Summer Is Fun, But Don't Get Burned!

Hello summer! It’s that exhilarating time of the year when our hearts are open to the long days and endless possibilities and the sun warms our hearts, our spirits and our skin. Are you shedding your clothes and heading to the pool, a lake or a river to cool off? When summer is in full force, unfortunately so is the UV radiation from our brilliant sun. It is often hard to think about the potential damage we can get from this bright radiant light, but protecting your skin (and your children’s skin) is an important part to consider while you are basking in the joys of summer fun. I wrote a newsletter three years ago briefly discussing skin cancer, but I wanted to give this subject more attention now since skin cancer rates are on the rise. I also realized that many of my patients don’t know the signs to look for on their skin with regards to the different types of skin cancer. If you are concerned about aging wrinkling skin, you want to learn more about the signs of skin cancer and how you can protect yourself from the sun’s damaging UV rays, I have written this newsletter for you. I hope after today you will feel more educated and learn better ways to protect yourself and why you should always avoid traditional sunscreens! Skin Cancer Statistics

Skin cancer is the most common cancer in the United States
Current estimates are that 1 in 5 Americans will develop skin cancer in their lifetime
It is estimated that approximately 9,500 people in the U.S. are diagnosed with skin cancer every day
More than 2 people die of skin cancer in the U.S. every hour
More than 1 million Americans are living with melanoma
When detected early, the nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), affects more than 3 million Americans a year and women have a greater incidence than men for both types of NMSC
About 90 percent of NMSC are associated with exposure to ultraviolet (UV) radiation from the sun and most sunburns are associated with UVB exposure
Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by about 40 percent

Aging Skin Statistics

An estimated 90 percent of aging & wrinkled skin is caused by the sun
People who use sunscreen with an SPF of 15 or higher daily show 24 percent less skin aging than those who do not use sunscreen daily
Sun damage is cumulative as evident by only 23 percent of lifetime exposure occurs by age 18
UVA is associated with aging skin

Our skin structure and what happens when it gets damaged The skin is made up of three main layers: the hypodermis, the dermis and the epidermis. The hypodermis is the deepest section of skin, and is primarily a place of connection and fat storage. The dermis contains most of the connective tissues of the skin, as well as nerve endings, sweat glands, and hair follicles. The primary function of the epidermis is to provide a weather and water-proof layer to protect the body. The epidermis is made up mostly of keratinocytes, but also contains melanocytes (which produce melanin), Merkel cells, and Langerhans cells. The epidermis that has melanin pigment can block UV radiation from damaging DNA. We have DNA repair enzymes designed to prevent cancers, but there are factors as to why this system doesn’t do its job properly. For one, certain people are lacking the genes for these necessary enzymes and therefore they have higher rates of skin cancer as a result. Environmental insults are another reason (exposure to sun and sun burns) and the exposure and damage can be too high to repair the cells. These insults coupled with low anti-oxidant status and a poor immune system can lead to cancer. UV exposure wreaks a lot of its havoc on the skin by generating free radicals, which are unstable oxygen molecules with an uneven number of electrons. In their search for stability, they steal electrons and ultimately damage body cells, proteins and your skin’s DNA. UVB radiation also induces mutation of the p53 suppressor gene and these mutations allow a proliferation of abnormal cells and this can lead to cancers, especially SCC. 4 Main types of Skin Cancer and how to identify them Basal cell carcinoma (BCC) is the most common form of skin cancer. An estimated 3.6 million cases of BCC are diagnosed in the U.S. each year. One of three main types of cells in the top layer of the skin are basal cells. When the basal cells in the outermost layer of the skin (epidermis) gets damaged, it creates uncontrolled growth of cells. BCC can occur when DNA gets damaged from exposure to UV radiation from the sun or indoor tanning but 1/3 of all BCC occur in areas of the skin that receive little or no UV radiation so you can find them in all areas of the body, however we typically find them on the face and chest. What do BCCs look like?

