Skin cancer prevention and early detection

An ounce of prevention is truly worth a pound of cure with regard to skin cancer, though it is not always preventable. That said, there are many simple things you can do to lower your risk, such as being safe in the sun, being careful with chemicals at work, testing your well water, eating a healthy diet, and addressing other modifiable risk factors.

Detecting skin cancer as early as possible requires an understanding of the potential signs and symptoms, knowing if you're at greater risk, doing self-skin examinations, and visiting your healthcare provider regularly if recommended.

Lifestyle

There are several everyday things you can do to decrease your risk of skin cancer. While you can't do anything about habits and exposures of the past, taking note of these today—and making related changes—can go a long way.

Choose an Effective Sunscreen

Not all sunscreens on the market are the same, and the products available offer variable protection. Both UVB and UVA rays from the sun can cause the skin damage that can lead to skin cancer. Since 2011, sunscreens that claim to be "broad spectrum" must offer UVA protection, but the degree of protection and length that the coverage lasts can vary widely.

Take time to learn about the ingredients that offer UVA protection and read labels when choosing a product. The Environmental Working Group's Sunscreen Guide provides further assistance for choosing a product, such as information on the risk of allergic reactions and much more.

Finally, once you've selected a product, be sure to use it wisely: Apply it at least 30 minutes before going outside, reapply at least every couple of hours (more if you've sweat a lot or went swimming), and be sure that your sunscreen is not expired.

Stay Safe in the Sun

While using sunscreen is a major part of sun safety, there are many other things you can do that can make a difference. Not only has the incidence of skin cancer increased since sunscreen became available, but some dermatologists are now recommending spending 10 or 15 minutes in the sun before applying sunscreen to boost vitamin D.

In addition, there's no good evidence that sunscreen reduces the risk of melanoma, the kind of skin cancer that causes most deaths from the disease; it's still important to use sunscreen, however.

Other ways to reduce your exposure to UV rays include:

• Avoid mid-day sun (for example, limit time outdoors between 11 a.m. and 2 p.m.; some dermatologists suggest avoiding the sun from 10 a.m. to 4 p.m.)
• Cover up with protective clothing. Tightly woven fabrics are better than loosely woven articles. Dark clothing provides more protection than light, and dry clothing is more effective than wet. Clothing is now available that provides UV protection as well.
• Wear a wide-brimmed hat to protect your face and scalp, as well as sunglasses to protect your eyes and eyelids.
• Sit in the shade and/or use an umbrella.
• Remember that you can still get a sunburn if it is cloudy, and reflections from water, snow, or a sandy beach can increase your risk of a burn.
• Skip the tanning booth altogether.

Eat a Healthy Diet

There have been many studies in recent years looking at the ability of phytochemicals, the biologically active compounds in fruits and vegetables, to reduce the risk of skin cancer—and many of these are promising.

Making an effort to put healthy food in your body may provide additional protection beyond that offered by sunscreen and safe sun exposure alone. While the science is young, most of the nutrients that have been studied are part of an all-around healthy diet that may reduce the risk of many medical conditions, not only skin cancer. In other words, it appears that—to some degree, anyway—you can "eat" your sunscreen.

According to a 2018 review in the International Journal of Molecular Sciences, these phytochemicals appear to have benefits in the battle against both non-melanoma and melanoma skin cancer due to their anticancer effects, and best of all, are widely available and cost-effective.

Some plant-based substances that have shown promise in reducing melanoma risk include:

• Epigallocatechin gallate, found in green tea
• Resveratrol, found in tomatoes and, especially, tomato sauces
• Curcumin, a component of turmeric found in curry dishes and mustard
• Capsaicin, found in red bell peppers and chili peppers
• Genistein, found in chickpeas and many soy products
• Indole-3-carbinol, found in cruciferous vegetables such as broccoli, cauliflower, and cabbage
• Fisetin, found in persimmons, strawberries, kiwi, mangoes, and more
• Proanthocyanidins, found in many berries, pistachios, and baking chocolate
• Silymarin, found in artichokes
• Luteolin, found in spices such as oregano, sage, thyme, and celery seed
• Apigenin, found in parsley, onions, chamomile tea, and wheat grass

Quit Smoking

Smoking may significantly increase the risk of squamous cell carcinomas.

Work Safely With Chemicals

There are a number of chemicals and other substances that can increase the risk of skin cancer, such as coal tar, paraffin, and arsenic.

The first step is to be aware of any chemicals you are working with at home or at work. Read labels and follow safety precautions. Employers are required to provide Material Data Safety Sheets on any chemicals you may have contact with through your employment.

Wearing gloves is important, whether or not it is recommended on a label. Your skin is permeable and can both develop cancer itself and allow the introduction of carcinogens into your body, which may cause other concerns.

Testing

Getting tests done on your environment and yourself can give you additional insight into ways you can work to prevent skin cancer.

Water

Unlike municipal water systems, water from private wells does not undergo mandatory testing and could be contaminated by arsenic.

That said, scientists are re-thinking the previously tolerated level of arsenic in public water systems due to findings in a 2015 study that suggest that arsenic in drinking water may be linked to skin cancer even when the levels fall in the acceptable range.

Vitamin D Levels

Remember, sun protection is important—period. However, skin cancer can and does develop in non-sun-exposed regions of the body, and avoiding the sun completely can lead to vitamin D deficiency, which is associated not only with an increased risk of skin cancer, but many other cancers as well.

The data on using vitamin D as a cancer prevention strategy is inconclusive. That said, particularly if you are lacking, it cannot hurt to add it to the other, more proven prevention strategies you are employing.

