May is Skin Cancer Awareness Month! While the best way to prevent skin cancer is to avoid sun exposure entirely, for most of us, a sunny day is too good to resist. To help you protect yourself from sun exposure, dermatologist Dr. Emily Ruiz from Brigham and Women’s Mohs and Dermatologic Surgery Center at Brigham and Women’s Faulkner Hospital, reviews five “over the counter” products that claim to impact skin cancer risk.
Nicotinamide is a form of vitamin B3 that has been shown to reduce basal cell carcinoma and squamous cell carcinoma by 23 percent. Nicotinamide has protective effects against ultraviolet damage, which is obtained through sun exposure. The vitamin is safe and can be purchased over the counter. “My colleagues and I recommend starting the vitamin (500mg twice a day) to all of our patients with a history of a basal cell carcinoma or squamous cell carcinoma or with extensive sun damage,” says Dr. Ruiz.
NSAIDs, such as ibuprofen and aspirin, may have a modest effect on skin cancer prevention. Studies have shown a reduction of 15 percent in squamous cell carcinoma with non-aspirin NSAIDs and 18 percent with any NSAID. Dr. Ruiz says, “Some studies in melanoma have also shown positive results, one with a 43 percent reduction in melanoma when taking continuous aspirin for 5 years, while other studies have failed to show any risk reduction. Since studies have included varying doses of NSAIDs, it is difficult to know how much to take and high doses of NSAIDs have side effects, such as ulcers. So I do not routinely recommend taking NSAIDs to my patients.”
Polypodium leukotomos is a tropical fern found in Central and South America and has antioxidative, immunomodulatory and anti-inflammatory effects, and is currently being marketed as oral sun protection. “A recent small study found that the extract altered the tolerable level of ultraviolet B light (the more carcinogenic form of ultraviolet light) to varying degrees. However, it is difficult to extrapolate dosing in clinical practice from the study. Thus, I do not currently recommend this to my patients, but I do plan to try the extract myself this summer!” says Dr. Ruiz.
“Although alcohol is not a classic ‘over the counter’ product, it has been in the spotlight in the past year as alcohol is estimated to be responsible for 3.5 percent of all cancer deaths,” says Dr. Ruiz. She says two meta-analyses suggested an association between skin cancer and alcohol intake. One study found that the risk of basal cell carcinoma increased by 7 percent and squamous cell carcinoma increased by 11 percent for every standard beer or small glass of wine each day. Another study showed a 20 percent increase in melanoma in drinkers and the risk increased with the number of drinks. However, these studies do have their limitations and there is no definite link between alcohol and skin cancer. So what is the recommendation? Dr. Ruiz says the American Cancer Society recommends limiting alcohol consumption to one drink per day for women and two drinks per day for men.
Sunscreen has been shown to reduce both melanoma and squamous cell carcinoma. Studies have shown that sunscreen reduces melanoma by 50 percent and squamous cell carcinoma by 40 percent compared to individuals who used sunscreen at their own discretion. “As the weather starts to improve, remember to apply a broad-spectrum sunscreen with at least SPF 30 prior to going out in the sun,” says Dr. Ruiz. “Reapply every 2 hours and apply liberally (1 teaspoon to each arm, head and neck, front torso and back and 2 teaspoons to each leg)!”
To make an appointment with Dr. Emily Ruiz or another dermatologist at Brigham and Women’s Faulkner Hospital, call 617-983-7500.
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