Flip Flops, Baseball Caps, and Skin Cancer

It’s the middle of summer and a heat wave covers much of the US. Not surprisingly, skin cancer and sun protection have been the focus of many news articles and health warnings. A health warning that I haven’t seen before is the warning that wearing flip flops and adjustable baseball caps increases the risk of skin cancer. The increased risk is attributed to sun exposure to skin areas (e.g. tops of feet, scalp/neck) that are usually covered and often are overlooked when sunscreen is applied.

Skin cancer is the most common type of cancer in the US. Basal cell carcinoma is the most common subtype, followed by squamous cell carcinoma of the skin. Melanoma occurs less frequently, but is much more deadly. Skin cancers are caused by ultraviolet (UV) radiation from the sun and places I wish would close down and never reopen —tanning salons. I read somewhere that tanning salons now outnumber the number of McDonald’s in the US. The problem with tanning salons is that the lamps in the tanning beds emit UV radiation that is about 10-times stronger than the sun's rays that occur naturally. Not surprisingly, both the incidences of skin cancer, as well as its severity, are on the rise—largely because of tanning salon radiation.

Although many people with darker skin or skin that tans rather than burns tell me that they don’t need sunscreen, they actually do. Melanoma skin cancer rates of Latinos are now close to those for Caucasians. African Americans have a much lower melanoma survival rate when compared to Latinos and Caucasians.

It’s important to remind patients that they need to read sunscreen labels and look for sunscreens that protect against both UVA and UVB radiation. They also need to know that an SPF 15 sunscreens blocks 93% of UVB rays while an SPF 30 sunscreen blocks 97%. And although an SPF of 50 is thought by many to be far superior it blocks only slightly more (98%). I haven’t yet instructed any patients to avoid wearing flip flops and baseball caps. Seems a little silly to me; however, I do tell patients to cover all areas of exposed skin with sunscreen. And I review skin cancer prevention information with each patient at this time of year; I’ve been surprised at the number of patients who lack knowledge about sunscreens and can benefit from this information.