A release from the college explains that in the first experiment of its kind, the King’s team assessed the DNA damage in the skin after lowering sunscreen application thickness below 2mg/cm2 – the amount manufacturers use to achieve their SPF rating.

Results showed that sunscreen with a sun protection factor (SPF) of 50, applied in a typical way, would at best provide 40% of the expected protection. The findings have prompted the King’s team to suggest that consumers use a much higher SPF sunscreen than they think necessary, to ensure they’re protected from sun damage.

As part of the research scientists divided a cohort of 16 fair-skinned volunteers into two groups of eight – (three women and five men in each). One group received a single UVR exposure, to simulate sunlight, to areas treated with high SPF sunscreen of varying thickness, ranging from 0.75mg, through 1.3mg up to 2mg/cm2.

The other group received exposures on five consecutive days – to mimic continuous holiday exposure. The amount of UVR exposure was varied during the course of the experiment, in order to replicate the conditions in holiday destinations, such as Tenerife, Florida and Brazil.

Biopsies of the UVR exposed areas of skin showed that, for the group that were repeatedly exposed to UVR, considerable DNA damage was found on the areas that received no sun protection, even though the UVR dose was very low.

Damage was reduced when sunscreen was applied at a thickness of 0.75mg/cm2 and considerably reduced when 2mg/cm2 of sunscreen was applied, even with much higher UVR doses.

Five days of exposure to high dose UVR with the sunscreen at 2mg/cm2 showed significantly less damage than just one day’s low UVR dose exposure without sunscreen across all samples.

The release quotes report author, Professor Antony Young from King’s College London as saying, “There is no dispute that sunscreen provides important protection against the cancer causing impact of the sun’s ultra violet rays. However, what this research shows is that the way sunscreen is applied plays an important role in determining how effective it is. Given that most people don’t use sunscreens as tested as tested by manufacturers, it’s better for people to use a much higher SPF than they think is necessary.”

Nina Goad of the British Association of Dermatologists said: “This research demonstrates why it’s so important to choose an SPF of 30 or more. In theory, an SPF of 15 should be sufficient, but we know that in real-world situations, we need the additional protection offered by a higher SPF. It also shows why we shouldn’t rely on sunscreen alone for sun protection, but we should also use clothing and shade. An extra consideration is that when we apply sunscreen, we are prone to missing patches of skin, as well as applying it too thinly.”

The good news? Melanoma, the deadliest form of skin cancer, accounts for only 1 percent of all skin cancers. More commonly diagnosed are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – both non-melanoma skin cancers (NMSC). If caught early enough, these NMSCs can be easily treated, in most cases.

Unfortunately, as you age, you have a greater chance to develop NMSC, likely due to accumulated sun exposure over the years. So, how you can protect your skin beyond sunscreen? What are the symptoms and signs of skin cancer? What are your treatment options if you are diagnosed?

Here are the three things your need to know to protect, detect and treat NMSC:

Protect yourself from those harmful rays

Whether it’s the height of summer in sunny California or the dead of winter in notoriously cloudy Ohio, protecting your skin from UVRs year-round is a must.

Clothing is the first line of defense. Tightly woven fabrics, like denim and wool, help keep UVRs out better than lightweight materials, such as bleached cottons and silk, which let more UVRs in. Wearing darker fabrics also helps block the rays from penetrating the skin.

Hats and sunglasses are critical, since your face and neck typically get the most sun exposure.

The Skin Cancer Foundation advises everyone to wear hats with a brim that extends three inches or more all the way around to shade the face, neck, ears, and even the top of the shoulders. Since 5 to 10 percent of all skin cancers arise on the eyelids, shop for shades that will block 99 percent to 100 percent of UVRs.

No matter what the forecast, don’t leave the house without a Sun Protection Factor (SPF) 30 or higher sunscreen. It should be worn all day, every day on all exposed areas of your body. And, whenever possible, seek shade.

Symptoms and signs

While no one is immune to skin cancer, most basal cell and squamous cell carcinomas typically appear after age 50. Individuals who are fair-skinned and sunburn easily, or those with a history of sunburns, have a higher risk.

The American Academy of Dermatology recommends performing skin self-exams every month. Although many people know how to identify the suspicious irregular-shaped moles that could be melanoma, fewer are familiar with the warning signs of NMSC. BCC is the most common type of skin cancer and often appears as small bumps or itchy red or pinkish spots that may bleed easily from slight friction. It also often appears on the face and might be confused with a pimple.

Meanwhile, SCC typically appears as a rough or wart-like growth that is thicker and more irregular in shape compared to BCC. Skin cancers are visible but not usually symptomatic, so if you notice any new or suspicious spots on your skin, it is important to contact a dermatologist immediately.

You have NMSC. Now what?

If you’ve been diagnosed with NMSC, don’t panic. Medical advancements and innovative technologies to remove skin cancer have come a long way in recent years. Caught early enough, NMSC is usually treatable. Depending on the size and location of the skin cancer, most patients have a variety of treatment options.

One of the most common procedures, which is considered the “gold standard” treatment, is Mohs micrographic surgery. Mohs is a half-day, outpatient procedure that enables clinicians to examine 100 percent of the entire tumor’s margin, reducing the likelihood of NMSC recurrence. Curettement (scraping), and excision, are other common, effective surgical options which involve removing the cancer cells and surrounding healthy tissue. However, with this approach, some patients risk scarring. If lesions are superficial, topical chemotherapy and/or cryosurgery (the freezing of cells with liquid nitrogen) are other non-surgical procedures, but these are more commonly used to treat pre-cancerous cells.

