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24th May 2022

SPF50+ protection against skin cancer

Skin cancer is unfortunately a common occurrence that can affect most of us in one way or another. In basic terms, skin cancer is characterised as the uncontrolled growth of abnormal cells in the skin. There are two main types of skin cancer: (1) benign non-melanoma that includes the most common type, basal cell carcinoma (BCC) and the second most common type, squamous cell carcinoma (SCC); and (2) the less common but significantly more dangerous and aggressive type, malignant melanoma.[1,2] Over 95% of all skin cancers are attributed to exposure of the skin to the sun’s UV radiation, and usually develop on the body areas that get more sun exposure, including the head, face, neck, shoulders, lower arms and legs, but can occur anywhere on the body. UV radiation can also come from artificial sources such as tanning lamps.[2,3]

However, the association between sun exposure and melanoma is very complex. Two pathways have been hypothesised for the development of melanoma. One typically affects areas of the skin with long-term sun exposure, such as the head and neck in older individuals (>55 years old) with few melanocytic nevi (commonly known as pigmented spots on the skin or moles). The other pathway concerns primarily areas of the skin less exposed to the sun, such as the trunk in younger individuals with multiple melanocytic nevi.[4]

When unprotected skin is exposed to UV radiation, how the skin cells look and behave can change dramatically. BCC and SCC occur when something goes wrong in the most prominent cells within the skin known as keratinocytes. While BCC may appear as a pearl-coloured lump or slightly scaly area that is shiny and pale or bright pink, SCC often appears as a thickened, red, scaly or crusted spot or rapidly growing lump. Both BCC and SCC affected skin may bleed and become inflamed.[2,3,5]

Melanoma occurs when something goes wrong in the melanin-producing cells (melanocytes) that give colour to the skin. Excessive sun exposure can lead to DNA damage within these cells, which ultimately leads to new cells growing out of control and eventually forming a mass of cancerous cells. Melanoma can start as a new brown or black spot that grows on the skin, or as an existing spot, freckle or mole that changes size, colour or shape.[2,3,6,7]

Employing sun protection strategies, namely, avoiding excessive sun exposure, seeking shade and wearing protective clothing as well as using sunscreens with a high and broad-spectrum Sun Protection Factor (SPF) if sun exposure cannot be avoided, can often help to reduce the occurrence of skin cancer.[8-10]

 

Skin cancer in the UK – facts and figures

The UK ranks 32nd in the world for deaths secondary to skin cancer, with an average of 2.7 deaths per 100,000 people, and is considered to be within the group of countries with the highest skin cancer related death rates.[11] In 2013, there were over 14,500 confirmed cases, accounting for 4% of all cancer cases in the UK, and making malignant melanoma the 7th most common cancer in men, and 5th most common cancer in women in the UK. Malignant melanoma is the most common type of cancer for young adults aged 25-29 years old, and the second most common type of cancer for young people aged 15-29 years old. More recently, in 2016, there were around 16,000 confirmed cases of malignant melanoma.[12] Melanoma is prone to metastasise (spread), making it responsible for up to 90% of skin cancer deaths; 2285 deaths in the UK in 2016 alone. Furthermore, among Caucasian populations in the UK, the incidence of melanoma has quadrupled over the last 30 years, and is expected to be among the cancers with the fastest increasing incidence over the next 20 years, rising by a further 7%.[12,13]

BCC and SCC are very common in the UK as well. In 2015, more than 142,000 new cases were diagnosed, with about 80% being BCC and the remaining 20% SCC. Similar to melanoma, the incidence of BCC and SCC has risen over recent decades, with an increase of 61% over the past 10 years alone.[11,12]

 

How does the sun’s UV radiation affect the skin?

The sun’s UV radiation is composed of UVA, UVB and UVC components based on photon (a basic particle of light) wavelength, with UVA having the longest wavelengths (315-400nm), UVB being mid-range (290-320nm) and UVC being the shortest wavelengths (100-280nm).[9] UVA rays, which are not absorbed by the ozone layer, penetrate deep into the skin. UVB are partially absorbed by the ozone layer, but are still dangerous as they still penetrate the skin, mostly affecting the surface of the skin and are the primary cause of DNA damage and sunburn. Since ambient sunlight is composed of UVA (90%-95%) and UVB (5%-10%) radiation, skin cancer is caused primarily by exposure to UVA and UVB radiation, with most UVC radiation absorbed by the ozone layer.[9,10]

The intensity of the sun’s UV radiation varies not only throughout the year, but throughout the day too. UVB intensity is the highest during the summer months, but UVA reaches the earth surface all year round. At noon, when the sun is at its highest point in the sky, the sun rays have the least distance to travel through the atmosphere, meaning that the intensity of the sun’s rays is markedly increased. In the early morning and late afternoon, the sun rays pass at an angle through the atmosphere and the intensity of UVB radiation is significantly reduced but still harmful.[14]


Maximising sun protection

To help protect the skin from the sun’s UV radiation and to reduce risk of skin cancer, the following action steps should be followed as closely as possible on a daily basis:[12,15]
• Wear appropriate protective clothing to cover as much of your skin as possible[12]
• Avoid intense sunlight, especially between 11am-3pm, and seek shade whenever possible[12]
• Avoid sun tanning and do not burn[12]
• Apply SPF50+ sunscreen generously and regularly[12]
• Watch for the UV Index (the amount of skin-damaging UV radiation reaching the earth’s surface at any instant of time)[16]

 

 

What is the Sun Protection factor (SPF)?

