1. Stay out of the sun in the summer between 10 am and 4 pm – daylight saving time. That is when the sun’s rays are the strongest.
2. Try to cover up – something as simple as wearing a broad brimmed hat can significantly reduce exposure to the skin where skin cancer is most common (nose, lips and ears). Wear long sleeves as well. The best clothing is a tightly woven cloth. Dark colors give the most protection.
3. OSHA RULE 29 CFR 1910.132 (a) requires employers to protect employees against overexposure to the sun’s radiation if the employee is exposed to sun and radiation as a result and nature of the job.
4. Sunglasses with UV protective lenses should be used for eyes to reduce the risk of cataracts. And especially wrinkles around the eyes.
5. For sun protective clothing, contact – SUN PRECAUTIONS, 2815 Wetmore, Everett, WA 98201, 1-800-882-7860 for catalog and information.
6. Stay in the shade when possible. Check the length of your shadow – stay out of the sun if your shadow is shorter than you are.
7. Avoid reflective surfaces like white boat decks, sand and snow. Wear a T-shirt when snorkeling.
8. For skin you cannot hide or cover, use a truly broad-spectrum sunscreen
   a. apply sunscreen 15-30 minutes before sun exposure
   b. reapply every 2 hours if swimming or sweating (some of the new sun blocks may last 4-6 hours)
   c. Apply the equivalent of ½ to 1 teaspoon of the sunscreen to your face. Apply the same amount to each arm and exposed areas of the shoulders and neck (when wearing an open necked T-shirt). Apply 1-2 teaspoons to each leg and 2 teaspoons to the upper body if that skin is exposed. Apply sunblock evenly.
   d. Remember to use sunblock when driving (or get the film installed – see 8 above).
9. Note – sun blocks don’t provide complete sun protection. They are an extra aid to prevent sun damage and should be used with common sense, protective clothing, etc.

• Vichy's Capital Soleil 60 (the Best) has both Mexoryls (SX and XL)
• Anthélios L 60 (The previous Best) has Mexoryl XL

• Neutrogena 55 or 70 with Helioplex PFA 5.94 This has a nice dry feel
• PreSun Ultra (cream or gel) 30
• Shade 30 or 45
• PreSun Ultra Spray 27
• Coppertone 50 or Coppertone Shade 45

• PreSun 28 Block (white)
• COTZ 58 – Contains Only Titanium and Zinc or Total Block 60 or 65 by Fallene 1-800-332-5536
• Vanicream 35 or 60
• Lipstick – DuraScreen 30

• Parsol 1789 (avobenzone)
• Zinc Oxide (Z-Cote is best)
• Titanium dioxide
• Mexoryl SX is now in the USA (butyl methoxydibenzoylmethane)
• Tinosorb S and Tinosorb M (Not in the USA yet)
• Mexoryl XL (not in the USA yet)

REMEMBER
SUNSCREENS ARE DESIGNED TO PROTECT YOU AGAINST UNAVOIDABLE SUN
SUNSCREENS ARE NOT SUPPOSED TO BE USED TO INCREASE YOUR TIME IN THE SUN
AVOIDING SUN IS STILL THE BEST POLICY
TANNING BEDS CAUSE INCREASED SKIN CANCER AND AGING OF THE SKIN
THERE IS NO “SAFE TAN”

For adults who are avoiding sun, vitamin D3 supplements are preferred. A typical adult needs vitamin D3 400 IU per day and more recent recommendations are for 1000 IU per day. Calcium can be obtained in soy milk, green vegetables, even in supplemented orange juice. It is well absorbed. Or you could take a calcium supplement such as Tums and vitamin D3 or a combined vitamin D3 and calcium supplement (discuss with a pharmacist). These are best taken with a meal.

