According to Cancer Research UK, rates of melanoma, the most deadly form of skin cancer, are at a record high in the UK, and the number of cases this year is projected to reach 20,800. However, sales of sun-care products increased by more than 11 percent in 2023, according to the market research analyst Kantar, despite a decline in general skin-care sales. So, where are we going wrong?
Dr. Zainab Laftah, a consultant dermatologist at HCA The Shard in London, says that although our awareness of sun protection has improved, “there are still huge gaps in knowledge about the risks associated with high UV radiation exposure,” and the public remain confused by the sometimes contradictory advice.
The health expert Professor Tim Spector recently tweeted that people should stop using SPF 50 sunscreen all year round because it “blocks our natural defences” by reducing vitamin D production, which, along with sunshine, is “helpful for melanoma survival.” Yet his posts were described as “frighteningly inaccurate” by others.
The positive news? Dr. Bav Shergill, a consultant dermatologist at the Queen Victoria Hospital, East Grinstead, and a spokesman for the British Association of Dermatologists, says it is “a reasonable estimate” that almost nine in ten cases of melanoma in the UK are preventable. And earlier this year, it was reported that a cancer vaccine being trialed in the UK could halve the risk of dying from melanoma. In findings presented to the American Society of Clinical Oncology conference, researchers described the effects of the vaccine, called mRNA-4157 and developed by Moderna, as “extremely impressive.” One of a range of vaccines in development, it is tailored to each melanoma patient and injected into their arm after surgery. It works by training their immune system to recognize the unique mutations on tumors and to track cancer cells.
“Personalized melanoma treatment with vaccines is a very exciting prospect and one we hope will become available to all within the next few years,” Shergill says.
In the meantime, we asked leading dermatologists what more we can do.
1. Beware the sunscreen paradox
The conundrum that more of us claim to use sunscreen yet rates of melanoma and other skin cancers are rising has been dubbed the “sunscreen paradox” by dermatologists at McGill University in Canada. In a paper published last year in the journal Cancers, they reported that “people use sunscreen as a ‘permission slip’ to tan.”
Shergill says that using a product marketed to protect against skin cancer can provide a false blanket of security. “The biggest mistake Britons make is in thinking that sunscreen is all you need to avoid skin cancer, as even if wearing it there are still risks of getting sunburnt. We know that most people don’t apply enough or may stay in the sun longer than the protection is effective for, because they are falsely overconfident they won’t come to harm.”
2. Use a minimum of SPF 30
“Using a broad-spectrum SPF 30 which has 98 percent UVB protection is adequate providing it has a high UVA protection and it is applied generously and regularly, but an SPF 50 with 99 percent protection is preferable,” Laftah says. “As a general rule, you need half a teaspoon of sunscreen for your face, neck and ears and six to eight teaspoons of sunscreen to cover an entire body, but most people don’t use anywhere near enough.” Sunscreen starts to lose effectiveness at about the two-hour mark, or even sooner if you engage in an activity that might have wiped it off, such as swimming, sweaty workouts or toweling yourself dry, so reapplication is essential.
3. Don’t forget to apply sunscreen to your feet
Badly sunburned feet are a common sight in summer as many Britons forget to apply sunscreen when wearing sandals and sliders. “If people do use SPF 50 as recommended, they still tend to neglect putting it on their lower legs and feet, which are common sites for skin cancer,” says Emma McConnachie, a consultant podiatrist and spokeswoman for the Royal College of Podiatry. “Check your feet and toenails regularly, looking for any new moles or changes in appearance, as melanoma can appear anywhere on the foot, including on the soles or beneath a toenail.”
4. Pay attention to ears, lips and hair parting
Dr. Mary Sommerlad, a consultant dermatologist and spokeswoman for the British Skin Foundation, says that it’s worth spending a few more minutes to target the hard-to-reach areas of the body that are often missed, leaving them prone to sun damage. Legs are the most common anatomical site for melanoma in women, with the backs of the knees often overlooked. In men with thinning hair, the top of the head is obviously vulnerable to sun damage, but the lips are also a very commonly affected site for men over the age of 50, with the lower lip more likely to be affected as it tends to get more sunlight exposure. Women are more likely to wear lipstick or salve containing SPF.
“Our ears are exposed and get burned very easily, as do the hands and forearms and the eyelids, which are also prone to skin cancer,” Sommerlad says. “Other prime sites to target are the back, the chest and décolletage, and your hair parting where skin is directly exposed to the sun’s rays.”
