen, what should I be looking for?
Dr Rogers: ‘The most important question to ask is: does this sun screen offer “broad spectrum UVA/UVB protection”? That means that it screens out both the burning UVB rays, and the ageing UVA rays. In the past, many sun screens only offered a very low level of UVA protection, but fortunately that’s changing.’
Dr Newton-Bishop: ‘There are two kinds of sun block available. One is the reflective type, which is also known as a “physical” block; this contains minerals which bounce back light to stop the UV hitting your skin. The other type is a chemical sun screen, which works by absorbing the UV light and preventing it entering the skin, where it can cause damage. If you have sensitive skin, the reflective sun blocks can be better, as the chemicals in high-factor sun screens can irritate when they interact with the sun. A lot of people who think they have a heat rash are actually allergic to their sun screen.’

Isn’t a higher number even better?
Dr Simmons: ‘SPF15 gives you a good level of protection. And actually, the higher numbers can be misleading: once you get above SPF15, the numbers aren’t truly representative of how much more powerful they are. In fact, they are only a little more powerful than an SPF15 – which is why, in Australia, products with higher factors are labelled SPF15+, and there’s nothing on the market above that. There was a feeling that the consumer would be pressurised into buying the strongest sun screen because of the worries about melanoma, whereas scientifically, there is no evidence that high factors make a difference. And a higher figure just lulls you into a false sense of security and encourages you to stay out longer than you should.’

But if I choose an SPF15, isn’t it true that I can stay out 15 times longer than if I left my skin unprotected?
Dr Simmons: ‘In theory, yes, but my advice is to head for the shade long before that. For anyone who goes in the sun, creams are still a good insurance policy – but they aren’t the only protection you should be looking at. If you are vulnerable to burning easily without protection, it’s foolish to push your cream’s SPF to the limit.’

Supposing I am wearing an SPF15 – and have pushed it to the limit. Can I slap on more and get extra protection?
Dr Newton-Bishop: ‘No, that’s a complete misconception. You must get out of the sun then, or you risk a real burn. You’ve truly reached your Waterloo, exposure-wise.’

Why do I have to reapply sun screen?
Professor Smith: ‘The sun actually breaks down some of the protective ingredients in suncare. So your sun cream may be SPF15 when you put it on – but that dwindles. So you must keep reapplying, preferably every hour – or more often if you’re swimming, playing sports or playing with your children.’

When’s the best time to apply sun screen?
Dr Simmons: ‘If you’re pale or freckled, put it on before you go out in the morning, and reapply frequently.’

Should I be rubbing it into my skin to get the best results?
Professor Brown: ‘The key is to apply it liberally – an ounce is needed to cover the whole adult body – and not to rub it in too hard.’

What time of year should we be wearing sun screen?
Professor Smith: ‘April to October in the UK and anywhere further north. All year round if you’re going to the Mediterranean or anywhere nearer the Equator.’
Dr Simmons: ‘But if you go walking in Scotland in spring and it’s a clear, sunny day, you can still get burned, so use your common sense. If it’s bright and you’re out in the sun, wear sun screen. Or look for a day cream or a foundation with an SPF15.’
Professor Brown: ‘Don’t forget, it doesn’t matter where you got your sunburn – Brighton or Bangkok – it’s still dangerous.’
Dr Rogers: ‘And if you’re abroad, don’t be deceived by the fact that it’s cloudy. On a cloudy day in London in midwinter you don’t need a sun screen. On a cloudy day in the South of France in midwinter – or anywhere closer to the Equator than that, or in a mountainous area such as the Alps, where the air is thinner – you do.’

Why is it so important to protect children?
Dr Simmons: ‘There is convincing evidence that malignant melanoma is linked with sun exposure – and sunburn – in childhood.’
Dr Newton-Bishop: ‘Not only that, but childhood exposure is also a factor in other forms of skin cancer. And exposure in your childhood and teens is going to have an impact in how many wrinkles you have at 40. Which is something teenagers ought to think about.’

So if the damage was done when I was young, isn’t it too late to do anything?
Professor Brown: ‘I think you have to be vigilant throughout life, rather than sit back and say, “Oh well, the damage is done, I might as well go on spit-roasting myself.” It’s never too late.’
Dr Rogers: ‘There is some evidence, for instance, that you can still benefit from reducing sun exposure in later life. With patients in Australia who have what’s called actinic keratoses – pre-cancerous skin lesions – it’s been observed that changing their behavioural sun exposure actually reduces these lesions, even at a relatively late stage. So because the other, non-melanoma forms of skin cancer are linked with cumulative sun exposure, that’s a very good reason to change your lifestyle.’

