Using cancer registry data, investigators have identified a subset of patients with early-stage melanoma with almost no melanoma-related deaths, potentially representing cases contributing to overdiagnosis. The research, which is published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, may help clinicians determine which patients have a very low risk of death from melanoma after removal of the growth.

For the study, Megan M. Eguchi, MPH, of the University of California, Los Angeles; Kathleen F. Kerr, PhD, of the University of Washington; David E. Elder, MB, ChB, FRCPA, of the University of Pennsylvania; and their colleagues, analyzed information from the U.S. Surveillance, Epidemiology, and End Results (SEER) database on patients who were diagnosed in 2010 and 2011 with stage 1 melanoma that was 1.0 mm or less in thickness and had not spread to the lymph nodes. Models were developed to identify patients with a very low risk of dying from melanoma in 7 years as well as those at higher risk of death.

 Among the 11,594 patients in the analysis with follow-up data, the overall 7-year rate of mortality from melanoma was 2.5%. However, the models identified a subset of 25% of patients from the large cohort with risk below 1%. These patients tended to be younger, and their cancers exhibited minimal invasion into the skin. A very small subset of patients (less than 1%) who skewed older and had slightly more advanced tumors (although considered low risk by current criteria) had a greater than 20% risk of death, and these patients can be considered for potentially lifesaving, more complex therapy.

The findings show that a subset of melanoma patients with very low risk of death can be identified using a few standard risk factors. It is hoped that this study’s findings can be used as a starting point for future research using additional study designs and variables beyond those available in the SEER database to further improve this classification.

“Given the very low risk of death from melanoma associated with some of the cases identified in this study, and if these findings can be verified and perhaps extended in other studies, the use of a different term such as ‘Melanocytic neoplasm of low malignant potential’ may be more appropriate than that of melanoma, as has been done with some other neoplasms or tumors formerly labeled as cancers,” said Dr. Elder. “Such a term may potentially alleviate people’s concerns related to prognosis and outcomes and begin to address the problem of overdiagnosis.”

Additional survey findings include:

49% said they are more worried about avoiding sunburn than preventing skin cancer.

32% said they are more worried about avoiding wrinkles than preventing skin cancer.

25% said they got a sunburn in 2020.

“These findings are surprising and seem to suggest that many people do not take skin cancer seriously or perhaps believe skin cancer won’t happen to them,” says board-certified dermatologist Robert T. Brodell, MD, FAAD, professor and founding chair of the department of dermatology and professor of pathology at the University of Mississippi Medical Center. “Yet, one in five Americans will develop skin cancer in their lifetime, and nearly 20 Americans die from melanoma, the deadliest form of skin cancer, every day.”

According to the United States Centers for Disease Control and Prevention (CDC), anyone can get skin cancer. People with some characteristics, however, are at greater risk:

A lighter natural skin color

Skin that burns, freckles, reddens easily, or becomes painful in the sun

Blue or green eyes

Blonde or red hair

More than 50 moles

A family history of skin cancer

A personal history of skin cancer

“While there are many risk factors for skin cancer that people can’t control, such as having red or blond hair or blue or green eyes, there are other risk factors that we can control, like preventing sunburns and avoiding tanning, both indoors and out,” says Brodell. “Unprotected exposure to ultraviolet rays is the most preventable risk factor for skin cancer, including melanoma.”

Research shows the incidence of skin cancer among non-Hispanic white individuals is almost 30 times higher than that among non-Hispanic Black or Asian/Pacific Islander individuals. While not as common among people with skin of color, skin cancer is still a risk. Research also indicates that skin cancer in patients with skin of color is often diagnosed at a more advanced stage, when it’s more difficult to treat.

“What’s concerning is that invasive melanoma — melanoma that grows deeper into the skin or spreads to other parts of the body — is projected to be the fifth most commonly diagnosed cancer for both men and women this year,” says Brodell. “We need to make sure that everyone understands their risk for skin cancer and takes steps to prevent it as well as detect it early before it spreads.”

Keeping risk factors in mind along with practicing safe sun — such as seeking shade, wearing sun-protective clothing, and applying sunscreen — is critically important, says Brodell. He also emphasizes that skin cancer is highly treatable when caught early, so it’s important to know what to look for and encourages everyone to perform regular skin self-exams. (The AAD’s 2021 SPOT Skin Cancer survey showed that 32% of U.S. adults have never done a skin self-exam).