It can be hard to get enough vitamin D through diet alone, and historically, limited sun exposure has been the primary method of getting this important vitamin (vitamin D is produced in the skin via exposure to sunlight and functions more like a hormone in the body than a vitamin).

Fortunately, a simple blood test can tell you whether your level is normal or not (the majority of Americans are deficient), and your healthcare provider can talk to you about ways to raise your level if it is too low. Be sure to ask for the number associated with your vitamin D level when you have it tested.

The normal range of vitamin D, per the Mayo Clinic, is 30 to 80, but some researchers feel that a number of 50 or higher is better for cancer prevention purposes.

If you do supplement vitamin D, know that taking too much can lead to painful kidney stones.

Skin Checks

The prognosis of skin cancer, in general, is far better than with some other cancers. Part of the reason for this is that these cancers can be seen and are therefore detected at an earlier, more curable stage. This, of course, means that it's important to check your skin frequently.

While healthcare providers may have a trained eye, not everyone sees a dermatologist regularly, and nobody is as motivated as you are to take care of your health. Since people of all races, skin colors, and ages can get skin cancer, it's a good idea for everyone to examine their skin on a regular basis.

Guidelines for doing self-skin checks vary by organization.

The American Cancer Society, the Skin Care Foundation, and the American Academy of Dermatology recommend monthly skin self-examinations.

How to Perform a Skin Self-Check

Checking your skin is easy, quick, and decidedly low-tech. All you need is a full-length mirror, a handheld mirror, a comb, and a bright light. As you look at each part of your body, learn the pattern, location, and size of blemishes on your skin so that you can quickly detect any changes that occur.

Keep in mind that potentially cancerous growths may appear anywhere, even in areas not typically exposed to the sun, and that some skin cancers are not caused by the sun at all.

Here are the steps to follow:

1. After a shower or bath, examine your head and face, using both mirrors for hard-to-see areas. Use a comb to separate your hair so you can check your scalp. Don’t forget your ears, under your chin, and your neck.
2. Examine the tops and bottoms of your hands, including your fingernails and in between your fingers.
3. Examine your forearms, upper arms, underarms, chest, and belly. Women will need to check the skin under their breasts.
4. Sit down and check your thighs, shins, tops and bottoms of your feet, in between your toes, and toenails.
5. With the hand-held mirror, check your calves and the backs of your thighs, lower back, buttocks and genital area, upper back, and back of your neck. Be as thorough as possible.

A partner can also help with this, if willing.

Screening

There are no unanimous guidelines on how often people should see their primary care healthcare provider or a dermatologist for a formal skin check, with a few exceptions:

The American Academy of Dermatology recommends a regular examination by a healthcare provider for people older than age 50, for those who have dysplastic nevus syndrome, and for those who have had multiple melanomas.

Ask your healthcare provider what schedule he recommends based on your specific risk factors.

Skin Cancer Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Man

Those who are at an average risk can ask their primary care healthcare provider to do a total cutaneous exam (TCE) during annual physicals. Ophthalmologists, gynecologists, and even dentists can also check your skin during their respective examinations.

For those who have significant risk factors, regular visits with a dermatologist seem to be wise. A 2016 review found that the sensitivity (how likely they were to find cancer) and specificity (the ability to correctly know who doesn't have cancer) in detecting melanoma were both somewhat higher for dermatologists than for primary care healthcare providers.

If you are unable to examine your skin adequately and/or see a healthcare provider, consider seeking out free exams available nationwide. To find one, use the American Academy of Dermatology (AAD)'s "SPOTme" skin cancer screening database. An exam lasts only about 10 minutes and involves no blood work or other invasive procedures. Since 1985, AAD has conducted almost 2 million screenings and has detected more than 180,000 suspicious lesions.

If AAD does not have a program in your area, the Skin Cancer Foundation sponsors a traveling RV that stops periodically at participating Rite Aid stores and other locations in 50 cities nationwide. Just show up and a local board-certified dermatologist will conduct a full-body screening exam at no cost to you.

Preventive Treatments

Getting treatment for conditions that can lead to skin cancer or that can help you get ahead of elevated risk can be an essential part of a prevention strategy for some people.

Precancerous Skin Lesions

There are some skin conditions that are considered precancerous, such as actinic keratoses. Seeking treatment for these may reduce your chance that they will progress to cancer. Actinic keratoses can be treated in a number of ways, ranging from cryosurgery (freezing them) to curettage (scraping them) to prescription creams.

Chemoprevention

For people who have a significantly elevated risk of developing skin cancer, medications may be considered. Accutane (isotretinoin) and Soriatane (acitretin) have been found to decrease the number of basal cell carcinomas in people with basal cell nevus syndrome and xeroderma pigmentosum. Erivedge (vismodegib) also appears to be effective. Accutane can also reduce the incidence of squamous cell carcinomas in people with xeroderma pigmentosum.

Frequently Asked Questions

Do I need sunscreen with UVB or UVA protection to prevent skin cancer?

Your sunscreen should have both. This is called broad spectrum sunscreen. You need protection from ultraviolet B waves that burn the skin and ultraviolet A waves that prematurely age skin and damage DNA. Both sources of UV radiation increase your risk of skin cancer.

What’s considered early detection when diagnosing melanoma?

There is no official definition of early detection for skin cancer, but finding cancer before it has spread is an important factor in successfully treating it. By stage 3, melanoma has already reached the lymph nodes and the chances of successful treatment are lower.

Should I avoid going outside in the summer to limit the risk of skin cancer?

Being outdoors provides many health benefits and should be part of a healthy lifestyle that reduces overall cancer risk. To reduce the possibility of skin cancer, though, use a broad spectrum sunscreen with an SPF of at least 15; reapply it if you’re outdoors for an extended time and wear protective clothing including a hat.