What kind of clothing are most protective?
Professor Brown: ‘When it comes to hats, the bigger, the better, with a tight weave rather than a loose straw weave.’
Dr Simmons: ‘A thin chiffon beach shirt isn’t enough to give you protection. Clothing should be a tight weave that won’t let UV through – a standard cotton T-shirt is good. But if you go to a hot country with children, keep them covered if possible; little Lycra sunsuits are brilliant – then you only have to apply cream to the forearms and lower legs. And the French legionnaire-style hats – which cover the vulnerable neck area – are fantastic.’

There was some publicity recently that sun screens may actually cause cancer. Should we be worried?
Dr Newton-Bishop: ‘This was based on research into melanoma in the last ten years – and looked at sun screens that had been used in the preceding 20 years. In those days, the priority was getting a deep, mahogany tan – and suncare was formulated to facilitate tanning, not to protect. The real culprit is the sun itself – so that’s why we have to devise ways of protecting ourselves from it.’

Is sun exposure the only risk factor for melanoma?
Dr Rogers: ‘No. Just as someone who never smoked can get lung cancer, so somebody who didn’t get much sun exposure can get malignant melanoma. But the sun is the most important environmental risk factor identified to date for both melanoma and non-melanoma skin cancers.’

Would I be safer on a sun bed?
Professor Brown: ‘My advise would be to avoid sun beds totally.’
Dr Rogers: ‘We don’t yet have concrete evidence that sun beds cause skin cancer – because we just don’t know the long-term effects of large doses of UVA exposure. But there is an impression – from some patients who’ve developed skin cancer – that there’s a link with sun beds. I’d draw an analogy with cigarettes: even though doctors had noticed a higher rate of lung cancer in smokers long before the 1950s, it wasn’t until then that they could prove it with epidemiological studies. It may be a long time before we can link sun beds with skin cancer for certain, but my advise is better safe than sorry.’

Is there anything I can do to minimise the damage if I accidentally OD on UV?
Dr Simmons: ‘Moisturise, moisturise, moisturise. Whatever you do, you’ve killed that layer of cells – and they’re going to drop off. But moisturising the skin will make sure that the new replacement layers of skin are nice and moist. At the moment, that’s the best you can do. But there’s some very exciting work going on in the labs with vitamin A and vitamin E, and how they may affect repair of UV-irradiated skin – so I think that within the next five years, we’ll see creams that can slow down the damage that’s been done.’

So if I still don’t think pale can be interesting and want to go brown, what’s my best bet?
Dr Newton-Bishop: ‘I’d rather people were happy with their natural skin colour – but if you find it really hard to give up the idea that brown is beautiful, then a fake tan is the only safe option. So long as you remember that fake tan offers absolutely no protection at all, and you need to wear your SPF15 when you go outdoors.’

What would be your ultimate safe sun message?
Dr Simmons: ‘Think of safe sun as a lifestyle: a mix of shade, clothing and sun screen.’
Dr Newton-Bishop: ‘If you care about ageing and you want to protect against skin cancer, keep out of the sun in the middle of the day; wear clothing and a big hat – and see sun screens as being useful, but not number one on the list. Above all, aim to reduce your overall sun exposure.’
Professor Smith: ‘I’d like to see safe sun advice on the agenda with the facts of life. Actually, I think the United Kingdom should follow the example of the Australians, with their “Slip, Slap, Slop” campaign: slip on a T-shirt, slap on a hat and slop on some sun screen. And bring back the siesta, if you don’t want to be a wrinklie in middle age.’
Professor Brown: ‘Don’t be frightened into not going out at all – but be wise and think like the Latin people: avoid the strongest sunshine in the middle of the day, use your head and put a hat on it. Wear a sun screen of SPF15 – and never spit-roast. Wear your sunglasses. And go to your GP if you see any suspicious changes in your skin. Believe me, I would far rather see a healthy patient ten times for something that’s nothing rather than one patient with melanoma.’
Dr Rogers: ‘You can still go on holiday and have a great time. But if you’re going to the beach or pool, make sure you avoid the peak sun hours of 11am to 3pm. If you’re swimming or snorkelling, put a T-shirt on – and wear a hat at all times. Above all, get away from the idea that you can just get to the beach, strip off and your sun screen will do the rest. A sun screen is useful – but it’s only part of the picture. And remember: there’s no such thing as a safe tan.’