Skin Cancer Warning Signs

Skin cancer warning signs include changes in size, shape, or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn’t heal. If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, the AAD recommends that you make an appointment with a board-certified dermatologist.

To help people find a possible melanoma on their skin, dermatologists created the ABCDEs of melanoma.

A is for Asymmetry: One half of the spot is unlike the other half.

B is for Border: The spot has an irregular, scalloped, or poorly defined border.

C is for Color: The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red, or blue.

D is for Diameter: While melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, they can be smaller.

E is for Evolving: The spot looks different from the rest or is changing in size, shape, or color.

To learn more from the AAD about sun protection and skin cancer prevention and test your skin cancer knowledge via a short quiz, click here. To find a board-certified dermatologist in your area, click here.

According to the AAD, other survey findings include:

49% said they are more worried about avoiding sunburn than preventing skin cancer.

32% said they are more worried about avoiding wrinkles than preventing skin cancer.

25% said they got a sunburn in 2020.

“These findings are surprising and seem to suggest that many people do not take skin cancer seriously or perhaps believe skin cancer won’t happen to them,” said board-certified dermatologist Robert T. Brodell, MD, FAAD, professor and founding chair of the department of dermatology and professor of pathology at the University of Mississippi Medical Center. “Yet, one in five Americans will develop skin cancer in their lifetime, and nearly 20 Americans die from melanoma, the deadliest form of skin cancer, every day.”

According to the United States Centers for Disease Control and Prevention (CDC), anyone can get skin cancer. People with some characteristics, however, are at greater risk:

*A lighter natural skin color

*Skin that burns, freckles, reddens easily, or becomes painful in the sun

*Blue or green eyes

*Blonde or red hair

*More than 50 moles

*A family history of skin cancer

*A personal history of skin cancer

“While there are many risk factors for skin cancer that people can’t control, such as having red or blond hair or blue or green eyes, there are other risk factors that we can control, like preventing sunburns and avoiding tanning, both indoors and out,” Brodell says. “Unprotected exposure to ultraviolet rays is the most preventable risk factor for skin cancer, including melanoma.”

Research shows the incidence of skin cancer among non-Hispanic white individuals is almost 30 times higher than that among non-Hispanic Black or Asian/Pacific Islander individuals. While not as common among people with skin of color, skin cancer is still a risk. Research also indicates that skin cancer in patients with skin of color is often diagnosed at a more advanced stage, when it’s more difficult to treat.

“What’s concerning is that invasive melanoma — melanoma that grows deeper into the skin or spreads to other parts of the body — is projected to be the fifth most commonly diagnosed cancer for both men and women this year,” says Brodell. “We need to make sure that everyone understands their risk for skin cancer and takes steps to prevent it as well as detect it early before it spreads.”

Keeping risk factors in mind along with practicing safe sun — such as seeking shade, wearing sun-protective clothing, and applying sunscreen — is critically important, says Dr. Brodell. He also emphasizes that skin cancer is highly treatable when caught early, so it’s important to know what to look for and encourages everyone to perform regular skin self-exams. (The AAD’s 2021 SPOT Skin Cancer survey showed that 32% of U.S. adults have never done a skin self-exam).

Skin Cancer Warning Signs

Skin cancer warning signs include changes in size, shape, or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn’t heal. If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, the AAD recommends that you make an appointment with a board-certified dermatologist.

To help people find a possible melanoma on their skin, dermatologists created the ABCDEs of melanoma.

A is for Asymmetry: One half of the spot is unlike the other half.

B is for Border: The spot has an irregular, scalloped, or poorly defined border.

C is for Color: The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red, or blue.

D is for Diameter: While melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, they can be smaller.

E is for Evolving: The spot looks different from the rest or is changing in size, shape, or color.

To find out more about skin health issues, click here to visit the AAD website.

Research presented at the 2019 AADSummer Meeting in New York shows that between 1970 and 2009, rates of melanoma, the deadliest form of skin cancer, have increased 800% among women ages 18-39, making it the second most common cancer in young women. During a similar timeframe, basal cell and squamous cell carcinoma rates have also sharply increased by 145% and 263%, respectively.

