Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

Why is the sun so bad for my skin?

Because the sun's rays, which are called ultraviolet A and ultraviolet B rays (UVA and UVB rays), damage your skin. Normal skin cells grow, divide and replace themselves. This keeps the skin healthy. The sun's rays damage these skin cells. This leads to early wrinkles, skin cancer and other skin problems. Being in the sun often over time, even if you don't burn, can lead to skin cancer. A tan is the body's attempt to protect itself from the sun's harmful rays.

Are tanning beds safer than the sun?

No. Tanning beds use ultraviolet rays. Makers of the beds may claim that they use "harmless" UVA rays. But both UVA and UVB rays cause skin damage. While UVA rays take longer than UVB rays to damage the skin, they go deeper into the skin than UVB rays.

Where is skin cancer most likely to occur?

Most skin cancers occur on parts of the body that are repeatedly exposed to the sun. These areas include the head, neck, face, tips of ears, hands, forearms, shoulders, back, chests of men, and the back and lower legs of women.

What are the risk factors for skin cancer?

A number of things may put you at higher risk of having skin cancer someday.

	Fair skin
	Red or blond hair
	Light-coloured eyes
	Sunburning easily when exposed to the sun
	Having many moles, freckles or birthmarks
	Working or playing outside
	Being in the sun a lot as a child
	Having had a serious sunburn
	Others in your family having had skin cancer
	Trying to get a tan in the sun or with a sunlamp

What does a normal mole look like?

A normal mole is solid tan, brown, dark brown or flesh coloured. Its edges are well defined. It's usually smaller than 5 mm (1/4 inch) in diameter and has a round or oval shape. It should be flat or dome-like.

How can I tell if my mole isn't normal?

The main thing to look for is any change in a mole that you have or the appearance of a new mole. Most normal moles appear by age 30. Any moles that appear after age 30 should be watched carefully and brought to the attention of your family doctor. Skin cancer doesn't have to start around a mole. It can also appear on previously smooth skin. Don't wait for the area to hurt - skin cancer rarely causes pain.

Signs of skin cancer

ABCDE rule

A for Asymmetry: A mole that, when divided in half, doesn't look the same on both sides

B for Border: A mole with edges that are blurry or jagged

C for Colour: Changes in the colour of a mole, including darkening, spread of colour, loss of colour, or the appearance of multiple colours such as blue, red, white, pink, purple or gray

D for Diameter: A mole larger than 5 mm (1/4 inch) in diameter

E for Elevation: A mole that is raised above the skin and has an uneven surface

Other signs include

	A mole that bleeds
	A fast-growing mole
	A scaly or crusted growth on the skin
	A sore that won't heal
	A mole that itches

How can I prevent skin cancer?

The key is to avoid being in the sun or using sunlamps. If you're going to be in the sun for any length of time, wear clothes made from tight-woven cloth so the sun's rays can't get through to your skin, and stay in the shade when you can. Wear a hat to protect your face, neck and ears, as well as sunglasses.
Remember that clouds and water won't protect you - 60% to 80% of the sun's rays can get through clouds and can reach swimmers at least one foot below the surface of the water. Snow, white sands and concrete can reflect the sun's rays and increase sun exposure.

Should I use sunscreen?

Using sunscreen may or may not help lower your risk of skin cancer. Sunscreens may even raise the risk of skin cancer because people may stay in the sun longer if they think they're protected and so end up getting more sun overall. Also, many sunscreens only protect against UVB rays.

If you can't protect yourself by staying out of the sun or wearing the right kind of clothing, you may want to use sunscreen to help protect you. But don't think that you're completely safe from the sun just because you're wearing sunscreen. It's important to wear sunscreen when out in the sun, even in winter.

How should sunscreen be used?

Use sunscreen with a sun protection factor (SPF) of 15 or more, which has both UVA and UVB protection. If you're at a high altitude (such as in the mountains), if you plan to be outside a long time or if you sunburn easily, you may want to use a sunscreen with an SPF that's higher than 15.

Tips on preventing skin cancer

	Avoid the sun, especially from 11 a.m. to 4 p.m., when the sun's rays are the strongest.
	Don't use tanning beds or sunlamps.
	Wear protective clothing and hats.
	Seek shade or make your own shade.
	Use sunscreen with SPF 15 or higher which has both UVA and UVB protection.
	Check your skin yourself regularly for signs of skin cancer.
	If you see an area on your skin that looks unusual, ask your family doctor about it.

Be sure you put the sunscreen everywhere the sun's rays might touch you, including your ears, the back of your neck and bald areas of your scalp. Put more on every hour if you're sweating or swimming.

It's okay to use sunscreen if you're pregnant. Sunscreen isn't recommended for use on babies younger than six months old. If your baby is this young, keep him or her out of the sun. Be very cautious with a baby at the beach, because reflected sunlight from sand and water can burn a baby's tender skin, even in the shade of a beach umbrella.

What's the best way to do a skin self-examination?

The best way is to use a full-length mirror and a hand-held mirror to check every inch of your skin.

1. First, you need to learn where your birthmarks, moles and blemishes are and what they usually look like. Check for anything new, such as a change in the size, texture or colour of a mole, or a sore that doesn't heal.

2. Look at the front and back of your body in the mirror, then raise your arms and look at the left and right sides.

3. Bend your elbows and look carefully at your palms and forearms, including the undersides, and your upper arms.

4. Check the back and front of your legs.

5. Also look between your buttocks and around your genital area.

6. Sit and closely examine your feet, including the bottoms of your feet and the spaces between your toes.

7. Look at your face, neck and scalp. You may want to use a comb or a blow dryer to move hair so that you can see better.

By checking yourself regularly, you'll get familiar with what's normal for you. If you find anything unusual, see your doctor. The earlier skin cancer if found, the better the chance it can be cured.

For more information, contact the Canadian Cancer Society at 1-888-939-3333.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.