Open sores that don’t heal
Shiny bump or nodule that has grown (not a fleshy mole you’ve always had that is unchanged)
Red, irritated patch
Scar-like area that is flat white, yellow or waxy in color. It can look like there is a halo around a spot.
Skin growth with elevated edges and an indentation in the center, can be crusty or smooth

At times, BCCs may ooze, crust, itch or bleed. In patients with darker skin, about half of BCCs are pigmented (meaning brown in color). While BCCs rarely spread beyond the original tumor site “metastasis” yet if allowed to grow, these lesions become locally invasive, grow wide and deep into the skin and destroy skin, which is disfiguring and even penetrate to the bone and the brain, which is dangerous. Squamous cell carcinoma (SCC) is the second most common form of skin cancer. An estimated 1.8 million cases of SCC are diagnosed in the U.S. each year. One of three main types of cells in the top layer of the skin (the epidermis), squamous cells are flat cells located near the surface of the skin that shed continuously as new one’s form. SCC mostly occur in UVB damaged areas of the skin such as the head, lips, neck, ears and hands. However, if there is oxidative stress to the body the squamous cells can get affected and therefore the cancer can be found on non-sun exposed skin, similar to BCC. Risk factors are sunburns as a child, radiation, light skin, hazel or blue eyes and blonde or red hair. What do SCCs look like?

SCCs can appear as scaly red patches, open sores, rough, thickened or wart-like skin, or raised growths with a central depression
At times, SCCs may crust over, itch or bleed

Like BCC it is rare that SCC is fatal, however if allowed to grow these lesions can spread to other parts of the body “metastasize” and become invasive and grow into deeper layers of the skin as well, which can result in disfigurement and can be dangerous to organs. Melanoma

Most people have heard about the dangers of Melanoma and what to look for but it is worth mentioning again that Melanoma is a serious form of skin cancer that begins in the cells known as the melanocytes. Melanoma can spread to other organs rapidly if not caught and treated in the early stages. Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes in the melanocytes, resulting in uncontrolled cellular growth. Melanoma can arise from an existing mole or appear as a new lesion Unlike BCC, Melanoma can occur nearly anywhere on the body Fair skinned people are more at risk of developing Melanoma What does Melanoma look like? Look for anything new, changing or unusual anywhere on your body. We always look for something out of the ordinary and doesn’t match the rest of your moles. Melanoma can present in the nails and even the palms of hands or feet.

A is for Asymmetry. Most melanomas are asymmetrical.
B is for Border. Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.
C is for Color. Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colors red, white or blue may also appear. Rare melanomas are colorless
D is for Diameter or Dark. While it’s ideal to detect a melanoma when it is small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 mm, or ¼ inch in diameter) or larger.
E is for Evolving. Any change in size, shape, color or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching or crusting.

Merkel Cell Carcinoma (MCC)

Less known than Melanoma is Merkel cell carcinoma, which is a rare and aggressive form of skin cancer and is about 3-5x deadlier than Melanoma. Merkel cells are located deep in the top layer of skin. Merkel cells are connected to nerves, signaling touch sensation as “touch receptors.” They are usually located on sun-exposed areas such as the head, neck and eyelids but like Melanoma, they can also appear anywhere on the body. About 5 percent of MCCs occur in the mucosal sites such as the mouth, nasal cavity and throat. Risk factors are also fair skinned people with excessive sun exposure but it’s usually diagnosed over age of 50, when someone has a weakened immune system. What does Merkel Cell Carcinoma look like?

Painless shiny or pearly lesions or nodules
It can appear as a pearly pimple-like lump, red, purple or bluish-red
Dimensions vary but average size at detection is about 1.7cm (dime sized)
They are often misdiagnosed as cysts or infected hair follicles

Prevention & Screening for skin cancers

Get annual screens from a Dermatologist (some clinics have a free screening event periodically)
Don’t use tanning beds
Avoid getting a sun burn! To do this, avoid being outside in the direct sun between 10am-4pm or “peak hours”
Wear a wide brimmed hat and UV protected sun glasses and consider UV protective clothing
Find as much shade as you can but to get the benefits of Vitamin D, allow 15 min of unprotected sun to arms/legs only (slightly pink response) and then cover with sunscreen
Apply mineral based sunscreen 30 SPF rating every 2 hours and always protect your face, chest, scalp with sunscreen
Rub the sunscreen in one direction to avoid the white pasty appearance known to be associated with mineral sunscreen lotions