If you’re not a candidate for surgery, prefer a non-invasive option or are concerned about scarring, Xoft® electronic brachytherapy (eBx) is an alternative option. eBx is a painless, in-office procedure lasting about five minutes per treatment, with no down-time or scarring and a reduced risk of complications compared to traditional NMSC surgical options.

Of course, there are risks and benefits with any NMSC treatment, so be sure to consult with your doctor about the options best suited for your individual needs.

Skin cancer has no season, so it is important to be vigilant all year long to ensure you can quickly address any suspicious moles or lesions you find. Be sure that your dermatologist examines all of your skin! 

Kathleen Hutton, M.D. trained at Mayo Medical Clinic. She is a board certified dermatologic surgeon practicing in Newport Beach, Calif. She is known as one of the premier dermatologists in Orange County specializing in diseases of the skin, skin cancers, moles, acne and cosmetic rejuvenation of the face and body. 

A release from the hospital quotes Ruxandra Sîrbulescu, PhD, of the MGH-VIC, lead and corresponding author of the report, as saying, “Our demonstration that B lymphocytes – immune system cells that are abundant in the blood – can accelerate wound healing in both healthy and diabetic skin potentially opens up an exciting path to a new treatment for chronic wounds, such as diabetic foot ulcers. Diabetic foot ulcers are the most common cause of non-traumatic major amputations around the world and the costliest type of chronic wound to care for, so an inexpensive and safe way to accelerate healing would have great benefits.”

Patients with diabetes are at risk of developing chronic wounds, particularly foot ulcers, because of two complications of the illness. Neuropathy damages the nerves in the skin, particularly the hands and feet, causing a loss of sensation that can lead to repeat injuries of the same structures. Vascular disease limits blood flow to the skin and adjacent tissues, cutting off the supply of oxygen and nutrients required for healthy tissue healing. Between 19 and 34 percent of patients with diabetes develop chronic foot ulcers, the presence of which significantly increases their risk of death compared with patients without foot ulcers.

Healthy wound healing has four phases: blood clotting to stop bleeding, inflammation to remove dead and damaged cells, proliferation of new tissue and the remodeling of tissues to be stronger and better organized. It is believed that chronic wounds get stuck in an inflammatory phase, with a low-oxygen microenvironment and the persistent presence of enzymes that break down tissue proteins. Recent studies from the VIC and other centers have identified several unsuspected roles for B lymphocytes, including the secretion of powerful anti-inflammatory molecules. A previous study from members of the MGH team, in collaboration with scientists at the St Joseph’s Translational Research Institute, found that injecting B cells into cardiac tissue damaged by a heart attack improved structural and functional recovery in an animal model.

For the current study the team first isolated mature B cells from the spleens of diabetic and nondiabetic mice. Their series of experiments showed that a single application of concentrated, mature B cells accelerated wound healing and improved the quality of tissue repair in both animal models. B cell treatment also quickly reduced the size and improved the healing of chronic skin ulcers in the diabetic mice, increasing the number of both nerve endings and blood vessels in regenerated tissue.

Remarkably, the same healing effect was produced when B cells from older obese diabetic mice were applied to acute wounds in similarly aged, obese diabetic mice. Both groups of animals were equivalent to 55- to 60-year-old morbidly obese patients with uncontrolled diabetes, the most difficult population to treat. The sort of mature B cells used in this study have a limited life span, and once applied on a wound, they remained active at the site for up to 14 days. This makes them easier to control than other types of cells used in therapies and makes side effects unlikely. Overall, the presence of B lymphocytes was associated with increased tissue proliferation, reduced cell death and a more supportive environment for wound healing.

Sîrbulescu notes that it is possible to isolate high numbers of a patient’s B cells through a standard blood pheresis procedure, allowing collection of enough cells for several treatments at a single session. The team has been working with colleagues at Dana-Farber Cancer Institute to develop protocols to create the type of enriched B cell preparation that could be used to treat patients. “While more work is required to elucidate the cellular and molecular mechanisms through which B cells exert their beneficial function in wound healing, we are in the process of obtaining the required regulatory approvals to conduct a first clinical study in patients with diabetic foot ulcers. With adequate funding, we believe we could apply this technology clinically within one to two years” she says. The team is working in collaboration with study co-author Dennis Orgill, MD, PhD, of the Wound Care Center in the Plastic Surgery Division at Brigham and Women’s Hospital to set up a clinical study in patients with diabetic foot ulcers.

Mark Poznansky, MD, PhD, director of the MGH-VIC and senior author of the Wound Repair and Regeneration report adds, “Having a novel therapeutic that is based on the immediate isolation of a patient’s own cells, with minimal manipulation, will represent an attractive option for the wound care field; and a successful option that accelerates healing would greatly benefit patients, as diabetic ulcers typically need up to a year or more heal. Further development of the B cell application therapy may lead to novel ways of addressing the pathologies underlying the formation of chronic wounds.”

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Poznansky is an associate professor of Medicine at Harvard Medical School (HMS), and Sîrbulescu is an immunology researcher at MGH and a research fellow in Medicine at HMS. Additional co-authors of the Wound Repair and Regeneration paper are Chloe K. Boehm, Erin Soon, Ben Maxner, Nicolas Chronos, MD, Ann Sluder, PhD, MGH Vaccine and Immunotherapy Center; Moses Wilks, PhD, Hushan Yuan, PhD, Charalambos Kaittanis, PhD, Marc Normandin, PhD and Georges El Fakhri, PhD, MGH Department of Radiology; and Iulian Ilies¸ PhD, Northeastern University. Support for the study includes grants from the Trinity Innovation Fund of Holy Cross Hospital, Ft. Lauderdale, Florida; the VIC Innovation Fund, and National Institutes of Health grant 5R01 EB017699-03.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $850 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2017 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of “America’s Best Hospitals.”