Melanoma Prevention Strategies For Individuals With Fair Skin

Understanding melanoma

Definition and characteristicsMelanoma is a type of skin cancer.¹ In healthy skin, sun exposure causes cells below the surface (melanocytes) to produce melanin. This pigment spreads across the exposed skin to form a suntan. A suntan acts as a shield against harmful ultraviolet (UV) radiation from the sun. 

When melanocytes are exposed to too much UV radiation, the DNA instructing them to produce melanin becomes damaged. This causes melanocytes to stop working properly and the skin becomes red and burnt. 

If your skin is unprotected from the sun for a prolonged period, melanoma can form. Which is where melanin clusters in an area and spreads cancerous cells. This is more common in fairer-skinned individuals, whose melanocytes are less active.²

Prevalence, types and contributing factors

A global study published in 2020 estimated 325,000 cases of melanoma skin cancer and 57,000 related deaths that year, and was more common in those assigned male at birth (AMAB) than people assigned female at birth. The number of melanoma cases is forecasted to increase by up to half by 2040, as the chart below shows.³ 

The study found the highest rates of melanoma in Australia and New Zealand, followed by Western Europe and North America, with the lowest rates seen in Asian and African countries.

Melanoma can form anywhere on the skin, and there are four main types:⁴

Melanoma skin cancer spreads more easily than other skin cancers.⁵ If melanoma spreads downwards, it may reach the bloodstream or lymph nodes in the immune system and move to other organs (metastasis).⁶ So, spotting the signs early is vital.

With the types of melanoma skin cancer in mind, there are six key risk factors that can increase the likelihood of a melanoma diagnosis:⁷

Sun protection measures

Seeking shade and avoiding peak sun hours

Now you know the melanoma risk factors, the simplest way to avoid skin damage from the sun is to limit the time you’re exposed to it. 

This applies all year, as your skin can be exposed to UV rays known as UV-A and UV-B at any time of year, not just in the summer.⁷ For example, UV rays can reflect from surfaces such as water and snow. Most weather apps and websites give a UV rating, so if the UV rating is three or higher, you must limit time in the sun. Peak UV ratings are usually 9 am–4 pm.

Wearing protective clothing and accessories

On top of using sun cream, what you wear while out is an important factor in protecting yourself in the sun. 

• Umbrellas and parasols provide great sun protection
• Long-sleeved shirts and long trousers or skirts help cover your body. Tighter fabric gives better protection, as does darker clothing
• Hats are not only a great fashion accessory, but they help to cover your ears and forehead - areas that are more easily burnt. Just make sure that the hat doesn’t have holes in it e.g., a straw hat

Applying sun cream properly and regularly when buying sun cream it is easy to get lost in all the brands and the numbers. Simply put, you want to block as many different types of UV from reaching your skin as possible. So, using broad-spectrum creams is best, as these block both UV-B and UV-A radiation. Check the packaging to see if the cream is broad-spectrum. 

You may be used to hearing the abbreviation SPF, which stands for sun-protection factor. This is the ability of the cream to filter out UV radiation; the higher the SPF, the more UV it filters out. 

It is recommended that you use at least two tablespoons of sun cream at SPF 15 or higher, reapplying it after activities like swimming or physical activity that makes you sweat. As a rule, if you are in the sun for two hours or more, reapply sun cream. 

Sun cream is only effective for three years before it should be disposed of. It is best stored in cool places for freshness. 

Self-examination and early detection

Conducting regular skin self-examinations

The more often you check your skin, the more likely you are to catch skin cancer early, when it is more treatable. You could do this whilst getting ready in the morning or before bed. 

It’s recommended you check your skin once per month.¹⁰ It could just save your life! 

All you need is a full-length mirror and a hand-held mirror.¹¹ Take 10 with this step-by-step video to check your skin.

Recognising ABCDEs of melanoma detection

Melanoma skin cancers are typically seen on or near moles(small and raised brown or flesh-coloured patches of skin).¹² 

Moles differ from freckles, as freckles are not raised and form in healthy skin from a normal number of melanocytes. You can see if your skin is healthy using the ABCDE method:¹³

Seeking professional advice for suspicious moles

If in doubt, ask! Whilst it’s recommended that you visit your physician once every year for a skin exam, you can note anything suspicious during your skin self-examination to take to your healthcare provider. Ask to be referred to a skin specialist, such as a dermatologist, for advice and support. 