ADVICE ABOUT TANNING

Tanned skin, whether from out-of-doors or a tanning parlor, is a sign that the skin has been damaged. The sales pitch that tanning beds offer a “safe tan” is not true. The bulbs used in tanning beds emit 2-3 times the intensity of UltraViolet A (UVA) radiation that the earth receives from the sun, and emit UVB as well. An individual who is exposed to tanning bed radiation for 30 minutes receives sun damage equivalent to that obtained during an entire day spent “baking” at the beach. The regular use of tanning beds greatly increases the risk of skin cancer (especially deadly melanoma) and accelerates premature aging of the skin. Experts have wondered “Why buy skin cancer when you can get it for free?”
Getting a ‘base tan' is about as useful to prevent skin cancer as a few puffs on a cigarette is to prevent lung cancer.

PATIENTS AND SUNSCREENS

Some sunscreen publicity is confused and confusing. Patients indicate that they have heard that sunscreens are of no value in preventing either melanoma or non-melanoma skin cancer. Doctors should point out that these reports are based on retrospective (backwards-looking) studies that were done with old-fashioned sunscreens that today would be considered unacceptably low SPF and with inadequate UVA protection.

These studies are not reliable for deciding such important issues. The best current evidence suggests that sunscreens have a legitimate role in preventing early skin cancer (particularly the early squamous cell carcinoma known as actinic or solar keratosis) – especially when used as part of a comprehensive strategy of sun exposure reduction. Doctors should also point out that sunscreen protection is not complete, while reminding patients that properly applied sunscreens will protect against sunburn. Patients may also need the reassurance that designing sunscreens that are more fully protective of human skin remains a major goal of researchers. Unfortunately, the USA has a broad selection of the worst formulated sunscreens in the world , with the best being available in Europe and some of these products being available in the Caribbean and in Canada. There are some new products in the USA but we are still behind in recognizing and adopting the best.

People should have a realistic concept of the limitations of sunscreens and a comprehensive understanding of the behavior necessary to protect against the ravages of sun exposure. Sunscreen should be thought of as a means to reduce the delivered dose of UV, while accepting that it cannot completely block all the ill effects of sunlight.

The concept should more properly be that sunscreens are only backups which should come into play (ideally at least) when other means of primary sun exposure reduction fail, or when there is simply no other realistic way to reduce exposure.

Patients must know that, just as we don't know which cigarette smokers will get lung cancer, we don't know who among us will get skin cancer.

Great genetic differences among individuals contribute to the development of (or protection against) cancer.

For susceptible people, it's especially important to employ all currently available modes of protection against solar exposure.

Here are the sun protection strategies we recommend to patients:

• Avoid sun exposure during the most intense period of the day (10 am – 4 pm). Hazy and partly cloudy days are just as damaging.
• Try to cover up. An act as simple as wearing a broad-brimmed hat can significantly reduce exposure to the parts of the human anatomy where skin cancer is most common (nose, lips, and ears).
• Ultra short beanshave haircuts and baseball caps are going to generate thousands of skin cancers on ears in the next thirty years. This is totally avoidable.
• Wear long sleeves whenever possible.
• When the above will clearly fall short (especially at a pool or the beach), use a broad spectrum SPF 30 (minimum) sunscreen.
  The story that “anything over SPF 15 is a waste” is nonsense – it comes from outdated information.
  
  • For patients with skin types I-III (consult your dermatologist to determine your skin type), use a broad-spectrum sunscreen with SPF 30 minimum and preferably SPF over 55 (although cosmetics and moisturizers labeled SPF 15 are fine for times when you do not anticipate extended sun exposure).
  • Apply the equivalent of a half to one teaspoon of the broad-spectrum high SPF sunscreen to your face. Apply the same amount to each arm and exposed areas of the shoulders and neck (when wearing an open-necked T-shirt). Apply the equivalent of between one and two teaspoons to each leg and two teaspoons to the upper body when you expose more skin.
    
• Be aware of your skin. If you notice signs of short-term reddening or longer-term photoaging – wrinkling, dryness – you are already in trouble. Minimize further exposure to sunlight (though it is a good idea to minimize such exposure long before such signs appear).
• Visit a dermatologist if any rough, discolored, crusty, bleeding, bumpy spot appears.