What is Skin Cancer?

Skin cancer occurs when skin cells grow in a rapid and uncontrolled way. Normally, new skin cells will grow when old ones die or become damaged. However, sometimes this does not happen and a clump of cells is formed. This clump can become cancerous and if not caught and treated early it could spread to other parts of the body.¹

How Common is Skin Cancer?

Skin cancer is considered the most common form of cancer. In the United States more than 9,500 people are diagnosed with skin cancer every day.² About, 1 in 5 people in the U.S. will have skin cancer in their lifetime.² In Suffolk County specifically, about 482 people are diagnosed with skin cancer each year.³

What Causes Skin Cancer?

The primary cause of skin cancer is too much exposure to ultraviolet (UV) rays from the sun and indoor tanning.^1,2 These rays cause damage to your skin and this damage can happen years before skin cancer even begins to develop. Other risk factors for skin cancer include age, genetics, working outdoors, and having fairer skin.⁴

What is an UV Index?

The Environmental Protection Agency’s (EPA) UV Index is a daily forecast of the expected risk of overexposure to UV radiation from the sun.⁵ The UV Index is a useful tool that can help guide you on what actions to take when outdoors and planning outdoor activities in order to prevent skin cancer. The UV Index can be found on most weather websites and apps.

• 0 to 1: Low – Minimal protection from the sun is needed.
• 3 to 7: Moderate to High – Protection from the sun is needed.
• 8-11: Very High to Extreme – Extra sun protection needed.

Types of Skin Cancer

The most common types of skin cancer include basal cell carcinoma, squamous cell carcinoma, and melanoma.

Basal cell carcinoma is the most common skin cancer in Caucasians, Latinos and Asians.⁶ Each year about 3.6 million Americans are diagnosed with this type of skin cancer.^2,7 Basal cell skin cancer is often found on parts of the skin that are exposed to the sun (hands, legs, face, etc.). Typically basal cell skin cancer is slow growing, rarely spreads to other parts of the body and is non-life threatening if detected and treated early.⁶

Squamous cell carcinoma is the most common skin cancer among African Americans and the second most common among Caucasians.⁶ About 1.8 million Americans are diagnosed with squamous cell skin cancer each year.² This type of skin cancer is also usually found on sun-exposed body parts like the neck, hands, scalp, ears, etc. However, for African Americans, it often appears in non-sun-exposed areas of the skin as well, and often occurs on the scalp, head, neck, genitalia and legs.6 If left untreated squamous cell skin cancer can grow deep in the skin and spread.⁷

*Specific risk factors for squamous cell carcinoma in African Americans can include repeated and prolonged trauma to the skin. This can include sores on the skin that won’t heal or keep returning (i.e., chronic ulcerations).⁶ Albinism, a genetic disorder that results in pale skin because the body is unable to produce melanin properly, is also a risk factor. Lastly, vitiligo, an autoimmune disease that causes the loss of skin color and pigmentation can also increase the risk of squamous cell carcinoma in African Americans.⁶

Melanoma is rare but is the most dangerous and deadliest form of skin cancer. This is mainly because it tends to spread in the body.⁸ However, if detected and treated early, melanoma can be cured. It is estimated that in 2022, about 197,000 people will be diagnosed with melanoma in the US.2 Melanoma often looks like a dark spot on the skin and can arise from moles that may already be on your body. These spots can be found in both sun-exposed and non-sun-exposed areas of the body.⁷ In people of color melanoma can most often occur on the palms, soles of the feet and under the nails.⁶

Image source: American Academy of Dermatology Association https://www.aad.org/public/diseases/skin-cancer/types/common

There are various ways to practice sun safety and lower your risk of skin cancer.

Suffolk County Free Sunscreen Dispensers

Below includes a list of parks and golf courses that provide free sunscreen (SPF 30) dispensers to help protect those who are enjoying local outdoor activities from the harmful rays of the sun.

Source: https://libn.com/2019/05/24/free-sunscreen-program-expands/

4. AVOID Indoor Tanning

Indoor tanning can drastically increase your risk of skin cancer. One tanning session before the age of 35 can increase your risk of melanoma by 75%.^17,18 Tanned skin is NOT healthy skin, it means your skin is damaged. Tanning beds can emit higher UV levels closer to your body than the sun resulting in intense damage and a higher risk of skin cancer.¹⁹

5. DO Examine Your Body

It is important to check your skin regularly (at least once a month). Doing this can help detect early signs of skin cancer. You should be sure to check your skin from head to toe using a full length mirror to look for any spots, sores, or moles that don’t look normal. For more detailed steps on how to examine yourself and what to look for, please visit the American Academy of Dermatology Association (AAD).

