“There are many confounding factors that alter cancer rates, like an aging population (cancer risk increases with age), better detection of melanoma, commercial interests promoting tanning beds, message fatigue (“it can’t happen to me”), changing population demographics, and so on,” says Dr. Ian Hamann, one of Australia’s leading dermatologists. “The mortality rates for melanoma are staggering. More people are diagnosed with skin cancer each year in the US than all other cancers combined.
We know that skin cancer’s direct cause is the sun’s ultraviolet rays, and we know the many preventative measure we can take - so why are mortality rates still on the rise?
In recognition of Skin Cancer Awareness Month, GSB sat down for a Q&A with Dr. Hamann to get to explore this issue, and to better understand how people can be more vigilant in preventing sun damage and detecting early signs of skin cancer.
In much of western culture, tanned skin is often viewed as healthy, beautiful, and desirable. We glorify sports such as tennis and rugby, with players enduring long hours in the sun, and from a young age we are taught the importance of participating in outdoor activities to maintain a balanced lifestyle. With these lifestyle habits and attitudes towards the sun, it’s easy to forget the hard facts and rules when it comes to skin cancer prevention. Here’s what Dr. Hamann had to say about the issue.
GSB: With so much advertising and information on the leading cause of skin cancer and sun prevention, why do you think it’s still on the rise?
Dr. Hamann: “This is complex. Cancer prevention often requires significant lifestyle changes. In the case of skin cancer, this involves sensible sun protection from childhood throughout life. At the same time we need a certain amount of sunlight to produce vitamin D, which is essential to a healthy body and active mind."
What are measures people can take in preventing skin cancer?
“Being aware of the UV index is crucial, and exercising at times when the index is low. In fact, in winter, there will be days where no sun protection is required.
When the UV index is above 3 you can burn and increase your risk of skin cancer, so it’s important to understand how the UV index works and to always be using this as a guide.
Cover up exposed areas with suitable clothing, use rash vests for swimming, and wear a broad brimmed hat.
"Cover up exposed areas with suitable clothing, use rash vests for swimming, and wear a broad brimmed hat."
Use 50+ SPF broad spectrum sunscreen for areas that can’t be covered, and don’t forget the face even when wearing a hat, because reflection can account for 50% of exposure on the face. However, that’s not to say you should use sunscreen as an excuse for sun baking.
If you have a history of skin cancer, I would recommend taking nicotinamide (vitamin B3) 500mg daily. This has been shown to have a protective role in preventing skin cancer.”
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What are things you should look for when detecting early signs of skin cancer?
“Look for changes. This may mean growth, colour change, bleeding, ulceration or other alteration in a skin lesion or development of a new lesion which is not stable. If you believe you are at risk, or have a bad family history, consult your family doctor or a dermatologist.”
Do you think self-tanning is a safer option?
“Tanning is never an option. Whilst a tan reduces subsequent burning, the process permanently damages your skin cell DNA, promotes the production of cancer cells, and prematurely ages your skin.
‘Sun beds’ are predominantly long wave UV and may have an intensity of up to 50 times natural sunlight. They are believed to have significantly increased the risk of melanoma in young women who regularly tanned in their teens.
Fake tanning creams are a better alternative to the sun, but you need to be mindful of the chemicals in these products and frequent use over a sustained period of time are not recommended.”
What should people look for when choosing a sunscreen? Is a higher SPF better, or is this a myth?
“SPF is important but only refers to UVB protection, not UVA, which is a longer wave length and in greater abundance. UVB produces more burning, but UVA penetrates the skin more deeply and may be more important in melanoma production. UVA is very important in solar aging. Always look for a broad spectrum sunscreen, which protects your skin from UVA. Products that aren’t broad spectrum must carry a warning that they only protect against sunburn, not skin cancer or skin aging.
After an SPF of 30, the increment of extra protection gets smaller with each increase. We recommend 30+ SPF as a minimum, with 50+ SPF as ideal. The FDA requires any sunscreen with SPF below 15 to carry a warning that it only protects against sunburn, not skin cancer or skin ageing. It is more important to put enough sunscreen on to properly cover the exposed skin and to reapply every few hours, or after swimming.”
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What advice would you give to people on how to take better care of their skin?
“The two most important ways to maintain great skin are sun protection and avoiding smoking. Good diet, exercise, hydration, and avoiding excessive alcohol all help. Good cosmeceuticals will enhance your skin’s health, but are not going to significantly rescue sun damaged skin and protect from the toxicity of smoking.”
If you have any concerns about skin cancer spots consult your local GP or see a dermatologist.
Dr. Ian Hamann graduated in medicine with honors from the University of New South Wales in 1979. After completing his residency at St Vincent’s hospital in Sydney he spent 11 years in rural general practice. He soon realized his special interest was in the diagnosis and management of skin cancer through surgery, he then spent another 5 years training to become a specialist dermatologist at the rural Infirmary in Edinburgh and the Royal Prince Alfred hospital in Sydney. In 1998 he commenced practice as a consultant dermatologist, predominantly in rural general practice on the mid north coast of NSW, whilst also working as a consultant dermatologist at Westmead hospital Sydney.