Skin Cancer

Sunscreen is a hot topic – and not just because it’s a summertime staple!

There are also many myths and misconceptions surrounding sunscreen’s safety, effectiveness and usefulness. 

So, if you’ve ever been confused about when – or if! – to use sunscreen, you’re not alone.

We asked dermatologist Anisha Patel, M.D., about common sunscreen myths. Read on for her answers.

Myth 1: All sunscreens work the same way.

False. Sunscreens can prevent sunburn in different ways.

Chemical sunscreens: The active ingredients in chemical sunscreens absorb UV rays as they hit the skin, Patel explains.

Physical blocker sunscreens: Physical sunscreens, which are also called mineral sunscreens or sun blocks, use ingredients such as zinc oxide and titanium dioxide to form a barrier on the skin’s surface that reflects UV rays.

Not sure whether to use a chemical or physical sunscreen? Hybrid sunscreens contain both chemical absorbers and physical blockers. 

When selecting a sunscreen, MD Anderson dermatologists recommend choosing a broad-spectrum product with at least sun protection factor (SPF) 30. 'Broad spectrum' means the product protects from both UVA and UVB rays which can lead to sun damage and skin cancer. SPF refers to the amount of UVB rays it blocks.

Myth 2: It doesn’t matter what kind of sunscreen I choose.

False. While wearing sunscreen is always a good choice, each type of sunscreen has instructions that must be followed to ensure your skin is protected. 

Sunscreen comes in formats including cream, lotion, spray, powder and stick.

Each type of sunscreen has benefits and limitations. For example, many spray sunscreens are clear and absorb into the skin quickly, but this feature can make it challenging to see if you’ve missed a spot.

Overwhelmed by options? MD Anderson dermatologists recommend physical blocker sunscreens. Patel says this is because they have the broadest range of UVA and UVB protection.

Whatever type of sunscreen you choose, always review its instructions for information on how – and how frequently – to apply and reapply.

Myth 3: Sunscreen causes cancer.

False. There is no medical evidence that sunscreen causes cancer. However, there is a lot of evidence that UV rays from the sun and tanning beds do.

In the past, some sunscreens were recalled for being contaminated with a chemical called benzene. Benzene is not normally found in sunscreen. This recall doesn’t mean you should stop wearing sunscreen, dermatologists say.

Still, some may feel more comfortable using sunscreens that don't absorb into the skin – that is, those physical blockers sunscreens described above.

Additionally, sunscreen isn’t the only way you can practice sun safety.

“There are a lot of sun protective options outside of just the creams and sprays,” Patel says.

Other ways to protect yourself from sun damage include:

• Wearing protective clothing that is dark and tightly woven, with ultraviolet protection factor (UPF) 50+
• Wearing a wide-brimmed hat
• Wearing sunglasses with UVA and UVB protection
• Seeking shade between 10 a.m. and 4 p.m. when sun rays are strongest

Myth 4: I have dark skin. I don’t need to wear sunscreen.

False. Dark skin is susceptible to sun damage.

It takes more sun exposure for darker skin types to get sun damage, Patel says. She explains this is because melanin, which gives skin its color, provides DNA with a small amount of sun protection. Still, this small amount of protection doesn’t prevent sun damage altogether.

“Darker skinned people can still get a sunburn, still get skin cancers and definitely still get photoaging from UV exposure,” Patel says.

Regardless of your skin color, apply sunscreen liberally 30 minutes before going out in the sun, and don’t forget to reapply every two hours or after swimming or sweating.

Myth 5: My sunscreen is waterproof, so I don’t need to reapply it after swimming or sweating.

False. According to the Food and Drug Administration (FDA), there is no such thing as waterproof sunscreen.

There is, however, water-resistant sunscreen. The FDA writes that these products offer water-resistant sun protection according to the time and SPF level specified on each product.

Heading for a beach day or outdoor workout? Choose a water-resistant sunscreen and follow the product instructions on how often to reapply. 

Myth 6: My sunscreen is SPF 50, so I don’t need to apply it as often.

False. No matter the SPF number, chemical absorber sunscreens only work for about two hours and should be reapplied after swimming or sweating.

Regardless of the SPF level you choose, you need to reapply with the same frequency, Patel says.

If you have trouble remembering to reapply, Patel suggests using a physical blocker sunscreen. These products don’t rub in or disappear into the skin, so it is easy to determine when to reapply.

