Make sunscreen part of a daily routine

It might seem as though sunscreen is unnecessary on cloudy days, or days when you think you’ll only be outside for a short time, but Dr. Pon recommends putting on sunscreen every day, no matter what.

“It’s a good habit, a good routine to get into every day,” she says, adding that weather can be unpredictable, and a day that starts cloudy and overcast could become bright and sunny later on. “You should prepare for the day, not just for that instance when you’re out.”

And while it might seem that sunscreen only needs to be a part of a summer routine, Dr. Pon says people should continue to wear sunscreen in the winter months as well.

“UV rays can bounce off the snow and ice and get reflected, so it’s important to use sunscreen all year round, and every day.”

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Skin cancer: warning signs and symptoms

The COVID-19 pandemic means a lot of our activities and socializing will be outside this summer. While we’re enjoying the warm weather and sunshine, it’s important to remember sun safety, and that includes being aware of any skin changes that could indicate skin cancer.

Melanoma

Pay attention to moles that are asymmetrical, have a diameter of 6mm (larger than a pencil eraser), have an uneven border, have changed colour or have changed rapidly.

Basal cell or squamous cell carcinoma

Typically found on face, upper chest, neck; areas with high sun exposure

Basal cell carcinoma is often a sore that will bleed, scab and bleed again without healing, and it grows slowly over time.

Squamous cell carcinoma is often a crusty sore that won’t heal and can also grow slowly over time.

Early detection is very important for skin cancer, so if you have any of these symptoms, don’t hesitate to contact your family doctor, who can refer you to a dermatologist if necessary.

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Selecting a sunscreen

“The best sunscreen is the one that you like and that you’re going to use,” says Dr. Pon. She says it should be a minimum of SPF 30, but other than that, whether it’s a cream, spray or even tinted sunscreen doesn’t matter as long as you’ll wear it daily.

Dr. Pon does say not to rely on SPF in moisturizers or makeup as the only sunscreen you wear, though.

“Typically, these have a lower SPF than an SPF 30,” she says. “Also, more than half a teaspoon is recommended for the face and neck, and people don’t put that much makeup on their face.”

If you’re going to be outside for the day, plan to reapply sunscreen every two to three hours, and more frequently if you’re sweating or swimming. You should be applying more than half a teaspoon of sunscreen to each arm, and more than a teaspoon to the chest, torso, back and each leg.

Know your skin

In addition to wearing sunscreen daily, it’s important for people to check their skin for any changes that could indicate sun damage. For those who have a lot of moles, freckles or spots, Dr. Pon says an easy way to track any changes is to take pictures of the spots and use them for reference.

“We do recommend people check their moles once a month,” says Dr. Pon. “I always recommend to my patients the first day of the month or the last day of the month, so it becomes routine.”

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Our long winter means I want to get outside ASAP. I know I’m not the only one who wants to shake off the winter cobwebs with some fresh air!

But before we do, remember these tips from a dermatologist to help us protect our skin from the sun.

A history of sunburns increases the risk of skin cancer, including melanomas. Sun exposure can also cause wrinkles, dry skin and age spots.

Dr. Mary McKenzie, dermatologist in Sunnybrook’s Melanoma Clinic, recommends using a sunscreen 30 SPF or higher if you will be outside. Some make-up and face creams now have SPF between 15 and 30 – that’s OK for your daily use. (For example, if you are just going from your house to car to head to the grocery story and back but not spending time outside, that makeup will provide enough coverage.) If you’ll be outside longer — to take a walk, sit in the backyard or wait in line outside of the hardware store, reach for an SPF 30 or higher. If your skin gets irritated after applying sunscreen, try a mineral formula. If you tend to break out after applying sunscreen, try a formula that is made for acne-prone skin.

While skin cancer is more common in people with light or pale skin, red hair or freckled skin, people with other skin types and tones are not without risk. People of all complexions should also wear sunscreen daily and practice sun safety.

