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Prevention of Skin Cancer

by SCCF Boardmember David South, MD

Flyfishers are at particular risk for skin cancer (CA) due to prolonged exposure to sunlight and secondary reflection from water and sand.

Sun (UVL) damage is cumulative and responsible for 90% of aging.

UVL is responsible for 90% of non-melanoma skin CA (NMSC) and 70-85% of malignant melanoma (MM). Hereditary factors are also important, especially with MM. The annual cost of treating skin CA in USA is $8.1 Billion.  Two die of skin CA every hour in the USA.

The most common is Basal Cell CA, with 4.3 million annual cases in USA. Fortunately very treatable and only 2,000 related deaths/year. Squamous Cell CA accounts for 1 million cases with 15,000 deaths/year.

MM accounts for 200,000 cases and 7,000 deaths per year, as it is more aggressive and less treatable, and unfortunately its incidence doubles every decade. MM has a 2:1 male to female ratio. Only 20-30% of MM starts in existing moles, so it is important to look for new black lesions.

Sun protection is the key to avoiding skin CA. Hats (no mesh), sun-gloves, “Buff” bandanas for face and neck, sunglasses, long sleeved shirts and pants are the best. Thread count is most important….a $10 Kmart shirt that you can’t see through when held up to light is equal in protection to an $85 one impregnated with SPF chemical.

Sunscreens have repeatedly been shown experimentally to prevent most BCC and SCC, and at least 50% of MM. They have recently come under scrutiny and controversy regarding THEORETICAL effect on human hormone production, bleaching of coral reefs, effect on algae in still waters, and presence of nanoparticles in the bloodstream. To date there is NO EVIDENCE for harm in any of these areas.

The “bad” ingredients suspected are: Benzophenone (Oxybenzene), Avobenzone, Homosalicalate, Octinoxate. Sunscreens thought to be “safe” are the mineral type (containing mainly zinc oxide or titanium dioxide), but these wash and wear off easily, requiring reapplication every few hours. “Safe” brands include: Think Sport, All Good Sport, Stream 2 Sea, Mama Koulenne, Art of Sport Skin Armor, Hello Bello, Babo Botanicals, Purely Simple and Sun Bum.

Thankfully as flyfishers, if properly clothed we only need a dab of sunscreen on ears, nose and hands, so we don’t need to sweat safety issues.