sensitive skin . It is important to note that , especially for people of color , chemical sunscreens may be preferred due to the tendency of mineral sunscreens to leave a white cast behind . Nonetheless , there are tinted mineral sunscreens on the market as well . Overall , the best sunscreen is whichever type someone will actually use !
Another note on SPF : the level of SPF protection does not rise in direct proportion to the designated SPF rating . For example , while SPF 30 filters out 97 % of UV rays , SPF 50 filters out 98 %. 11 Hence , selecting SPF levels higher than 30 isn ’ t as protective as many think . People are often surprised by nasty sunburns after a one-time application of SPF 50 + on the beach . The triggering variables in such cases are lack of reapplication and inadequate amount of sunscreen applied . Utilize any sunscreen with SPF higher than 30 as you should with SPF 30 . Apply sunscreen to dry skin at least 15 minutes before heading outdoors . Once outdoors , reapply sunscreen every two hours or after swimming or sweating , following the instructions on the bottle . Use sufficient sunscreen to cover all exposed skin , including the feet , back of neck , ears and scalp . Typically , adults require about 1 ounce , or the size of a golf ball , to adequately cover their entire body .
SUNSCREEN USE AND SKIN CANCER IN SKIN OF COLOR
Individuals with darker skin pigmentation may have never encountered a sunburn , leading them to believe that sunscreen is unnecessary or simply not considering it due to the absence of immediate repercussions . However , UV exposure increases the risk of skin cancer in everyone – no matter the skin tone . And if that ’ s not incentive enough to start using sunscreen , sunscreen can also be used to prevent premature aging and prevent worsening of dyspigmentation . 12
Although skin cancer diagnoses are more common among white patients , research indicates that patients of color are more often diagnosed with melanoma when it has reached its advanced stage , making treatment more challenging and leading to lower survival rates . 13 , 14 , 15 , 16 For patients without direct access to a dermatologist , regular self-examinations are key to detecting potential skin cancer early . The ABCDE rule — assessing asymmetry , border irregularity , color variation , diameter and evolving characteristics — can aid in identifying suspicious lesions that may warrant further examination . Both physicians and patients with skin of color should be aware that skin cancer can manifest differently compared to those with lighter skin tones . This variation often leads to overlooked and delayed diagnoses until the disease reaches advanced stages . Notably , people with darker skin are susceptible to skin cancer in less sun-exposed areas , such as acral lentiginous melanoma affecting the nail beds , palms and soles . 17
OUR CALL TO ACTION
Physicians play a crucial role in addressing the disparities in sun protection practices among individuals with skin of color . Misconceptions surrounding sunscreen use and the unique manifestations of skin cancer in darker skin tones underscore the need for informed guidance and proactive measures . We encourage all health care providers , especially those in primary care , to educate all patients , regardless of skin color , on the importance of proper sunscreen use for skin cancer prevention . Our hope is that by integrating the insights shared here into clinical practice and patient education efforts , physicians can empower individuals of all skin tones to prioritize skin health and mitigate the risks associated with sun exposure .
References :
1
Fliorent , Rebecca et al . “ Racial Differences in Perceived Risk and Sunscreen Usage .” Cureus vol . 15,1 e33752 . 13 Jan . 2023 , doi : 10.7759 / cureus . 33752
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American Academy of Dermatology Association . ( 2022 , April 22 ). Skin Cancer . https :// www . aad . org / media / stats-skincancer
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Arnold M et al . Global burden of cutaneous melanoma attributable to ultraviolet radiation in 2012 . Int J Cancer . 2018 April . https :// doi . org / 10.1002 / ijc . 31527 .
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American Academy of Dermatology Association . ( 2023 , Jul 19 ). Sunscreen . https :// www . aad . org / media / stats-sunscreen
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Centers for Disease Control and Prevention . USCS Data Visualizations . gis . cdc . gov . Published June 2021 . https :// gis . cdc . gov / Cancer / USCS /#/ AtAGlance /
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American Cancer Society . “ American Cancer Society | Cancer Facts & Statistics for Kentucky .” American Cancer Society | Cancer Facts & Statistics , 2024 . cancerstatisticscenter . cancer . org /#!/ state / Kentucky .
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Google Trends . “ tanning beds ”, “ sunscreen ”. Accessed April 24 , 2024 . https :// trends . google . com / trends / explore ? date = all & geo = US & q = tanning % 20beds , sunscreen & hl = en
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Bajgar , Robert et al . “ Differences in the Effects of Broad-Band UVA and Narrow-Band UVB on Epidermal Keratinocytes .” International journal of environmental research and public health vol . 18,23 12480 . 26 Nov . 2021 , doi : 10.3390 / ijerph182312480 https :// doi . org / 10.3390 / ijerph182312480
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Wang , Pei-Wen et al . “ Comparison of the Biological Impact of UVA and UVB upon the Skin with Functional Proteomics and Immunohistochemistry .” Antioxidants ( Basel , Switzerland ) vol . 8,12 569 . 20 Nov . 2019 , doi : 10.3390 / antiox8120569 https :// doi . org / 10.3390 / antiox8120569
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Matta MK , Florian J , Zusterzeel R , et al . Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients : A Randomized Clinical Trial . JAMA . 2020 ; 323 ( 3 ): 256 – 267 . doi : 10.1001 / jama . 2019.20747
11
Osterwalder , U ., and B . S . P . F . Herzog . “ Sun protection factors : world wide confusion .” British Journal of Dermatology 161 . s3 ( 2009 ): 13-24 .
12
Fatima S , Braunberger T , Mohammad TF , et al . The Role of Sunscreen in Melasma and Postinflammatory Hyperpigmentation . Indian J Dermatol . 2020 ; 65 ( 1 ): 5- 10 . doi : 10.4103 / ijd . IJD _ 295 _ 18
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Cormier , Janice N et al . “ Ethnic differences among patients with cutaneous melanoma .” Archives of internal medicine vol . 166,17 ( 2006 ): 1907-14 . doi : 10.1001 / archinte . 166.17.1907
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Siegel , Rebecca L et al . “ Cancer statistics , 2022 .” CA : a cancer journal for clinicians vol . 72,1 ( 2022 ): 7-33 . doi : 10.3322 / caac . 21708
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Agbai , Oma N et al . “ Skin cancer and photoprotection in people of color : a review and recommendations for physicians and the public .” Journal of the American Academy of Dermatology vol . 70,4 ( 2014 ): 748-762 . doi : 10.1016 / j . jaad . 2013.11.038
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Dawes SM et al . Racial disparities in melanoma survival . J Am Acad Dermatol . 2016 Nov ; 75 ( 5 ): 983-991 .
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Bradford , Porcia T et al . “ Acral lentiginous melanoma : incidence and survival patterns in the United States , 1986-2005 .” Archives of dermatology vol . 145,4 ( 2009 ): 427-34 . doi : 10.1001 / archdermatol . 2008.609
Onajia Stubblefield is a second-year medical student at the University of Louisville School of Medicine .
Sarah Taheri is a first-year medical student at the University of Louisville School of Medicine .
June 2024 11