“Because there’s a delay between UV exposure and when skin cancer appears, most women don’t think it will happen to them,” said board-certified dermatologist M. Laurin Council, MD, FAAD, FACMS, an associate professor of dermatology at Washington University in St. Louis. “This data reveals the disproportionate rise in the number of skin cancers in women and the need for further education regarding UV exposure.”

Continued use of indoor tanning devices by Caucasian girls and young women is of particular focus among dermatologists, as researchers estimate that it may cause more than 400,000 cases of skin cancer in the U.S. each year. Women are far more likely to use indoor tanning devices than men (7.8 versus 1.9 million) and of the women who began tanning before the age of 16, more than half (54%) did so with their mother.

According to experts, even one indoor tanning session can increase a user’s lifetime risk of developing melanoma by 20%, squamous cell carcinoma by 67% and basal cell carcinoma by 29%. The risk increases for younger users; indoor tanning before age 35 can increase one’s risk of melanoma by 59%. This risk increases with each use.

Even one indoor tanning session can increase a user’s lifetime risk of developing melanoma by 20%.

“It’s important that young people understand the potential impact of the habits they form when they are younger,” Council said. “There are serious, long-term consequences to activities such as sunbathing and using indoor tanning devices.”

Council recommends that parents talk with their children about limiting UV exposure, which is the easiest way to prevent skin cancer. This means practicing sun-safety habits, such as seeking shade, especially when the sun’s rays are the strongest between 10 a.m. and 2 p.m.; wearing protective clothing, including a lightweight, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses; and regularly applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Parents should also discourage the use of indoor tanning devices.

“Everyone should be happy with the skin they were born with and protect it,” Council said. “Some skin cancers are treatable with surgery, but others are more advanced and may be deadly. It’s important that we modify risky behaviors such as UV exposure to prevent the occurrence of skin cancer.”

For more information, check out the AAD’s Indoor Tanning Fact Sheet, its Skin Cancer Fact Sheet and its Melanoma FAQs.

And skin cancer is on the rise in the United States. The Centers for Disease Control and Prevention (CDC) estimates there were more than 80,422 people diagnosed with melanoma of the skin—the most serious form of skin cancer—in 2015 alone. About 4.3 million people are treated for basal cell cancer and squamous cell skin cancer in the United States every year, according to a 2014 report from the Office of the Surgeon General.

The U.S. Food and Drug Administration (FDA) is continuing to evaluate sunscreen products to ensure that sunscreen active ingredients are safe and effective and that (among other things) available sunscreens help protect consumers from sunburn and, for broad spectrum products with SPF values of at least 15, from skin cancer and early skin aging caused by the sun when used as directed with other sun protection measures.

Spending time in the sun without adequate protection increases your risk of early skin aging.

Sun damage to the body is caused by invisible ultraviolet (UV) radiation. Sunburn is a type of skin damage caused by the sun. Tanning is also a sign of the skin reacting to potentially damaging UV radiation by producing additional pigmentation that provides it with some—but often not enough—protection against sunburn.

Spending time in the sun increases your risk of skin cancer and early skin aging. People of all skin colors are at risk for this damage. You can reduce your risk by:

Limiting your time in the sun, especially between 10 a.m. and 2 p.m., when the sun’s rays are most intense.

Wearing clothing to cover skin exposed to the sun—such as long-sleeve shirts, pants, sunglasses, and broad-brim hats. Sun-protective clothing is now available. (The FDA regulates these products only if they are intended to be used for medical purposes.)

Using broad spectrum sunscreens with a Sun Protection Factor (SPF) value of 15 or higher regularly and as directed. (Broad spectrum sunscreens offer protection against both UVA and UVB rays, two types of the sun’s ultraviolet radiation.)

Always read the label to ensure you use your sunscreen correctly, and ask a health care professional before applying sunscreen to infants younger than 6 months.

In general, the FDA recommends that you use broad spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.

Apply sunscreen liberally to all uncovered skin, especially your nose, ears, neck, hands, feet, and lips (but avoid putting it inside your mouth and eyes).