Lips are super sensitive, and should be protected from the sun, particularly when you are near water (which reflects the sun). Try a chapstick with 30 SPF or more. And reapply often. Some colour lipsticks also offer SPF protection.

Don’t forget to apply sunscreen to the commonly missed places — your ears, tops of your feet and hands. Wear a hat to protect the top of your scalp (in particular if your hair is thin, fair or if you are bald) or apply sunscreen on the top of your head. Dr. McKenzie says the top of the head is a common trouble spot when it comes to skin cancers.

Cover up or find shade

There are ways to cover up besides sunscreen. Wear light, long-sleeve clothing to protect your skin. Linens are nice and airy. Or there’s sun-protective clothing available too. Wear a hat. Avoid the outdoors mid-afternoon when the sun is at its peak. Seek shade. Carry an umbrella.

And wear shades

Dr. McKenzie doesn’t recommend putting sunscreen on your eyelids – sweat can make the sunscreen run into the eyes and sting. Sunglasses do double duty – they protect the eyeballs and the eyelids. So don’t forget them!

If you find your eyes do sting (often from sunscreen mixed with forehead sweat) try a mineral sunscreen.

Rub it in

Be sure to put a thick coating of sunscreen on your skin (about a shot glass worth) and rub it in. If you are using a spray sunscreen, keep the bottle close to the skin when you spray. “With the spray bottles, it’s a little harder to tell if you’ve missed a spot,” Dr. McKenzie says. “Be sure to still rub it in and use enough sunscreen.” Don’t spray it in the wind – you want to make sure it’s getting onto your body.

After sun

Is there anything we can do to feel better or minimize a sunburn’s effects? Dr. McKenzie says try a mild cortisone cream, available over-the-counter, to reduce the inflammation. But, most importantly, try to avoid the burn by using sunscreen and following the other tips above.

(This post was reviewed and updated April 28, 2023)

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When caught early, melanoma is a highly treatable form of cancer.

Thank you to Dr. Mary McKenzie, dermatologist, and Dr. Teresa Petrella, medical oncologist, for their tips on prevention and screening for melanoma.

Wear sunscreen.

This ain’t news. But we’ll remind you: We should all be wearing daily sunscreen of 30 to 60 SPF on exposed skin. Add this to your morning routine. While getting a sunburn doesn’t mean you’ll automatically develop skin cancer, a history of sunburns does put you at higher risk.

This means you (no matter your skin tone).

While melanoma is more common in those with fair complexions, red hair or freckling skin, other skin tones and types are not exempt. People with dark complexions should also wear sunscreen daily.

Say “absolutely no” to tanning beds.

No good can come of spending time in a tanning bed. Just don’t do it. The law in Ontario says teens under 18 aren’t allowed. But adults shouldn’t use tanning beds either. According to SkinCancer.org, people who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent. Other studies have found that the risk of melanoma goes up with the hours/sessions/years spent using tanning beds. (More on that here.)

Check yourself and your partner/friend/family members.

You (and sunscreen!) are your best defense against melanoma. Perform self-screening each month. Remember, not all melanoma follow these ABCDEs to a T. So check in with your doctor or dermatologist regularly if you have moles.

Here’s what you are looking for, from Melanoma.Org. If you have moles or lesions with any of these factors, make an appointment with your family doctor or dermatologist. Look for moles or lesions on the skin that are:

A – asymmetrical in shape. (This means they aren’t an even circle or oval.)

B – border. Non-cancerous moles tend to have smooth edges. Melanoma lesions often have irregular edges.

C – colour. A spot that has more than one colour (brown, black, red, tan) or colour that isn’t evenly distributed.

D – diameter. Is the mole wider than 6 millimeters? (about the size of a pencil eraser)

And most important of all:

E – Evolution. If and how your moles change can be the most important thing to consider when screening yourself for melanoma. If your moles look different in colour, size or shape, call your doctor. 

Not just moles.

There are other types of skin cancers that don’t look like moles. Wounds that won’t heal; hard, pink acne-like lesions on your face that don’t go away — these could be suspicious. Make an appointment with your doctor or dermatologist if you have anything like this on your skin.