“If you can see the white on your face, it's still working,” she says.

Myth 7: There is SPF in my makeup. I don’t need to wear sunscreen.

False. While Patel says that sunscreen in makeup counts, it usually doesn’t provide the recommended SPF levels.

“It's typically only 5 to 15 SPF, and we recommend 30,” she says.

Check that your makeup offers at least 30 SPF, and supplement with additional sunscreen as needed. Finally, don’t forget to apply sunscreen to other exposed areas of your body, and make sure you reapply sunscreen as directed throughout the day.

Myth 8: I only need sunscreen when it is sunny.

False. Sunburn and sun damage may be associated with hot, sunny weather, but they can also occur in cold, cloudy conditions.

“Even when it's cold, sun is getting through the clouds,” Patel says. 

While clouds filter some UVB rays, they don’t block UVA rays which are a risk factor for melanoma, she adds.

So even if it’s cloudy or cold, you need to apply your sunscreen the same way you would if it were a warm sunny day.

Myth 9: Sunscreen doesn’t expire.

False. “You cannot rely on expired sunscreen,” Patel says. “Nothing bad is going to happen if you use an expired one in terms of increased toxicity. It just won't work.”

It is also important to store sunscreen properly. Specific storage instructions can be found in the product’s ‘Drug Facts’ section.

For example, if you store your sunscreen in a hot car or in direct sunlight, Patel says the product could degrade earlier than its expiration date.

"You have to look at the storage recommendations. Sunscreen will only last until the expiration date if you keep it within those temperature ranges," she says. "If you go outside of those temperature ranges, the molecules that are protecting your skin will degrade faster.”

Request an appointment at MD Anderson online or call 1-877-632-6789.

The sun’s ultraviolet radiation damages skin cells, which can lead to sunburn, early aging and even skin cancer. Thankfully, sunscreen can protect your skin. 

But choosing a sunscreen isn’t as easy as it might seem. Sunscreens work in different ways and come in a variety of formats. And, beyond that, some people have concerns about sunscreen’s safety, necessity and usefulness. 

For help navigating the sometimes cloudy world of sunscreen, we spoke to Saira George, M.D., a dermatologist at MD Anderson in Sugar Land. 

How does sunscreen work? 

Sunscreen ingredients prevent UV rays from damaging your skin. There are two categories of sunscreen ingredients, George says. 

Physical blockers 

Physical blockers contain minerals such as titanium dioxide or zinc oxide ground into fine particles. These minerals sit on the surface of the skin and reflect UV rays away from your skin “a lot like a shield or mirror would,” George says. Sunscreen products that contain physical blockers are sometimes called sunblock or mineral sunscreens. 

Chemical absorbers 

Chemical sunscreen ingredients form a thin protective film that absorbs UV radiation before it penetrates the skin. Sunscreen products that contain chemical absorbers are sometimes called organic sunscreens. 

Both types of sunscreen ingredients have pros and cons. 

For example, physical blocker sunscreens generally do not cause irritation, stinging or allergic reactions, but they can be white and greasy. Meanwhile, chemical absorber sunscreen ingredients are usually clear and easy to apply, but these are more likely to cause irritation and allergic reactions. 

Many sunscreens use a combination of physical blockers and chemical absorbers to maximize the benefits and reduce the downsides. Additionally, many broad-spectrum sunscreens need a combination of ingredients to protect against UVA and UVB rays, the two types of ultraviolet rays that cause skin damage.

Which form of sunscreen is best? 

Sunscreens also come in forms such as lotions, sprays and powders. But which one is right for you? 

George typically recommends lotion and cream products.

“In general, I tend to steer people away from spray and powder sunscreens because it is harder to get effective coverage with them,” George says. “I also worry about the risks of the sunscreen product inadvertently getting into an area like your eyes or being inhaled.” 

Whatever sunscreen format you choose, look for an option that: 

• Provides sun protection factor SPF 30 or higher 
• Has broad-spectrum protection against both UVA and UVB rays 
• Is water-resistant 

Make sure you apply sunscreen liberally and reapply it every two hours or after swimming or sweating. Be sure to review your sunscreen’s instructions for specific information on how much product to use and how often to reapply. 

George recommends trying different products until you find one you can apply correctly and don’t mind wearing. 

“There are so many different options for sunscreens now; there’s one out there for everyone,” she says. “The best sunscreen is the one you’ll wear regularly.”