Reapply at least every two hours. Apply more often if you’re swimming or sweating. (Read the label for your specific sunscreen. An average-size adult or child needs at least one ounce of sunscreen, about the amount it takes to fill a shot glass, to evenly cover the body.)

If you don’t have much hair, apply sunscreen to the top of your head, or wear a hat.

No sunscreen completely blocks UV radiation, and other protections are needed, such as protective clothing, sunglasses, and staying in the shade.

No sunscreen is waterproof.

Certain sunscreens have FDA-approved New Drug Applications. Others are marketed under the FDA’s Over-the-Counter (OTC) Drug Review. Sunscreens are available in forms such as lotions, creams, sticks, gels, oils, butters, pastes, and sprays.

Sunscreen products in forms including wipes, towelettes, body washes, and shampoos that are marketed without an FDA-approved application remain subject to regulatory action.

Although UVB rays are the primary cause of sunburn, both UVA and UVB rays contribute to skin cancer. All sunscreens protect against the sun’s UVB rays, but only those that are broad spectrum also have been shown to also provide sufficient protection against UVA rays to reduce the risk of skin cancer and early skin aging caused by the sun when used as directed with other sun protection measures.

Current FDA regulations that apply to sunscreens marketed without approved applications and containing certain active ingredients state:

Products that pass FDA’s broad spectrum requirements can be labeled “broad spectrum.”

Sunscreens that are not broad spectrum or that lack an SPF of at least 15 must carry a warning: “Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”

Water resistance claims, for 40 or 80 minutes, tell how much time you can expect to get the labeled SPF-level of protection while swimming or sweating.

Manufacturers may not make claims that their sunscreens are “waterproof” or “sweat proof.”

Products may not be identified as “sunblocks” or claim instant protection or protection for more than two hours without reapplying.

Remember, people of all skin colors are potentially at risk for sunburn and other harmful effects of UV radiation, so always protect yourself. Be especially careful if you have:

pale skin

blond, red, or light brown hair

been treated for skin cancer

a family member who has had skin cancer

If you take medications, ask your health care professional about sun-care precautions. Some medications may increase sun sensitivity. Even on an overcast day, up to 80 percent of the sun’s UV rays can get through the clouds. Stay in the shade as much as possible.

The FDA is committed to ensuring that safe and effective sunscreen products are available for consumer use. Because the body of scientific evidence linking UVA exposure to skin cancers and other harms has grown significantly in recent years, FDA is proposing a new requirement that all sunscreen products with SPF values of 15 and above must be broad spectrum, and that as the SPF of these products increases, broad spectrum protection increases as well. FDA is also proposing changes to the labeling of SPF values to make it easier for consumers to compare and choose sunscreen. FDA is also proposing raising the maximum proposed SPF value from SPF 50+ to SPF 60+.

Protect Your Eyes With Sunglasses

Sunlight reflecting off sand, water, or even snow, further increases exposure to UV radiation and increases your risk of developing eye problems. Certain sunglasses can help protect your eyes. When using sunglasses:

Choose sunglasses labeled with a UVA/UVB rating of 100% to get the most UV protection.

Do not mistake dark-tinted sunglasses as having more UV protection. The darkness of the lens does not indicate its ability to shield your eyes from UV rays. Many sunglasses with light-colored tints, such as green, amber, red, and gray can offer the same UV protection as very dark lenses.

Children should wear sunglasses that indicate the UV protection level. Toy sunglasses may not have UV protection, so be sure to look for the UV protection label.

Consider large, wraparound-style frames, which may provide more efficient UV protection because they cover the entire eye-socket.

This is especially important when doing activities around or on water because much of the UV comes from light reflected off the water’s surface.

Understand that pricier sunglasses don’t ensure greater UV protection.

Even if you wear contact lenses, wear sunglasses that offer UV protection.

Know that sunglasses are the most effective when worn with a wide-brim hat and sunscreen.

Yet according to dermatologists from the American Academy of Dermatology (AAD), most cases of skin cancer can be prevented by protecting your skin from the sun’s harmful ultraviolet rays. The best way to do this, they say, is by seeking shade, wearing protective clothing and applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. However, in a recent survey, the AAD found that not everyone is applying their sunscreen correctly — leaving people vulnerable to dangerous ultraviolet radiation from the sun.

