The Skin Cancer Foundation Journal

MAY 2015

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

Issue link: http://skincancer.epubxp.com/i/526209

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This is what I tell my patients when they ask me, "Do I have to wear sunscreen even when I'm out for just a few minutes?" While a minute amount of the sun's ultraviolet (UV) light is not going to cause skin cancer, when you add up all the minor exposures, they take their toll over time. This is true even when you are working inside by a window or driv- ing in your car. Did you know that the sun's ultraviolet A rays go right through window glass? [See Figure 1]. This is one reason why long-dis- tance drivers and pilots have an increased risk of skin cancer. In addi- tion, pilots regularly work high in the atmosphere, where the thinner stratospheric ozone offers less UV protection, and their windshields do not adequately protect them from the sun's UVA radiation. Airline pilots are exposed to the same amount of UV rays during a one-hour flight that they would be during 20 minutes in a tanning bed, accord- ing to a recent study from the University of California, San Francisco. 1 Many of my patients who are pilots were unaware of these facts until they already had skin cancer; they thought the cockpit protected them. Such misconceptions about the dangers of exposure to UV abound. UV PRIMER Two types of UV light reach Earth: A and B. UVB is the so-called "burning," shortwave ray that most of us associate with UV. It is stron- gest in summer and between the hours of 10AM and 2PM (though you can still sunburn at 4 PM!). The longer-wave ray, UVA, however, is a culprit most people aren't aware of. Until recently, the scientific community thought it was just a temporary tanning ray and aging ray. 2 It turns out that UVA penetrates deeper into the skin than UVB, and significantly increases the risk of melanoma and other skin cancers. 3 SUNSCREEN AND THE UVA RACE Unfortunately, many sunscreens filter out UVB quite well but fall short with UVA. Thus, people who stay out in the sun longer because their sunscreen staves off sunburn often may only be soaking up more UVA rays. European countries are ahead of us in sunscreen development. They created the designation "UPF," for "universal (or "ultraviolet") protection factor," signifying the product's combination of UVA and UVB protection, whereas our "SPF," for "Sun Protection Factor," has traditionally measured only UVB protection. In recent years, several sunscreen ingredients offering much-improved UVA protection have been approved in Europe, while in the US, possibly due to overzealous safety concerns, the FDA has not approved a single individual new sunscreen ingredient since the year 2000. (Ecamsule, or Mexoryl SX, though not FDA-approved as an individual ingredient, was given approval by the FDA in 2006 to be used in the US only in ecamsule- containing sunscreens registered under a New Drug Application.) All told, seven individual UVA ingredients are approved in Europe, vs. only three in the US. 4 In June of 2011 the FDA announced new rules changing sunscreen labeling in the US. Sunscreens with effective UVA- and UVB-filtering agents are now labeled "broad-spectrum," and those broad-spec- trum sunscreens that also achieve an SPF of 15 or greater are allowed to state on the label that they help prevent skin cancer and premature aging. This has helped the public become aware of the importance of UVA protection and choose sunscreens more wisely. Yet critics note that in the US, UVA protection even in broad-spectrum sunscreens could stand considerable improvement. Now, FDA approval of superior UVA-filtering ingredients could be coming closer. The Sunscreen Innovation Act (SIA) was passed into law by Congress on Sept 14, 2014, stepping up the approval process by mandating that the FDA rule on new ingredient applications within six months. The hope is to fast-track approval of over-the-counter prod- ucts with superior UVA protection that are already proven safe and ef- fective and in wide use overseas, including Tinosorb A and B, Mexoryl and Mexoryl SR. With this new law, companies can petition directly to the Secretary of Health and Human Services, which then must oversee the FDA's receipt, timetable of analysis and solicitation of further re- search. 5 Unfortunately, the FDA recently demanded further research on all new UVA ingredients submitted to it for approval. YOU CAN FIND GOOD UVA PROTECTION While FDA approval of new sunscreen ingredients is urgently needed, it is by no means impossible to find good broad-spectrum protection in the US. First, make sure your sunscreen is SPF 15 or higher (30 or higher is even better!), which guarantees effective UVB protection. Second, look for sunscreens containing zinc oxide or Figure 1: Unilateral Dermatoheliosis Left side of the face of a man who drove a truck for many years but never wore sunscreen. People who regularly drive long distances suffer significantly more sun damage on the side of their face closest to their side window. 37

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