The AAD also provides some great tips in identifying early warning signs of melanoma using the acronym “ABCDE”.²⁰

• Asymmetry: One part of the spot/sore does not look like the other.
• Border: The spot has an irregular shape that borders it.
• Color: Areas of the spot vary in color and are inconsistent (such as shades of tan, brown or black, or areas of white, red, or blue).
• Diameter: Melanomas are usually bigger than 6 millimeters (about the size of a pencil eraser) however they may be smaller.
• Evolving: The spot changes in size, color and/or shape.

If you find any new moles or spots that show signs of “ABCDE” you should make an appointment with your doctor or dermatologist.

Vitamin D is a nutrient that our bodies naturally produce but we can get additional amounts through our diets and supplements. Vitamin D has many benefits including healthier and stronger bones, increased immune system support, and fighting certain cancers.^21,22 Although we can synthesize the nutrient through sun exposure, it is recommended that sunscreen is used when out in the sun for more than a few minutes to reduce your risk of skin cancer. It is important to get Vitamin D through fortified foods and a rich diet. Some foods, such as cow's milk and plant based milk (such as almond, soy, coconut, rice, etc.), have Vitamin D added.²³ Vitamin D supplements are another option. Speak with your doctor about checking your levels and for guidance on what foods or supplements will help you maintain healthy levels.

*People of Color: “refers to diverse skin colors and includes people of African, Asian, Latino, Mediterranean, Middle Eastern, and Native American descent”.²⁴

There are many misconceptions and myths surrounding skin cancer and how it may affect individuals with brown and black skin colors.

Misconception 1: “People of color don’t get skin cancer”

People of all skin colors are at risk of developing skin cancer. Although rates of skin cancer in people of color are lower than in those with fairer skin, the survival outcomes are often worse.²⁵ This is because skin cancer can look different on people of color. As a result it is often detected at later stages when it is more difficult to treat. There is also a lower public awareness about melanoma in people of color. This is why it is important for those in brown and black communities to understand their risks and how to protect themselves from sun damage.

Misconception 2: “The melanin in my skin is enough, I have natural sun protection”

Melanin, the chemical which gives skin its brown or tan color, provides some natural protection from the sun’s ultraviolet radiation (UV). However, long term UV exposure can lead to harmful effects for everyone no matter your skin tone.²⁴ Skin cancer can also be found in places that have less melanin than the rest of your body (i.e., hands, inside of your mouth, etc.). This is why melanin alone does not serve as enough protection against skin cancer.

Misconception 3: “People of color don’t have to use sunscreen”

It is recommended that all people use sunscreen as an added protection against sun damage. Sunscreen can help reduce your risk of not only skin cancer but also hyperpigmentation, dry skin and aging lines.²⁶ People of color can also get sunburn. Although it may take longer for sunburn to occur, this damage can happen regardless of one’s skin color.^24,26,27 For some with darker skin tones, sunscreen can leave a gray or white casting on the skin which is a common complaint. If this is true for you, the solution is finding a sunscreen that works best for YOU. There are sunscreen products that are tinted in different shades to match your skin tone, sheer sunscreens and physical sunscreens for those with sensitive skin.

Self-Examination in People of Color

By checking your skin regularly, you could detect early signs of skin cancer. Many doctors and dermatologists recommend looking closely at your body at least once a month, checking your skin from head to toe. All you need is a full length mirror to help identify any spots or moles that don’t look normal.

What parts of my body should I pay attention to when checking?

Often, signs of melanoma in people of color appear in places on the body that seem protected from the sun (eyes, nail beds, lips, soles of the feet, etc.). This is why it is important to thoroughly check your entire body and learn what marks, freckles, pimples or moles exist so you can notice when changes occur. Melanoma can also frequently occur on the lower legs, face, arms, genitalia, areas of repeated injury, and pre-existing scars in people of color so checking those areas are also important.²⁸

What should I look for?

Specifically, people of color should check for:

• Dark spots/growths
• Sores that won’t heal (or reappear)
• Rough dry patches
• Dark lines near the fingernails or toenails
• Moles changing in color, size or shape

Don’t forget to make your doctor or dermatologist aware of any new spots or sores you may be concerned about.