“Sunscreen is a vital tool in the fight against skin cancer, including melanoma, the deadliest form,” says board-certified dermatologist Tanya Kormeili, MD, FAAD. “However, in a recent survey, the AAD found that only about a third of Americans are reapplying their sunscreen every two hours while outside. Since sunscreen wears off, incorrect usage leaves you unprotected and susceptible to skin cancer.”

Here, Kormeili shares five common sunscreen mistakes and how to avoid them:

Ignoring the label. There are a variety of sunscreens on the market. To effectively protect yourself from the sun, the AAD recommends looking for sunscreens that are broad-spectrum, water-resistant and have an SPF of 30 or higher.

Using too little. Most people apply only 25 to 50 percent of the recommended amount of sunscreen. However, to fully cover their body, most adults need about one ounce of sunscreen – or enough to fill a shot glass. Apply enough sunscreen to cover all skin that isn’t covered by clothing. Apply the sunscreen 15 minutes before going outdoors; reapply every two hours while outdoors or after swimming or sweating.

Applying only in sunny weather. Alarmingly, the AAD found that only about 20% of Americans use sunscreen on cloudy days. However, the sun emits harmful UV rays all year long. Even on cloudy days, up to 80% of UV rays can penetrate your skin. To protect your skin and reduce your risk of skin cancer, apply sunscreen every time you are outside, even on cloudy days.

Make sure your sunscreen isn’t out of date. If in doubt, throw it out.

Using an old bottle. The FDA requires that all sunscreens retain their original strength for at least three years. Throw out your sunscreen if it’s expired or you’re unsure how long you’ve had it. In the future, if you buy a sunscreen that lacks an expiration date, write the purchase date directly on the bottle so that you know when to toss it out.

Relying solely on sunscreen. Since no sunscreen can block 100% of the sun’s UV rays, it’s also important to seek shade and wear protective clothing, including a lightweight, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses with UV protection.

“Sunscreen is the most important skin care product you can use, as it helps prevent sunburn, skin cancer and premature skin aging, including wrinkles and age spots,” says Kormeili. “However, to ensure the best protection for you and your family, it’s important to follow the manufacturer’s directions before using.”

For more about skin health, click here to visit the AAD’s site.

Mohs (pronounced “moes”) surgery, also known as Mohs micrographic surgery, is uniquely able to help surgeons see where skin cancers stop. This means that patients are able to keep as much healthy skin as possible, since only unhealthy skin is removed.

The two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, are most appropriate for Mohs removal, especially when they occur in vulnerable areas around the eyes, nose, lips, ears, scalp, fingers, toes, or genitals. Occasionally, Mohs surgery can also be used on certain cases of melanoma and other, rarer skin cancers.

Unlike other types of skin cancer surgeries, Mohs surgery immediately allows the surgeon to determine that the cancer hasn’t spread. Mohs has the highest cure rate – up to 99% — for a skin cancer that hasn’t been treated before, and up to 94% for a skin cancer that recurs after previous treatment. Since more than 3 million Americans are diagnosed with skin cancer each year, it’s great to have such an effective treatment option to help so many of them.”

WHAT HAPPENS DURING MOHS SURGERY?

The doctors who perform Mohs surgeons must be highly trained, since they fulfill three roles during the procedure. They’re the surgeon who removes the cancerous tissue, the pathologist who analyzes the tissue under microscope, and the surgeon who repairs or reconstructs the resulting wound.

While the procedure is typically performed in a single visit, it can last several hours or longer. That’s because the Mohs process requires the patient to wait between each stage. During the wait, the doctor is determining whether cancer cells have remained after each microscopic layer of skin is removed. The process is repeated until no cancer cells are left.

Created by Dr. Frederic Mohs in the 1930s and advanced into its current form in the 1960s, Mohs surgery is done using local anesthetic, so patients experience little discomfort during the procedure. After the last layer of skin is removed and the doctor concludes no more cancer is present, the resulting wound can be repaired in several possible ways, depending on its size and depth. These include letting it heal on its own, closing it with stitches, using an adjacent flap of skin to cover it, or obtaining a skin graft from another body area to cover it.

