9 Things I’d Never Do As a Dermatologist

Summer’s coming. How many of these skin ‘don’ts’ do you do?
Woman with sunburn and sunscreen

According to the Centers for Disease Control, Vermont ranks No. 3 in the nation for new skin cancer cases diagnosed annually. While some skin cancers are influenced by genetics, there is also a strong behavioral component to skin cancer risk – and a lot of that risk is avoidable.

We asked Santana VanDyke, MD, one of the chief residents of dermatology at the University of Vermont Medical Center and future faculty member of the UVM Medical Center Division of Dermatology, to share some things that she would never do, based on her knowledge of skin cancer risk factors.

Here is her list of “nevers.”

1. Skip sunscreen

Ideally we should all be applying sunscreen to sun-exposed areas (especially the face, ears, and hands), no matter the plan, Dr. VanDyke advises. Be even more cautious if spending a lot of time outside, especially during peak mid-day hours, between 10 am and 2 pm, she says.

Use SPF 50 or above, and reapply every 2 hours, or every 30 minutes if you’re sweating or spending time in the water. Dr. VanDyke says the brand or type doesn’t matter much as long as the sunscreen is “broad spectrum.” However, she advises against using spray sunscreens, especially at a windy beach, as half of the product often blows away. For this reason, she prefers traditional lotions.

2. Laugh at hats, sunglasses, lip balm and protective clothing

Broad-brimmed hats and sun-protective clothing are a great idea, says Dr. VanDyke, because they keep us protected when we miss a spot with the sunscreen. And sun-protective clothing can be much more convenient than constantly reapplying sunscreen if you’re doing water sports.

Sunglasses are also important. It’s possible, Dr. VanDyke says, to get skin cancers in and around the eye, so these areas should also be protected from the sun. It’s very hard to get sunscreen all the way into the corners of our eyes without actually getting it in our eyes, so we often stop short of fully protecting ourselves. She advises people to wear sunglasses that offer 100% protection against UVA/UVB or 100% protection against UV 400.

Lip balm will not only prevent the discomfort of chapped lips, but lip balm with sunscreen (at least SPF 50) will also protect against cancer of the lips, something Dr. VanDyke sees quite frequently.

3. Get a “base tan”

It’s a common misconception that getting a “base tan” will protect you from getting a sunburn later. Not only is this not true, but it means you’re starting out the season by damaging your skin. Tanning is a sign of skin damage, Dr. Van Dyke says, which can ultimately result in DNA damage and the development of skin cancer. Tanning also ages the skin more quickly and can make you appear older.

4. Visit a tanning bed

“Where I grew up [Virginia], it was normal to go tanning. You would get a subscription before prom and you’d go for several sessions,” says Dr. VanDyke. Now she shakes her head. “Dermatologists hate tanning beds. Stay away from them at all costs.”

As for the “safer premium packages”, don’t believe it, she says. “They’re all bad. You’re being exposed to very harmful UV rays in very close proximity, without the protection that nature gives us in the forms of atmosphere and cloud cover.”

Using a tanning bed even just once dramatically increases your risk of skin cancer. One study showed that people who had used a tanning bed before the age of 20 faced a 47% higher risk of melanoma than the general population.

If you’ve used tanning beds in the past, visit a dermatologist annually for screening.

5. Get a gel manicure (without sunscreen)

The lights that are used to cure a gel manicure are basically mini tanning beds for your hands, says Dr. VanDyke. While nail salons sometimes refer to the lights as “e-lamps,” they use UV lights similar to tanning salons.

Based on what she learned at a recent dermatology conference, Dr. VanDyke is doubling down on her recommendation to wear sunscreen on your hands, which see a high incidence of skin cancer anyway, due to exposure while we’re driving.

Dr. VanDyke wants to see further research on the level of risk presented by gel manicures. But for now, she says, definitely wear sunscreen on your hands if you go.

6. Smoke

“Smoking causes DNA damage in the skin,” Dr. VanDyke says. “And that’s on top of any risk you may have due to your family history, or sun exposure.” Skin cancer is just one more reason to quit.

7. Ignore your family history

While basal cell and squamous cell skin cancers are primarily related to sun exposure, melanoma also has a genetic component, Dr. VanDyke says. Anyone with a first-degree relative who has had melanoma should have an annual check-up.

8. Ignore your personal history

Similarly, if you have a history of skin cancer yourself, if you’ve used tanning beds in the past, or if you’ve had a lot of sunburns throughout your life, you should also visit a dermatologist every year. Fairer-skinned people are generally at higher risk for skin cancer, especially those with significant sun damage. Patients who are immunosuppressed from certain types of chemotherapy or those who have undergone organ transplant should also definitely have their skin checked by a dermatologist.

9. Ignore new moles or skin changes

Dr. VanDyke’s final “don’t” is to ignore or dismiss any changes you see in your skin. Any spot or mole that meets the standard “ABCDE” test, she says, warrants a call to your doctor.

A – Asymmetry: A strange shape is suspicious.

B – Border: A smooth border is usually fine, but a choppy one is more worrisome.

C – Color: A lesion that’s very dark or multicolored needs to be looked at.

D – Diameter: Spots bigger than a pencil eraser.

E – Evolving: “This is the most important one,” Dr. VanDyke says. When a mole or a lesion is new or changing, call your doctor.

To this list, Dr. VanDyke adds a final letter she picked up during her training: “F, for ‘funny looking.’ If something just doesn’t look right, give your doctor a call. It’s always better to be safe than sorry.”

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