Sun Safety

As dental professionals, prevention is the cornerstone of our work. As well as oral health advice, many of us already bring a wider preventative information into our patient conversations and include topics like smoking, alcohol, diet, oral cancer, stress and diabetes.

With the summer holiday season just gone, could we have also offered our patients current advice on sun exposure?

Skin cancer is the fastest rising and the most common cancer in the U.K. but unfortunately there is reportedly a lack of awareness in the general public and with medical professionals.

There are two main types of skin cancer, Non-Melanoma skin cancers (NMSC) and Melanoma skin cancer, which are the most serious type of skin cancer. Both are related to sun exposure and it is estimated that 80-90% of them could be prevented with ''Safe Sun'' advice.

The primary types of Non-Melanoma skin cancers are Basal Cell Carcinima (BCS)  and Squamous Cell Carcinoma (SCC). Both of  these skin cancers are named after the types of skin cells from which the cancer develops. It is also possible for a NMSC to be mixture of both these types.

Melanoma is the least common but most dangerous type of skin cancer because it is fast growing and likely to metastasise. It originates in the skin’s melanocytes. 

Solar Ultraviolet radiation causes changes to the DNA in these cells and once damaged, this can lead to skin cancer. 

Children, and those that burn easily,  are at greatest risk, but everyone should avoid sunburn and the use of sun beds, both of which hugely  increase the risk of skin cancer. There has been a steep rise in melanomas in the 15-35 year old age group and in particular in young women in their 20s. This is thought to be related to sunbed use. 

People who spend a lot of time outdoors for work or leisure,   or winter sports enthusiasts, will also be at greater risk. 

Safe sun advice is not only for those travelling abroad. The  sun is often strong enough to cause damage between mid-March and mid-October in the UK, even when it is cloudy or cool. 

The best way to assess sun risk is to check the UV index. This scores daily UV rays from 1-9. It can be found in most weather apps. Sun protection should be considered  for any UV index above 3, especially in fair-skinned people. 

It is not possible to estimate the risk of skin damage and sunburn from the temperature outside. This is because the warmth from the sun comes from infrared rays not  UV. The weather can be quite cool and cloudy but still have a high UV INDEX. 

Safe sun advice is also helpful in the prevention of herpes simplex  (HSV-1) flare-ups. Up to 40% of people will experience a flare up after sun exposure UV protection can help reduce this. 

Skcin, an organisation which promotes prevention and early detection of skin cancer recommends the five Ss of skin safety 

SLIP - on light clothing to cover skin. This is the most effective barrier to sun exposure. A close weave fabric will provide the best protection. 

SLOP - on sunscreen. Sunscreen should be at least SPF ( sun protection factor) 30 and should be reapplied every 2 hours or after swimming. Broadly speaking, sunscreens can be divided into two types ; mineral or chemical. Mineral sunscreens tend to contain zinc oxide or titanium oxide particles that reflect UV radiation. With the advent of nanoparticles,  in the last decade, mineral sunscreens  have become less opaque and more agreeable to use, providing less “white cast” than traditional creams. Chemical sunscreens absorb UV radiation and so can be transparent. 

SLAP -on a hat, preferably with a wide brim. Caps don’t provide protection for neck and ears. 

SLIDE - on sunglasses to protect eyes from UV radiation. UV light can cause cancer of the eyelids and cataracts. 

SHADE - keep under shade where possible particularly during the hottest part of the day but keep in mind that UV will still be reflected from water, sand and snow. 

Everyone should avoid burning and the use of sun beds.

Public health England introduced the Making Every Contact Count (MECC) approach to behaviour change in 2008. This approach supports the opportunistic delivery of healthy lifestyle advice and is underpinned by behaviour change models. It is a useful model for raising awareness of risks and communicating simple ways of reducing them MECC consists of giving “ brief “or “very brief” advice as an  “intervention” and many of us already use this model to signpost and provide risk advice  in relation to smoking and alcohol.

The advice can be as brief as 30 seconds meaning it might fit well into our busy schedules. NHS England provides free MECC  e-learning for anyone interested in finding out more about this model. 

Patients often mention upcoming holidays abroad or school holidays  to us. This might be a good opportunity to provide very brief advice on individual skin cancer risk alongside the 5 Ss of skin safety. 

We could also advise on regular self checks for  skin cancer and melanoma much as we do for oral cancer. 

Non-melanoma skin cancer may present as a sore or ulcer or an area of skin that:

• doesn't heal within 4 weeks
• looks unusual
• hurts, is itchy, bleeds, crusts or scabs for more than 4 weeks

Melanomas tend to start in existing moles or present as new moles. Melanoma UK recommends the ABCDE rule of melanomas  as a guide to identifying suspicious lesions that need further investigation. Pigmented lesions showing any of the following signs should be flagged for professional assessment: 

• Asymmetry -any asymmetrical lesion 
• Border - a lesion with “ ragged” borders
• Colour - moles with two or more colours 
• Diameter - a mole larger than 5mm 
• Elevation - a mole that has become more raised
• And additionally 
• Firm - a mole that feels firm or solid 
• Growing - a mole that is showing any signs of growth 

As dental professionals, we may notice a suspicious lesion on a patient which they themselves have not been aware of, for instance, on the top of a patients head or ears, and in this case, we should advise the patient to seek further investigation. 

Patients can be reassured  that early detection of skin cancer gives the best treatment outcomes. 

Further information on Sun Safety and skin cancer can be found on the Skcin website and cancer research U.K. 

the British Association of Dermatologists have free downloadable leaflets on Melanoma ABCDE, Common Facts about Skin Cancer and Are You  at Risk of Skin Cancer. 

Kim Chambers is a dental hygienist and therapist in London. 

She works as an Oral Health Practitioner in North East London Community Dental Services alongside her clinical roles  at Great Ormond Street Hospital and private practice. 

She has a special interest in prevention and child dental health.

https://www.skcin.org

https://www.bad.org.uk

https://www.cancerresearchuk.org

Ichihashi M, Nagai H, Matsunaga K. Sunlight is an important causative factor of recurrent herpes simplex. Cutis. 2004 Nov;74(5 Suppl):14-8. PMID: 15603217.