Most of the time, Mohs surgery wounds heal beautifully and with little clue there was ever skin cancer present. Since as much healthy skin as possible has been retained, Mohs is the best technique for skin cancers developing in areas with only a little tissue beneath – such as the eyelid, bridge of the nose, ear, or top of the hand.

RISKS AND REWARDS OF MOHS SURGERY

Like every form of surgery, Mohs comes with certain risks – but these are minimal. They include bleeding, pain or tenderness around the surgical site, and infection. Other complications may include an enlarged scar, numbness or weakness surrounding the surgical area, or itching or shooting pain.

But the rewards of Mohs far outweigh the risks since the procedure offers the highest cure rate of any type of skin cancer surgery.

Mohs leaves the smallest possible scar for the largest possible peace of mind. While Mohs isn’t for every skin cancer patient, it’s useful for the vast majority. You can go home from Mohs surgery knowing your cancer is gone with little chance of it returning.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com.

Richard Torbeck, MD, is a board-certified and fellowship-trained dermatologist specializing in Mohs micrographic surgery for skin cancer and cosmetic dermatology at Advanced Dermatology P.C.

“Individuals who receive organ transplants need to take immunosuppressive medications for the rest of their lives, and this makes it more difficult for their bodies to fight disease, including skin cancer,” said board-certified dermatologist Christina Lee Chung, MD, FAAD, former director of the Drexel Dermatology Center for Transplant Patients in Philadelphia. “On top of that, some of these medications make the skin more sensitive to the sun’s harmful ultraviolet rays, which can further increase patients’ skin cancer risk.”

Chung says that organ transplant patients have a higher skin cancer risk if they have fairer skin, are male, have a pre-transplant history of skin cancer, receive their organ at age 50 or older, or have a lung or heart transplant. While skin cancer can affect organ transplant patients of any skin tone, she says, specific risk factors in these patients may vary based on their race. For example, she says, Caucasian patients have the highest skin cancer risk and are most likely to develop the disease in sun-exposed areas, as are Asian transplant patients.

In contrast, Latino and black transplant patients are more likely to develop skin cancer in areas that are protected from the sun, Chung said, with black patients especially at risk for human papillomavirus-related cancers in the genital area. While more research will be necessary to establish the unique skin cancer risk factors in organ transplant patients with darker skin tones, she says, a preliminary study she conducted at Drexel University suggests that those risk factors may include a history of warts, emigration to the U.S. from a country near the equator, a history of sexually transmitted infections, or a history of medical conditions that require immunosuppressive medications to be taken before transplant surgery.

“When it comes to skin cancer risk factors in this [organ transplant] population, it’s not one-size-fits-all,” Chung said. “However, it’s important for all organ transplant patients, regardless of skin tone, to recognize their skin cancer risk; protect themselves from sun exposure, which could further increase that risk; and regularly examine their entire body, including the genital area, for signs of skin cancer so they can detect the disease early, when it’s most treatable.”

The American Academy of Dermatology recommends a comprehensive sun protection plan that involves seeking shade, wearing protective clothing, and generously applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to exposed skin. The AAD also recommends that everyone conduct regular skin cancer self-exams, asking a partner to help them check hard-to-see areas like their back. Anyone who notices any new spots, any suspicious spots that are different from the others on their skin, or anything changing, itching or bleeding should see a board-certified dermatologist.

“In addition to taking action toward skin cancer prevention and detection, organ transplant patients also should establish a relationship with a board-certified dermatologist after their procedure,” Chung said. “A dermatologist can evaluate your unique risk factors and help you ensure the health of your largest organ: your skin.”

• Always apply sunscreen if you plan to be outdoors for an hour, even during cloudy days: sResearch proves that strong ray of lights gets through them and can cause damage. Never leave home without applying your sunscreen during the upcoming summer months.
• If possible, avoid direct sun exposure between 10 a.m. and 4 p.m. That’s when the sun is at its mightiest.
• Get naked and stand in your lit bathroom as you check for moles, any irregular shapes, or any lesions that bleed or won’t heal
• Always follow the ABCDE’s when self-examination; asymmetry, border, color, diameter and evolving.
• If you’re a fitness buff and prefer the outdoors be sure to start early in the day or very late in the afternoon. Get clothing with built in SPF to keep your skin protected. And, of course, still apply your sunscreen!
• If you live in a walking city and are fearful of fine lines and wrinkles, use the shady side of the street to walk your pooch or to do errands.