SPF is a measurement that is used in the ratings of sunscreens.[17]

SIMPLE EXPLANATION: The SPF number indicates how long the sun’s UV radiation would take to damage the skin when using sunscreen exactly as directed versus the amount of time it would take without any sunscreen.[17,18] An SPF of 15 means that it would take roughly 15 times longer for the skin to be damaged when using this product compared to skin that lacked sunscreen; while an SPF of 30 or 50 means that it would take roughly 30 or 50 times longer for the skin to be damaged when using this product compared to skin that lacked sunscreen.[17]

 


Adapted from Ego Pharmaceuticals Pty Ltd.[18]

 

SCIENTIFIC EXPLANATION: SPF is defined as the ratio of the least amount of UV radiation required to produce a minimal reddening on skin protected by sunscreen to the amount of UV radiation required to produce the same reddening on unprotected skin (i.e., the minimal reddening dose).[17]

 

The benefits of an SPF50+ sunscreen

One of the key skin cancer prevention strategies is the consistent use of an SPF50+ broad-spectrum sunscreen, that will ideally provide a combination of ingredients that covers both UVA and UVB radiation and offers high SPF, all in a cosmetically pleasing formulation.[18] Key to this strategy is the consistent, correct application of sunscreen according to the ‘7 teaspoon rule’ to ensure it will function as intended.

 


Adapted from Ego Pharmaceuticals Pty Ltd.[18]

 

Take-home message

Applying and re-applying sunscreen frequently and as directed is an important way to help reduce the negative side effects from harmful UVA and UVB radiation from the sun and to minimise the risk of skin cancer. Using an SPF50+ sunscreen in combination with protective clothing and shade is the best possible way to maximise protection from the sun’s UV radiation.

 

References

1. Cancer Council. Types of cancer: skin cancer [Internet]. Available from: https://www.cancer.org.au/cancer-information/types-of-cancer/skin-cancer. (Accessed: 07 February 2022).
2. Silpa SR, Chidvila V. A review on skin cancer. Int Res J Pharm. 2013; 4(8):83-88.
3. Cancer Council. Cancer types: understanding skin cancer [Internet]. Available from: https://www.cancer.org.au/assets/pdf/understanding-skin-cancer-booklet. (Accessed: 07 February 2022).
4. Ghiasvand R, Robsahm TE, Green AC, Rueegg CS, Weiderpass E, Lund E, Veierød MB. Association of phenotypic characteristics and UV radiation exposure with risk of melanoma on different body sites. JAMA Dermatol. 2019; 155(1):39-49.
5. Cives M, Mannavola F, Lospalluti L, Sergi MC, Cazzato G, Filoni E, Cavallo F, Giudice G, Stucci LS, Porta C, Tucci M. Non-melanoma skin cancers: biological and clinical features. Int J Mol Sci. 2020; 21(15):5394.
6. Bataille V, de Vries E. Melanoma-Part 1: epidemiology, risk factors, and prevention. BMJ. 2008; 337:1287-1291.
7. Cancer Council. Types of cancer: understanding melanoma [Internet]. Available from: https://www.cancer.org.au/assets/pdf/understanding-melanoma-cancer-booklet. (Accessed: 07 February 2022).
8. Svobodová A, Vostálová J. Solar radiation induced skin damage: review of protective and preventive options. Int J Radiat Biol. 2010; 86(12):999-1030.
9. Amaro-Ortiz A, Yan B, D’Orazio JA. Ultraviolet radiation, aging and the skin: prevention of damage by topical cAMP manipulation. Molecules. 2014; 19(5):6202-6219.
10. Sander M, Sander M, Burbidge T, Beecker J. The efficacy and safety of sunscreen use for the prevention of skin cancer. CMAJ. 2020; 192(50):E1802-E1808.
11. Robertson FML, Fitzgerald L. Skin cancer in the youth population of the United Kingdom. Journal of Cancer Policy. 2017; 12:67-71.
12. Jones OT, Ranmuthu CKI, Hall PN, Funston G, Walter FM. Recognising skin cancer in primary care. Adv Ther. 2020; 37(1):603-616.
13. Mistry M, Parkin DM, Ahmad AS, Sasieni P. Cancer incidence in the United Kingdom: projections to the year 2030. Br J Cancer. 2011; 105(11):1795-1803.
14. Elmarzugi NA, Keleb EI, Mohamed AT, Issa YS, Hamza AM, Layla AA, Salama M, Bentaleb AM. The relation between sunscreen and skin pathochanges: mini review. International Journal of Pharmaceutical Science Invention. 2013; 2:43-52.
15. USA Environmental Protection Agency. Sunscreens: the burning facts [Internet]. Available from: https://www.epa.gov/sites/production/files/documents/sunscreen.pdf. (Accessed: 07 February 2022).
16. Cancer Research UK. The UV index and sunburn risk [Internet]. Available from: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer/the-uv-index-and-sunburn-risk. (Accessed: 07 February 2022).
17. Paul SP. Ensuring the safety of sunscreens, and their efficacy in preventing skin cancers: challenges and controversies for clinicians, formulators, and regulators. Front Med (Lausanne). 2019; 6:195.
18. Ego Pharmaceuticals Pty Ltd. Expert care for the sun aware [Internet]. Available from: https://www.sunsense.co.uk/expert-suncare/. (Accessed: 07 February 2022).

 

This technical report reflects the science behind the topic only, and is not approved content for any Marketing purposes. If you wish to use this content to promote Ego products, please make sure that you do so appropriately and submit whatever content you create to Regulatory Affairs for review.

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