Is sunscreen safe? 

When it comes to sunscreen, the benefits outweigh any potential risk. 

UV damage plays a central role in the development of most melanomas, basal cell cancer, squamous cell cancers and other less common skin cancers, George says.

Studies show that sunscreen can help prevent skin damage caused by UV radiation. Regardless, George says many patients still ask about the necessity or safety of sunscreen. 

“I understand the concern. What’s more natural than sunlight? But we have to understand that there are carcinogens in nature, and too much UV radiation from the sun is an example of that,” she says. “Our bodies have amazing protective mechanisms in place to handle sun damage, but they haven’t evolved to overcome damage from the excessive sun exposure many of us rack up in our lifetime.” 

Studies show that the chemical and nonchemical sunscreens available today all appear to be safe. 

“We have lots of evidence to support sunscreen’s protective effects and very little that shows any dangers or risks from sunscreen’s use, but I can sympathize with concerns about chemicals in everyday products,” George says. 

If you are worried about sunscreen safety, George recommends choosing a simple mineral sunscreen which protects the skin by using physical blocker ingredients. 

When do we need to wear sunscreen? 

Sunscreen is often associated with hot, sunny summer days. But MD Anderson experts recommend wearing sunscreen and using other sun protection methods year-round.

“Peak UV intensity does tend to be much higher during the summer or on a bright cloudless summer day,” George says. “But as long as the sun is out, we are still getting exposed to some degree of ultraviolet radiation – including on cloudy or winter days.” 

She notes that altitude and reflective surfaces like snow and water can increase UV exposure. This means that it is important to apply sunscreen before activities like skiing or spending time by or in the pool. 

How else can I protect my skin from sun damage? 

Sunscreen is just one part of what George calls a “sun protection package.”

Ideally, your sun protection package will include multiple ways to protect your skin from the sun. 

Other ways to protect your skin from sun damage include: 

• Staying out of the sun during the peak UV hours of 10 a.m. to 4 p.m. 
• Wearing protective clothing. Choose items that are dark and have a tight knit or ultraviolet protection factor (UPF) 50+. 
• Wearing a wide-brimmed hat 
• Wearing sunglasses with UVA and UVB protection 

“My biggest advice about sunscreens is to remember they are specifically named “screens,” not “blocks” and should be used as part of a full sun protection package,” George says. “When you are trying to protect your skin, sunscreens are certainly helpful, but they aren’t a perfect shield.” 

Request an appointment at MD Anderson online or call 1-877-632-6789. 

Sunburn causes skin sensations that many of us are all too familiar with: stinging, burning, blistering, peeling, and, of course, that hallmark redness.

But why does sunburn happen? And are there any health risks that last after a sunburn has faded?

Dermatologist Saira George, M.D., answers these questions and shares how to prevent and treat a sunburn.

How your skin changes during a sunburn

Often, burns are associated with heat sources like flames or stoves. But did you know that it’s not actually the sun’s heat that causes sunburn?

Instead, George explains that ultraviolet radiation is responsible for sunburn.

“Sunburns are from ultraviolet radiation – or UV rays – causing damage to the skin,” she says.

When ultraviolet radiation from the sun reaches the skin, it damages the skin cells and causes mutations in their DNA.

“Our bodies have a lot of amazing mechanisms to prevent and even correct these mutations,” George says. “But if the skin cells get more UV exposure than they can handle, the damage may be beyond repair, and the cells die off. Blood vessels dilate to increase blood flow and bring immune cells to the skin to help clean up the mess. All this causes the redness, swelling and inflammation we associate with a sunburn.”

The sunburn will eventually heal, but some of the surviving cells will have mutations that escape repair. These cells could eventually become cancerous.

Cancers caused by sun damage

UV damage plays a central role in the development of the three most common skin cancers, George says.

These include:

• Melanoma
• Basal cell carcinoma
• Squamous cell carcinoma of the skin

She also notes that UV damage is linked to less common skin cancers, including:

• Merkel cell carcinoma
• Angiosarcoma
• Atypical fibroxanthoma

Tell your doctor about sun-related skin changes

After you get a sunburn, make note of any changes to your skin. Your doctor or dermatologist can examine these changes and recommend skin cancer screening, if needed.

“Anything that deviates from your normal skin that happens when you are in the sun or develops in an area that has received a lot of sun may be worth mentioning,” George says.