“No one should tune out advice on sun protection,” says Dr. Suzanne Friedler of Advanced Dermatology, P.C. “About 90% of non-melanoma skin cancers and about 86% of melanomas are associated with exposure to ultra-violet radiation from the sun.”

While skin cancer is the most serious consequence of sun exposure, it isn’t the only one. Changes to the skin that are generally associated with the aging process – sagging, wrinkling, dryness, discoloration – are actually caused by UV rays, which over time break down fibers in the skin causing it to lose elasticity. “Despite the damage done by the sun, we don’t want people to miss out on outdoor activities,” says Dr. Friedler. “We can’t prevent all sun exposure but there are simple steps we can take to minimize risk.”

Everyone knows the basics – use sunscreen, wear a hat, and stay out of the sun between 10:00am and 4:00pm – but not all sunscreens are equally protective and neither are all hats. Dr. Friedler provides some additional tips to help you protect your skin from damage this summer:

Use water-resistant, broad-spectrum sunscreen with an SPF (sun protection factor) of 50 or more every day, even when it is cloudy. Slather it on liberally before getting dressed and at least thirty minutes before going out. Reapply every two hours, more often if you’ve been swimming or perspiring. Don’t use old sunscreen – the active ingredients lose their potency after a year or two.

Don’t depend on makeup for sun protection. Even with SPF, makeup doesn’t bind to the skin as well as sunscreen, wears off, and isn’t applied thickly enough to be effective.

A baseball cap does not offer adequate sun protection! Wear a hat with at least a three-inch brim.

Wear clothing that is densely woven and dark in color or consider specially made sun-protective clothing that is made of fabric infused with radiation-absorbing chemicals. Look for an ultraviolet protection factor (UPF) of 30 or above.

UV radiation can damage not just the skin of the eyelid but the cornea, lens and other parts of the eye. Wear wrap-around sunglasses – all year round – that protect 99-100% of UVA and UVB rays.

Avoid tanning beds and sun lamps. They give out UVA and usually UVB rays as well.

Babies younger than six months should be kept out of the sun entirely and well protected with a hat and clothing anytime they are outdoors. For babies older than 6 months, when going outdoors, be sure to use a sunscreen with physical blockers such as titanium dioxide or zinc oxide and an SPF of at least 50.

“Remember that there is no such thing as a safe suntan,” says aesthetician Jayme Bashian of Simply Posh Aesthetic Spa. “Even a light tan from the sun is an indicator of skin damage. If you want the appearance of a ‘sun-kissed glow,’ consider sunless tanning, which can give you a tanned look without exposure to harmful radiation.” The active ingredient in most sunless tanning products is a color additive that reacts with dead cells in the skin’s surface to temporarily darken the skin and simulate a tan. The coloring typically wears off after a few days.

“Sunless tanning products are sold as lotions, creams, and sprays that you can apply yourself,” says Ms. Bashian, “but the best, most even results are obtained by professional spray tanning by hand or in an automated tanning booth that has nozzles that spray the entire body with tanning solution.” Topical sunless tanning products are generally considered safe alternatives to sunbathing, as long as they’re used as directed or by a qualified professional.

Despite the fact that UV rays are strongest during the summer months and the most damage to the skin occurs then, it is possible to enjoy outdoor activities – on the golf course, at the beach, on the tennis court, in the backyard – and protect your skin,

Suzanne J. Friedler, M.D. F.A.A.D., is a board-certified fellow of the American Academy of Dermatology, with expertise in many areas of medical and cosmetic dermatology. She has been with Advanced Dermatology PC since 2002.

Jayme Bashian is director and lead medical aesthetician for the Simply Posh Aesthetic Spa, a division of Advanced Dermatology PC and the Center for Laser and Cosmetic Surgery. She is board-certified in aesthetics, she works alongside leading cosmetic surgeons, who specialize in advanced aesthetics and cosmetic surgery.