5. Check what you wear to cover up
Sunscreen is just one of the steps needed to protect yourself from the harmful effects of the sun’s rays, Shergill says. “Avoiding sun exposure between 11 a.m. and 3 p.m., wearing hats and good quality outdoor clothing and being prepared for your day out is essential.”
Sommerlad says you should ideally opt for fabric with a close weave—holding the item up to the light to check you can’t see through the material is a good idea. Darker or brightly colored fabrics filter more UV rays than pale, light colors, and some clothing brands with SPF 50 ratings are available.
“Put children in swimsuits that provide coverage for their delicate skin, and even as an adult wear a rash vest if at the pool or swimming in the sea,” she says. A peaked cap or wide-brimmed sun hat and UV-blocking sunglasses with polarized lenses to beat bright glare are good additions.
6. Sunbathing isn’t the only risk
It’s a misconception that sunbathing is the only risky behavior for skin cancer. Shergill says it is easy for people to overlook the risks of outdoor sports that can involve hours of sun exposure, including golf, cricket, cycling, running and tennis, and activities such as gardening. Last year Polish researchers reporting in the journal Cancers warned that such activities “may result in sunburn, solar damage and skin cancers” including basal cell carcinoma, squamous cell carcinoma and malignant melanoma. “Don’t dismiss the redness of windburn or sunburn after sports as being not important,” Shergill says. “Sunscreen should be worn and reapplied during any outdoor sports and activities.”
Winter and water sports carry their own risks, with the sun’s reflection from water or snow sometimes doubling the amount of UV light absorbed by the skin. According to the Polish team, sweat, or any kind of moisture on the skin, can increase photosensitivity, which washes away any sunscreen and makes skin more vulnerable to sun damage. “Apply SPF before you head out and reapply regularly, particularly if you sweat a lot,” Shergill says.
7. Do we really need to wear sunscreen all year round?
Beauty experts tell us we need to wear SPF all year round to reduce the appearance of sun damage and wrinkles, but is it really necessary for skin cancer prevention in the cooler, darker months? The short answer is yes. “Both UVA and UVB radiation are emitted all year round, not just in the summer months,” Laftah says. “And UVA radiation can also penetrate clouds, which means you can still get sunburned on an overcast day.”
About 15 minutes of daily unprotected sun exposure during the summer is enough to boost vitamin D production, but sunscreen should always be applied at other times.
8. Does diet offer any skin protection?
Eating a healthy, Mediterranean-style diet packed with whole grains, fish, nuts, fruit, beans and vegetables is known to offer protection against many forms of cancer. Last year researchers from King’s College London showed that patients who followed this type of diet benefited most from treatment for advanced skin cancer.
A high intake of antioxidants, in particular lycopene, which is found in cooked tomatoes, watermelon, apricots and papaya, has been linked to a lower risk of some cancers, and in 2010 a study in the British Journal of Dermatology found that people who regularly ate tomato paste over ten weeks were 40 percent less likely to be sunburned than those who didn’t.
However, a healthy diet alone will not prevent skin cancer. “Most of the risks for skin cancer are lifestyle-related and there’s no robust scientific evidence that diet alone plays a big role in the prevention of skin cancer,” Sommerlad says.
9. Be extra-vigilant from your sixties onward
Although there’s an upward trend across all age groups, it is midlifers and older people who are most at risk. Among the over-80s, there has been a steep 57 percent increase in skin cancer diagnoses over the past decade, with a 7 percent rise among the 25-49 age group. “Generally, the longer you live, the more exposure your skin has had to UV radiation, so there’s a cumulative effect,” Laftah says.
There are other factors that contribute to risks rising in the over-70s. Older people may be less able to assess their skin due to deteriorating eyesight or not having a partner to check their back. “They might have weakened immune systems or take immunosuppressant medication that makes them more susceptible to conditions including skin cancer,” Laftah says. “There are numerous factors involved.”
10. Under-20s should try to avoid sunburn at all costs
Sunburn is “an acute inflammatory reaction” that follows overexposure to UV radiation. Every single episode of sunburn causes direct damage to DNA, resulting in the death of skin cells. If you burn in childhood or adolescence, your risk of developing melanoma in later life is doubled. “Skin cells damaged by sunburn can then mutate into cancer cells,” Shergill says. “Sunburn under the age of 20 is strongly associated with melanoma development in later life, and that is why avoiding sunburn when you are young is key to reducing the incidence of melanoma.”
Peta Bee is a U.K.-based freelance health journalist