Vitamin D

Vitamin D is essential for maintaining healthy bones, keeping your immune system strong, fighting different cancers, and is synthesized from sun exposure.²⁹

How Can I Ensure I am Getting Enough Vitamin D?

Having more melanin reduces your ability to synthesize Vitamin D from the sun. About every 2 out of 5 Americans may be considered Vitamin D deficient. However, for African Americans this rate is even higher with almost 4 out of 5 being deficient (76%).³⁰ Although limited amounts of Vitamin D can be obtained from the sun, the effects of UV exposure can be harmful. Another way to get Vitamin D includes a balanced and enriched diet. Foods like fatty fish (salmon, tuna fish, etc.), mushrooms and some dairy products can include Vitamin D as well.²⁹ Vitamin D supplements are another option. However, you should speak with your doctor about checking your levels and for guidance on what foods or supplements will help you maintain healthy levels.

Photosensitivity occurs when a person’s skin becomes very sensitive to sunlight or UV rays. When exposed to the sun or artificial sources of UV radiation (i.e., tanning bed), photosensitivity may result in:

• Skin sunburning more easily
• Itchy spots
• Redness
• Areas of swelling on exposed skin.³¹

Photosensitivity can be a response to certain medications, chemicals, plants, autoimmune diseases (e.g., Lupus) or metabolic diseases.³²

Medications that are known to cause photosensitivity in some individuals include:

• Antibiotics
• Antifungals
• Diuretics
• Oral contraceptives and estrogens
• Cholesterol lowering drugs
• Antihistamines
• Nonsteroidal anti-inflammatory drugs (NSAIDS) like aspirin and ibuprofen

Keep in mind, not all people who take or use the medications mentioned will have a reaction. But it is always good to be aware of which substances make your skin more sensitive to UV rays and talk to your doctor about your medication and whether you will be more sensitive to UV rays than usual.

Those at risk of photosensitivity should:

• Avoid direct sun and do not use a tanning bed.
• Use a water-resistant, broad-spectrum sunscreen with an SPF of at least 30.
  • Formulas that contain zinc oxide and titanium dioxide are less likely to cause a skin reaction and are good choices for people dealing with photosensitivity.³¹
• When outside, seek shade, especially between 10 AM and 4 PM. Also, keep in mind that the sun’s rays may be stronger when reflected off water, sand and snow.
• Wear long-sleeved shirts, pants, sunglasses, and broad-brimmed hats to limit sun exposure.

Childcare settings such as schools, summer camps, and daycares can be a great place for children to enjoy outdoor activities; however, it is important to keep everyone safe, so here are some recommendations that organizations and staff can consider to help protect both children and staff from overexposure to the sun’s rays while outdoors.

• Be mindful to protect the skin with sunscreen and protective clothing during field days, sports day, recess, physical education classes, and field trip adventures.
• Provide shade cover over playground equipment.
• Ensure pools and baseball dugouts have outside shade spaces to avoid direct sunlight.
• Continue sun safety all year round, not just in the summer. Even outdoor winter activities can lead to skin damage as intense UV rays reflect off the snow/ice onto the skin.
• Minimize outdoor activity during the midday hours of 10 AM and 4 PM when the sun’s rays are the strongest.
• Limit outdoor exposure for children under the age of 1, and strictly limit sun exposure for infants less than 6 months of age.

Gel manicures and pedicures have grown more and more popular over the years. Many people are attracted to this service because they last much longer than standard polish. Gel and shellac nail services require that salon customers dry their nails under a lamp with UV light.³³,³⁴. There are two types of UV light: UV-A and UV-B. The lamps used in nail salons release UV-A.³³ The rays that are emitted from UV light can be harmful and under certain circumstances may lead to skin damage and cancer.

Does UV Light Gel Manicures Increase my Risk of Skin Cancer?

Further studies regarding potential cancer risks of UV nail lamps are needed. However, existing research suggests that UV exposure from occasional gel manicures is minimal and poses little to no cancer risk.³³,³⁴,³⁵. Although cancer risk is low it’s important to be aware so that you can take steps to reduce your risk.

