skin cancer: journal time! What 4 things can you do to prevent it?

I am doing CME (continuing medical education), and I decided to do some reading on skin cancers. When I started my practice 20 years ago, I took out hundreds of skin cancers a year. When doing this CME, I found that skin cancer rates are rising (!!). The thought is there are more older people and we are better at diagnosing it. But what can you do to prevent it??

Read on, as I learned a few pearls today. (Like topical retinoid doesn’t reverse your risk of precancers like oral retinoid does….)

These are tips for NON melanoma skin cancer– Basal Cell and Squamous Cell cancers.  For more info on these cancers, read my next blog.

Things you can do to prevent non melanoma skin cancer:

1. SUN PROTECTION & AVOIDANCE.   I know this will get an eyeroll, but good skin care practices are still the best thing you can do.
   1. Daily sunscreen. It reduces new actinic keratosis (pre cancers), helps AKs go into remission, and reduces squamous cell cancers.
   2. Avoid sun 10-4pm
   3. Put SPF 15 or higher on, put on 15 minutes prior to going outside. Reapply every 2 hours.
   4. Wear protective clothing: wide brimmed hat, sunglasses, and long sleeved shirts.
2.  NO TANNING BEDS.  They are super bad.  They emit UVA radiation
   1. One study showed a 67 percent increased risk of developing squamous cell carcinoma for patients with a history of tanning bed use.
3. TAKE ORAL RETINOIDS. (e.g., acitretin, isotretinoin)
   1. They reverse actinic damage at the epidermal/dermal layer.  They are Vitamin A derivatives, which help prevent AKs and squamous cell cancers.
   2. Lifelong use is recommended for high-risk patients –history of multiple or high-risk nonmelanoma skin cancers, genetic disorders (e.g., xeroderma pigmentosum), transplant recipients, and psoriasis patients that have received high levels of psoralen with ultraviolet treatment.
   3. CANNOT USE WHILE PREGNANT or TRYING TO CONCEIVE.
4. ORAL VITAMIN B3. 
   1. reverses DNA damage induced by UV light.
   2. Take this over the counter supplement (500 mg, twice daily)
   3. One randomized controlled trial, those who took B3 for 12 months had significantly fewer new actinic keratoses, squamous cell carcinomas, and basal cell carcinomas

What do I think?

All the sun exposure stuff is well known. I give that talk yearly to our middle schoolers.  Avoiding tanning beds is also a no brainer. If you don’t want to do it to avoid cancer (think of those melanoma cases at age 23 in a tanning bed addict), then do it so your skin looks better when you get older. So it is good for you AND it keeps you pretty.

The Vitamin A and Vitamin B3 stuff though was new to me. The studies show oral Vitamin A reduced your risk, but topical retinoids did not. I will have to look into that one.  And the Vitamin B3 seems like a no brainer for anyone high risk.

I am writing this blog in part so I can send a few of my friends the links. (Yes, they are blond California girls…) I have friends who in their 40s already had multiple skin cancers and had to do topical chemotherapy (5FU) to try to help their skin.  Taking a few vitamins and statistically significantly reducing their future skin cancer risk? Priceless.