Melanoma caught early has an excellent prognosis – keep an eye on your skin and your family members’ and talk to your doctor if you see changes.

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The Question: I suspect I have acral melanoma on my foot and I want an excision biopsy done. Most family practitioners are unaware of what it is, and they simply did not know what it is. I waited for a long time and saw a dermatologist who wasn’t sure what it is either. He said it’s a birthmark even after telling him that I only had it for 1.5 years and it grew over the period of time. After reading some suggestions from melanoma survivors (who strongly think this doesn’t look good and need to be removed), I am trying to get an excision biopsy from a melanoma specialist, regardless of what it is for peace of mind.

The Answer: Right off the bat, doctors will tell you any new lesion is worrisome – especially one that is growing – and that it definitely needs to be seen. I like that you have reached out to melanoma survivors for advice and it sounds like they have been able to confirm for you that this mark on your foot looks suspicious.

The only part of your question that gives me pause is that two physicians have already seen and dismissed it – your family physician and a dermatologist, the latter of whom would be particularly well placed to spot a suspicious lesion. I do think you are correct to pursue a biopsy as you require a definitive answer only a biopsy can provide that to you. Your preference for a total removal of the lesion for “peace of mind” may be extreme, given that the growth is on the foot and if it’s large, it could involve a skin graft or a rotational flap to reconstruct the area, according to Frances Wright, a surgical oncologist at Sunnybrook, who specializes in melanoma.

“He needs to have someone look at it,” Dr. Wright said in an interview. “If it needs a biopsy, then it may need to be an incisional biopsy (removing the most suspicious area) rather than an excisional biopsy (removing the whole area) to minimize the morbidity of the reconstruction. Most general surgeons can biopsy the foot.”

There are four major types of melanoma: superficial spreading, which is the most common making up 70 per cent of all diagnosed cases, nodular, lentigo maligna and acral lentiginous, the latter of which accounts for about five per cent of all diagnosed melanomas. [Nodular melanoma accounts for 15 per cent of cases, while lentigo maligna represents 10 per cent of cases].

The type you wrote about – acral lentiginous melanoma – is a common form of melanoma in Asians and those with dark skin. It is sometimes referred to as a “hidden melanoma” because the lesions occur on parts of the body that are typically not easy to examine – or that even one necessarily thinks to examine. These melanomas present on the palms of the hands, soles of the feet and mucous membranes, including those that line the mouth, nose, female genitals, anus and underneath or near the toenails and fingernails.

In your case, the lesion has appeared on the sole of your foot. Typically, melanoma looks like a black spot. Sometimes people mistakenly believe the mark is due to bruising or a recent injury.

Doctors are taught the classic signs of a melanoma are asymmetric lesion, irregular borders, change in colour or multi-coloured, diameter >6mm or ulcerated/ bleeding.

“If it looks suspicious, you need to do a biopsy,” said Dr. Wright, associate professor of surgery at University of Toronto. “Something new that is changing can be worrisome. In the end it’s going to be a discussion between the physician and the patient on how worrisome it is.”

Sunnybrook’s Odette Cancer Centre is the only place in Canada that has a pigmented skin lesion clinic that runs every Monday. There, you can have your suspicious lesion looked at by a dermatologist and an oncologist, if need be. You can access it if you are referred by a family physician through our central referral fax number 416- 480-6179 or referral telephone number 416-480-4205.

“The majority – 70 per cent of melanomas, – present with a depth of less than 1 mm and have a very good outcome,” according to Dr. Wright. “There are a proportion of melanomas that do present deeper and can be life threatening.”

Another alternative is that you return to your family physician and ask to be referred to a general or plastic surgeon to do a biopsy and if necessary, have it removed. Many dermatologists perform these biopsies as well.

I agree you need to vigorously pursue this, get a biopsy and a definitive finding. The biopsy alone will likely give you that peace of mind you seek.

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