Consider the following to lower your exposure and keep your nails healthy:

• Wear Sunscreen: Bring your favorite broad-spectrum sunscreen and apply it to your hands 20 minutes before your manicure.³⁶
  • Although this precaution can be helpful it should be noted that it does not protect against a rare but potentially aggressive form of skin cancer that happens under the nail (subungual squamous cell carcinoma).³⁶
• Wear Gloves: Wear fingerless gloves to protect your hands from the UV light.
• Try an Alternative: Consider a service that doesn’t require a UV lamp or simply let your nails air dry.
  • For example, natural manicures can be a good alternative. There are also nail buffing creams and tools that can help your nails shine without the use of gel polish/UV light.
• Take a Break: Get gel manicures only on special occasions to lower your UV exposure and give your nails a chance to repair themselves.³⁵
• Take Care of Your Nails: It’s important to learn how to keep your nails strong and healthy before, during and after a gel manicure if that’s your service of choice. Get tips from the American Academy of Dermatology Association:
  WWW.AAD.ORG/Gel Manicures

For more information regarding sun safety:

• How to Protect Yourself and Your Family From the Sun: https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets-flyers/protect-from-the-sun.pdf
• CDC’s Play it Safe in the Sun: A Guide for Parents https://www.cdc.gov/cancer/skin/pdf/cycparentsbrochure.pdf
• Skin Cancer Foundation: All About Sunscreen https://www.skincancer.org/skin-cancer-prevention/sun-protection/sunscreen/
• Skin Cancer Foundation: UPF and Sun Protective Clothing https://www.skincancer.org/skin-cancer-prevention/sun-protection/sun-protective-clothing/

What’s going on in Suffolk County?

• Stony Brook Cancer Center: Cancer Prevention in Action (CPiA) https://takeactionagainstcancer.com/stony-brook-cancer-center/
• Take Action Against Cancer https://takeactionagainstcancer.com
• Colette Coyne Melanoma Awareness Campaign. Be Sun Smart. http://ccmac.org/