Tell your doctor about sun-related skin conditions such as:

• Rashes that develop in the sun
• Unusual growths in areas that have been sunburned or get a lot of sun
• New or growing spots that heal slowly, bleed or don’t look or behave like other spots on the skin

How to treat a sunburn

Sometimes, despite our best efforts, sunburns happen.

While it isn’t possible to reverse sun damage, there are ways you can protect and soothe your skin while it heals, George says.

Protect your skin

First, use sun protection to prevent additional sun damage to your skin as it heals.

Additionally, avoid exposing your sunburn to heat, harsh chemicals or friction.

Soothe your skin

Sunburn can be painful. To ease discomfort, George suggests applying cool compresses, calamine lotion or aloe-vera gel to the sunburned area.

If your skin is peeling or blistered, George recommends coating it with ointments like Vaseline, which she says can act like an “ointment bandage.”

Still not feeling relief? Over-the-counter anti-inflammatory pain medications like ibuprofen can reduce pain and inflammation.

What to know about reversing sun damage

Sun damage can also cause cosmetic changes such as sunspots, wrinkles and redness, George says.

Some beauty products claim they can reverse sun damage or even stimulate cell repair. But no research has shown that any topical skin care product or lotion can reverse sun damage.

“There’s no simple way to undo sun damage yet. But there are lots of simple ways to prevent it by being sun-safe and avoiding sunburns,” George says.

However, while skin damage can’t be undone on a cellular level, there are procedures that can make it less noticeable. 

“A lot of cosmetic concerns can also be addressed with your cosmetic provider if they are bothersome to you,” she notes.

How to prevent sunburn going forward

One of the best ways you can protect your skin? By preventing sunburns in the future!

Follow these sun safety tips to protect your skin from the sun and lower your cancer risk.

• Choose a sunscreen that has an SPF of 30 or higher, is water-resistant and offers broad-spectrum protection.
• Apply sunscreen at least 30 minutes before going in the sun.
• Reapply sunscreen every two hours, and after swimming or sweating.
• Seek shade when possible, especially when the sun’s UV rays are strongest between 10 a.m. and 4 p.m.
• Cover up with wide-brimmed hats, sunglasses with protection from UVA and UVB rays and UV-protective clothing.

“Preventing a sunburn is always better than treating one,” George says.

Request an appointment at MD Anderson online or call 1-877-632-6789.

When people talk about moles, they are usually referring to a variety of skin growths, including true moles — which are also called nevi — freckles and other growths. However, in dermatology, a mole is a very specific type of skin growth that looks a certain way under a microscope.

Ahead, I’ll share more facts you might not know about moles, including how to tell if they are healthy.

Raised or flat doesn’t mean healthy or unhealthy

We can’t rely solely on whether a mole is raised or flat to determine if it is healthy. Some moles and skin lesions naturally grow vertically rather than horizontally. Moles that grow up and down are going to feel more raised than moles that grow laterally.

Instead of whether a mole is raised or not, start with the ABCDE rule to help determine if your mole may be healthy or may be exhibiting signs of melanoma, a type of very high-risk skin cancer.

A is for asymmetry, or whether one half of the mole looks different from the other half.

B is for border. You can tell if your mole has an unusual border if it would be challenging to outline.

C is for color. Note if your mole is multiple colors.

D is for diameter. Is your mole larger than the size of a pencil eraser, or about 6 millimeters?

E is for evolving. Has your mole rapidly grown or begun to hurt, itch or bleed? If something is bleeding or painful, those are my signs that it should prompt attention.

You can also use the Ugly Duckling rule to determine if a mole may be abnormal. Ugly Duckling moles look different than your other spots. This could look like developing a black mole when all of the other moles on your body are brown.

If your mole meets any of the ABCDE criteria or follows the Ugly Duckling rule, make an appointment with a dermatologist for a skin cancer screening exam.

Having a high number of moles may increase your skin cancer risk

Having more moles — especially 50 or more — can increase your risk for melanoma.

If you have more than 50 moles, you are considered to have a higher risk for skin cancer and could benefit from an annual skin check with a dermatologist.

It is rarer to develop moles after age 40

Usually, after around age 40, people stop developing new moles. You can certainly develop other skin lesions after this age, though! Don’t be afraid to see a dermatologist about any type of new or rapidly changing spot on your skin, or a spot that bleeds, hurts or itches.

