Here comes the sun, and the Beatles say it's all right.
Your dermatologist might have said just the opposite up until a few years ago, but now is likely to be a little more equivocal.
At least Dr. Laura King, who owns Patient Preferred Dermatology in Los Alamitos, Calif., isn't as strongly against the sun as she used to be.
What changed? There is recent research on vitamin D that indicates it may be a greater factor than previously thought in preventing cancer and building strong bones. And the natural way to get vitamin D is through exposure to the sun.
The conundrum: One of the best ways to get skin cancer is overexposure to that same sun.
"The question is how much should you be in the sun so that you get adequate vitamin D, weighed against the skin cancer," King said in a phone interview last week. "So it's a balancing act, I think, and you really have to do this on an individual basis.
"I think it's been estimated that for a Caucasian, 10 minutes a day of just casual sun exposure, being normally clad, is enough vitamin D," she said. But even that is in question, because of the studies that show those with the highest amount of vitamin D have less cancer and better bones.
King knows of no established guidelines for sun exposure, and guesses are further complicated by race.
"The darker you are, the less vitamin D you're going to absorb from the skin," she said. On the other hand, those with dark skin have an advantage when it comes to skin cancer, because they also absorb fewer ultraviolet rays, which cause the damage that eventually results in the most common skin cancers -- basal cell carcinoma and squamous cell carcinoma. As soon as you stick your head into the sunlight, these rays are going to work, and, on average, the more hours you spend in the sun, the faster you're going to see those cancers, or actinic keratosis, which is a precancerous area. Adequate vitamin D is especially important for women, said King. "Women will get more osteopenia, a thinning of the bones, than men," she said. There is an alternative to wrestling with the problem of how much sun. "You can just take extra vitamin D supplements," said King. As for those common skin cancers, you pay for those on the installment plan. "They are both from cumulative sun exposure over several years," said King. "It's thought maybe about 30 years of sun exposure is the average for getting enough of a threshold to develop skin cancer. It's kind of like smoking. You've got to smoke for several years to get lung cancer."
On your head, the areas where the cancers show up are your face and, in men who are bald, on the scalp. "My suggestion," King said, "is if you're going out in the sun, you should at least try to cover up your face." She recommends a wide-brim hat. "Those baseball caps don't really give you all that much shade," she said. As for sunscreen, she says, look for products that protect against both UVA and UVB rays and have a 30 Sun Protection Factor. The SPF is a measure of the degree of sun protection. "There's no evidence that anything above 30 works better than 30," she says. The 30 refers only to the UVB. There's not a good system yet for UVA. "The two biggest mistakes that people make with sunscreens is not applying enough and not reapplying it," King said. "They shouldn't put a teeny bit on, but enough so they can feel it on their skin. And it's been said that if you're active, like playing tennis, you should reapply it every hour. And if you're not active, it should be every couple of hours." Older adults may need to be checked for skin cancers on the face or scalp caused by sun exposure. King said this can be done initially at a regular physical by a general practitioner, but there are three situations where she would recommend seeing a dermatologist.
"People who have had any kind of skin cancer, people who've had actinic keratosis, because it means they've had enough sun damage to get something, and people who have a family history of melanoma, meaning a first-degree level," she said. "Not basal cell or squamous cell carcinoma, because they are just too common." Melanoma doesn't usually appear on the face and it's not as common as the other two, but it's also much more deadly, she said. So what is King's final word on the sun? "What I usually tell patients -- and I do this myself -- is if you haven't had skin cancer before and if you're over 40 -- and this is not government policy -- I think it's fine to get a little bit of sun every day," she said. "And again, 'a little bit.' I have no quantification on that." Skin TipsSome things you should know about your skin, as explained by Dr. Laura King, owner of Patient Preferred Dermatology in Los Alamitos. Good sun: Vitamin D, which comes from sun exposure, has been found to prevent internal cancers and promote strong bones. (You can get vitamin D from supplements, as well.)Bad sun: Prolonged exposure to sun makes your skin more vulnerable to skin cancer. There is no conclusive information on exactly how much sun exposure is best.Race matters: Those who are light-skinned are in more danger of sun-caused skin cancer than those who are dark-skinned. On the other hand, the darker the skin, the less vitamin D is absorbed.What about tanning?: People who tan are in less danger of sunburn. But in getting the tan, they already have damaged their skin.Melanoma: The most dangerous type of melanoma usually doesn't occur on the face.What sunscreen is best?: Make sure your sunscreen protects against both UVA and UVB rays, with a 30 Sun Protection Factor (SPF) rating.Apply liberally: To be effective, sunscreen must be applied heavily. It should be reapplied every hour if you are active in the sun, every two hours if you're not.Hats: Wear a wide-brim hat for sun protection. Baseball hats don't provide enough shade.Acne and sunburn: Those who use a cream of retinoic acid (Retin-A) to treat acne become more susceptible to sunburn, because the treatment gets rid of dead skin cells on the surface that block the sun.See a dermatologist: When accumulated sun exposure over many years produces precancerous actinic keratoses (usually rough, scaly, tender areas) on your face, a dermatologist can remove them. You should see a dermatologist regularly if you have had any skin cancer, have had actinic keratoses or have an immediate relative who had melanoma.
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