Sunscreen Chemical alert! The good, the bad and why you should always read labels! Only two ingredients, zinc oxide and titanium dioxide, which are minerals, are classified as safe and effective based on current data. Unfortunately, most traditional sunscreens are full of chemicals, such as homosalate, octocrylene, octisalate, avobenzone and oxybezoneand, which are considered endocrine disruptors. Benzene or listed as Oxybenzone is one of the worst ingredients and besides it being highly penetrable into the skin, it is also considered carcinogenic and is an ingredient in many sunscreens. Considering our skin is the largest organ of our body and if we are already getting oxidative DNA damage from UV rays when in the sun, no wonder our level of skin cancer has been rising over the years, as well as hormonal cancers. See link below from EWG.org to learn more and find safe alternative sunscreens, like Badger Organic or Think Sport (I use the Everyday Naturally tinted Face Sunscreen for my face every day!) https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-chemicals/ The sunscreens are also ruining our coral reefs and aquatic life, but luckily there is some movement in states like Hawaii, Key West, Bonaire, Republic of Palau to ban chemical sunscreens to protect the oceans. Mineral sunscreen work by sitting on top of your skin and act like a mirror to reflect the UV rays right away. Because of this, they tend to be more “whitening” so again, applying by rubbing in one direction helps minimize this look. If you get a sunburn what should you do?

Apply Aloe Vera
Apply CBD topical or pills by mouth to reduce inflammation
Take Vitamin D 100,000 iu x2 days (or get an IM injection at BIH)
Receive an IV Vitamin C 15-20 grams with 1 liter of fluid at BIH asap!

Nutrients to protect against skin cancer

Because skin cancer is associated with a suppressed immunity and increased inflammation, take anything that will support your immunity and help protect you against cancer, especially anti-oxidants. Antioxidants will help fight off free radicals and prevent the damage that causes skin cancer and a few of the most important ones are; Vitamin C, D, E (mixed tocopherol high gamma), Zinc, Selenium, Alpha Lipoic Acid, Glutathione and Resveratrol. Polyphenols are excellent antioxidants and are found fruits, veggies, oils, spices and teas. Green tea has a high amount of Polyphenols and has anti-inflammatory and tumor–inhibiting properties, which can repair damaged DNA (drink 4-6 cups of freshly brewed daily). Diets high in beta carotene rich foods such as carrots and other orange colored foods may also reduce cancer risk. A study revealed that Nicotinamide B3 (NAD) reduces the rate of new skin cancers by 23 % in patients with history of lesions, which is not surprising since NAD is a major player in DNA repair (as previously mentioned in the NAD newsletter about the powerful benefits of NAD). I hope that you are now more informed about our potent sun and with this knowledge you can feel less fearful and still get out an enjoy these glorious summer days! Yours in health and wellness, Carrie Ballas Resources https://www.aad.org/media/stats-skin-cancer (read for more detailed statistics ) https://www.mayoclinic.org/tests-procedures/mohs-surgery/about/pac-20385222 (Mohs surgery) https://pubmed.ncbi.nlm.nih.gov/8228329/ (melanin and UV damage) https://pubmed.ncbi.nlm.nih.gov/25738852/ (DNA repair enzymes and skin cancer) https://www.nature.com/scitable/topicpage/dna-damage-repair-mechanisms-for-maintaining-dna-344/ (DNA Damage & Repair) https://pubmed.ncbi.nlm.nih.gov/18348455/ (UV damage and DNA repair in cancer) https://www.aimatmelanoma.org/melanoma-101/understanding-melanoma/melanoma-risk-factors/weakened-immune-system/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4570055/ (NAD and skin cancer) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077767/ https://academic.oup.com/jn/article/135/12/2871/4669980 (green tea and skin cancer) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774988/ (tea polyphenols and skin cancer) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060966/ (Resveratrol and skin cancer) Research on Sunscreens https://www.medscape.com/viewarticle/952106?src=WNL_trdalrt_210602_MSCPEDIT&uac=140967BK&impID=3415171&faf=1 https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-chemicals/ https://gothink.com/ https://www.badgerbalm.com/