It’s possible to remove raised moles, but not always recommended

While it is possible to remove raised moles, many dermatologists prefer not to remove healthy-looking moles unless they bother or worry the patient. That’s because removing a mole can leave a scar. Moles can also grow back after they are removed, which can look atypical.

I also warn patients against getting moles removed by providers who aren’t dermatologists. While it isn’t common, it is possible to get a skin lesion partially removed that turns out to be cancerous. This can complicate and delay a skin cancer diagnosis.

If you have a mole that bothers or concerns you, talk to your dermatologist about the best way to proceed.

When in doubt, see a dermatologist

Check your skin every month. It can be hard to notice skin changes on a daily or weekly basis, but monthly check-ins allow you to note if a mole or other spot on your skin is dramatically changing.

If you wonder if a skin spot requires a trip to the dermatologist, I always recommend making an appointment. It can be hard to figure out what skin spots are normal on your own, not to mention challenging to check your own scalp or back.

At a skin screening, a dermatologist will look at your skin, sometimes with the help of a magnifying tool called a dermatascope. They may ask you questions about the history of the spot, how long it has been there and the changes that prompted your visit.

If your dermatologist sees any concerning spots, they may perform a biopsy. This involves removing a mole and looking at it underneath a microscope to diagnose if it is cancerous.

Another benefit of making an appointment with a dermatologist for a full body skin assessment? Your dermatologist can keep an eye on any skin changes that happen over time. In this case, preventive care is as simple as taking a look at your skin.

Request an appointment at MD Anderson online or call 1-877-632-6789.

As a dermatologist, I examine skin all day, every day. If I see something concerning on your skin, I may perform a punch biopsy to learn more about it. A punch biopsy is a minimally invasive procedure that takes a sample of your skin to check for signs of disease.    

Here, I’ll answer common questions about punch biopsies.

What does a punch biopsy test for?

Typically, we’ll do a punch biopsy if we see a rash or something suspicious on your skin, or if we suspect you may have cancer.

We give a sample of your skin to a pathologist to look at under a microscope. This can help us diagnose skin cancer or other skin conditions like moles, inflammatory skin conditions or precancerous lesions. It can also help us rule out cancer.

Why is it called a punch biopsy?

A punch biopsy is described by the tool that is used to retrieve the skin sample.

Your doctor will use a sharp, circular (punch) tool to cut deep into the tissue and then use scissors to remove a small core of skin.

What happens during a punch biopsy?

A punch biopsy is an outpatient procedure. This means it is done in a clinic or doctor’s office, and you can go home afterward.

You will be awake during the procedure. First, a nurse or doctor will inject a numbing agent like lidocaine into the skin where the biopsy will be performed. You might feel some slight discomfort when the needle is injected into your skin. After that, you should not feel any pain.

Your doctor will then use the punch tool to cut into your tissue and retrieve the skin sample. The actual sample is very small. A standard punch biopsy size ranges from about 2 to 8 millimeters.

You may get 1 or 2 stitches, depending on the size of the biopsy. Then, we’ll clean the area with an alcohol swab, apply an antibiotic ointment and cover the area with a bandage.

The entire procedure takes about 15 minutes.

How long does it take for a punch biopsy to heal?

You will need to keep the area dry for 24 hours after your punch biopsy. After that, you can begin washing the area with regular soap and water. We tell patients to apply petroleum jelly and a bandage to the area until the stitches are removed. We remove the stitches 10 to 14 days after the biopsy, depending on the location of the biopsy. After that, you can treat the area like normal.

There will be a scar any time you cut the skin. So, the biopsy will leave a scar that is the same size as the punch. In most cases, we perform 4-millimeter punch biopsies, which are very small.

When will you get the results from a punch biopsy?

Your biopsy sample will be reviewed by a pathologist, and the results will be given to your doctor. Your doctor will then share the results with you. This usually takes about a week.

It’s important to note that a punch biopsy is a technique for sampling the skin to look for disease or skin conditions. It is not meant to be a definitive treatment. Your doctor will go over the results with you and discuss the next steps, whether that’s treatment, surveillance or something else.

I always stress to patients that a punch biopsy is a minimally invasive procedure that we do often. It is not painful. And it usually takes longer for you to read over and sign the consent forms than it does for us to do the actual biopsy. So, you don’t have to be nervous about it.

Anisha Patel, M.D., is a dermatologist at MD Anderson.

Request an appointment at MD Anderson online or call 1-877-632-6789.