1. Center for Disease Control and Prevention. (2022). What is Skin Cancer?.: https://www.cdc.gov/cancer/skin/basic_info/what-is-skin-cancer.htm
2. Skin Cancer Foundation. (2022). Skin Cancer 101 - Knowledge Is Your Best Defense. https://www.skincancer.org/skin-cancer-information/
3. New York State Cancer Registry (2015-2019). Cancer Incidence and Mortality for Suffolk County. https://www.health.ny.gov/statistics/cancer/registry/vol1/v1csuffolk.htm
4. American Cancer Society. (2019). Basal and Squamous Cell Skin Cancer Risk Factors. https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/causes-risks-prevention/risk-factors.html
5. United States Environmental Protection Agency. (2022). UV Index. https://www.epa.gov/sunsafety/uv-index-1
6. Haughton, A., 2022. Stony Brook Medicine. Skin Cancer: Causes, Tips for Prevention & What to Look For. https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:ae8c7b66-0ed8-3150-aa95-68742919e3a7
7. Cleveland Clinic. (2021). Skin Cancer. https://my.clevelandclinic.org/health/diseases/15818-skin-cancer#:~:text=The%20main%20cause%20of%20skin,a%20mass%20of%20cancer%20cells
8. American Cancer Society. (2019). What is Melanoma Skin Cancer?. https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.html
9. Simon, S. (2020). American Cancer Society. Spend Time Outside and Stay Sun Safe. https://www.cancer.org/latest-news/stay-sun-safe-this-summer.html#:~:text=Seek%20shade%3A%20Limit%20your%20direct,least%2099%25%20of%20UV%20light
10. American Academy of Dermatology Association (n.d). Sunscreen FAQs. https://www.aad.org/media/stats-sunscreen
11. Skin Cancer Foundation (2016). Sun Safe Babies. https://www.skincancer.org/blog/sun-safe-babies/#:~:text=Because%20infants'%20skin%20is%20so,10%20AM%20and%204%20PM
12. Food and Drug Administration (2021). Should You Put Sunscreen on Infants? - Not Usually. https://www.fda.gov/consumers/consumer-updates/should-you-put-sunscreen-infants-not-usually
13. Wisconsin Chapter: American Academy of Pediatrics (2021). Tips to Prevent Sunburn. https://www.wiaap.org/american-academy-of-pediatrics-offers-tips-to-prevent-sunburn/
14. American Academy of Dermatology Association (2022). Infant Sun Protection: How Parents Can Keep Their Baby Safe. https://www.aad.org/public/diseases/skin-cancer/prevent/sun-babies
15. Healthy Children Organization (2021). Sun Safety: Information for Parents About Sunburn & Sunscreen. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Sun-Safety.aspx
16. USCF Benioff Children's Hospital (2022). Sun Safety for Children and Babies. https://www.ucsfbenioffchildrens.org/education/sun-safety-for-children-and-babies
17. Skin Cancer Foundation. (2021). Tanning & Your Skin. https://www.skincancer.org/risk-factors/tanning/#sad
18. American Academy of Dermatology Association. (n.d). 10 Surprising Facts about Indoor Tanning. https://www.aad.org/public/diseases/skin-cancer/surprising-facts-about-indoor-tanning#:~:text=Science%20tells%20us%20that%20there's,cell%20carcinoma%20by%2029%25
19. U.S Food and Drug Administration. (2015). Indoor Tanning: The Risks of Ultraviolet Rays. https://www.fda.gov/consumers/consumer-updates/indoor-tanning-risks-ultraviolet-rays#:~:text=Exposure%20to%20UV%20radiation%E2%80%94whether,especially%20at%20a%20young%20age
20. American Academy of Dermatology Association (n.d). What to Look For: ABCDEs of Melanoma. https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes
21. Harvard T.H Chan (2022). The Nutrition Source – Vitamin D. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/
22. National Institutes of Health (2022). Office of Dietary Supplements. Vitamin D. https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
23. Skin Cancer Foundation (2022). Vitamin D & Sun Protection. https://www.skincancer.org/skin-cancer-prevention/sun-protection/vitamin-d/
24. American Academy of Dermatology Association (n.d). Skin Cancer in People of Color.https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/skin-color
25. Gupta, A. K., Bharadwaj, M., & Mehrotra, R (2016). Skin Cancer Concerns in People of Color: Risk Factors and Prevention. Asian Pacific journal of cancer prevention: APJCP, 17(12), 5257–5264. https://doi.org/10.22034/APJCP.2016.17.12.5257
26. Skin Cancer Foundation (2022). All about Sunscreen. https://www.skincancer.org/skin-cancer-prevention/sun-protection/sunscreen/#:~:text=and%20skin%20cancer!-,Who%20should%20use%20sunscreen%3F,whether%20or%20not%20you%20burn
27. UNC Health Talk (2022). Do People of Color Need Sunscreen? https://healthtalk.unchealthcare.org/do-people-of-color-need-sunscreen/#:~:text=Everyone%2C%20including%20those%20with%20darker,wrinkles%2C%20sagging%20and%20age%20spots
28. Haughton, A., 2022. Stony Brook Medicine. Skin Cancer: Causes, Tips for Prevention & What to Look For. https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:ae8c7b66-0ed8-3150-aa95-68742919e3a7
29. Harvard T.H Chan (2022). The Nutrition Source – Vitamin D. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/
30. Farrell, S (2019). The Cooper Institute. African-Americans At Greatest Risk of Vitamin D Deficiency. https://www.cooperinstitute.org/2019/09/24/african-americans-at-greatest-risk-of-vitamin-d-deficiency#:~:text=An%20estimated%2040%25%20of%20American,study%20by%20The%20Cooper%20Institute
31. Venosa, A. (2019). Sun Cancer Foundation. When You’re Extra Sensitive to Sunlight: What You Need to Know About Photosensitivity. https://www.skincancer.org/blog/what-you-need-to-know-about-photosensitivity/#:~:text=Lupus%2C%20dermatomyositis%20and%20porphyria%20are,Bilu%20Martin%3A%20phototoxic%20and%20photoallergic.
32. Food and Drug Administration (2015). The Sun and your Medicine. https://www.fda.gov/drugs/special-features/sun-and-your-medicine#:~:text=There%20are%20certain%20types%20of,(flucytosine%2C%20griseofulvin%2C%20voricanozole)
33. Bramlet, K. (2016). MD Anderson Cancer Center. Is Your Manicure Safe? https://www.mdanderson.org/publications/focused-on-health/is-your-manicure-safe
34. Schwartz, C., Ezaledin, H., and Merati, M. (2020). Ultraviolet Light Gel Manicures: Is There a Risk of Skin Cancer on the Hands and Nails of Young Adults? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492020/
35. Hollimon, N. (2022). WebMD. https://www.webmd.com/beauty/gel-nails-cancer
36. Skin Cancer Foundation (2023). Ask the Expert: Are the UV Lamps in the Dryers at the Nail Salon Safe to Use? https://www.skincancer.org/blog/ask-the-expert-are-the-uv-lamps-in-the-dryers-at-the-nail-salon-safe-to-use/