If you think you may have an unusual mole or area of skin and are worried about speaking to a specialist, it can help to take a friend or family member for support. 

Avoiding indoor tanning

Risks associated with indoor tanning

Indoor or artificial tanning typically includes using a sunbed. This is where a person lies in a rectangular electronic bed that produces mainly UV-A radiation and some UV-B radiation.¹⁴ 

This is often done to improve appearance or for perceived health benefits, such as an increase in vitamin D or a form of acne treatment. However, both remain unproven.¹⁵ 

In fact, the World Health Organisation’s International Agency for Research on Cancer classified sunbeds as a carcinogen. This means using them significantly increases your risk of a range of skin cancers, including melanoma.

Promoting alternative tanning options

Tanning is seen as desirable by many people. For some, it doesn’t come naturally due to having fairer skin and a lighter complexion. Thankfully, there are alternative tanning methods that don’t put your health at risk. 

Many supermarkets and pharmacies sell self-tanning products such as lotions, gels, sprays and bronzers.¹⁶ These are applied with a cloth or pad to the outer surface of the skin. 

Bronzers stay on until washed off, though most lotions and creams provide a visible tan 2–4 hours after application and can last from 3–7 days. This is because they contain an ingredient called dihydroxyacetone (DHA), a plant sugar that reacts with the amino acids in the outer skin layer to form a tan-coloured compound. DHA is resistant to water, soap and sweat. The tan will eventually fade due to the normal shedding of dead skin cells.

Healthy lifestyle practices

Balanced diet, hydration, and physical activity

Sun exposure is just one piece of the puzzle when it comes to skin health. Three other puzzle pieces are diet, physical activity and hydration. 

Some studies have suggested that eating lots of red meat (e.g., beef, lamb, pork, etc.,) may increase the risk of melanoma, as they contain compounds that trigger the suppression of the immune system, making it harder to fight cancers.¹⁷ 

Scientists are not yet clear on the effects of antioxidants such as vitamins C and E from fruits and vegetables on melanoma risk, as evidence is mixed.^18,19 Foods containing omega-3 fatty acids, such as fish and nuts, may protect against melanoma skin cancer, but there is no definitive evidence.²⁰ 

Regular moderate physical activity is thought to be protective against melanoma skin cancer and other cancers, as it can help relieve oxidative stress. This is a process where lots of unstable DNA-damaging oxygen by-products, known as reactive oxygen species (ROS), form when our cells respire.^21,22 Moderate exercise promotes the removal of ROS in our skeletal muscles, heart and liver.²³ This should be accompanied by drinking plenty of water, especially on hot days. 

Ask your healthcare provider if you have any questions relating to diet, hydration, physical activity and melanoma, as they will be able to debunk any myths. The World Cancer Research Fund’s 2019 report on diet, nutrition, physical activity, and skin cancer summarises some key facts and myths about diet and lifestyle and skin cancer:²⁴

Myth: consuming coffee might increase the risk of melanoma in people AFAB. 

• Fact: drinking water containing arsenic metal from rocks or soil raises the risk of skin cancers

Myth: drinking alcoholic beverages increases the risk of melanoma 

• Fact: being tall increases the risk of melanoma 

Avoiding smoking and excessive alcohol

Excessive alcohol consumption and cigarette smoking are linked to various poor health outcomes, such as many other cancers, heart disease, strokes and early mortality.^25,27 Some alcohols are considered more harmful than others; for example, there is thought to be a correlation between white wine and liquor consumption and melanoma skin cancer risk.¹⁹ This is believed to be because when these alcohols are digested in the body, more acetaldehyde is produced compared to other alcohols. This can damage DNA in cells in the skin, causing them to be more sensitive to sunlight. However, this theory is not supported, with scientists still trying to understand how these types of alcohol increase the risk of melanoma. 

As well as being linked to many health conditions, some studies have suggested that past smoking may lead to poorer survival outcomes for melanoma skin cancer.²⁸ Those who persistently smoke are thought to be 1.8 times more likely to die from melanoma, and former smokers are considered 1.75 times as likely to die from melanoma than those who haven’t smoked at all.

If you are concerned, speak to your healthcare provider about your current and previous alcohol consumption and smoking habits to receive tailored advice for your health needs.

Education and awareness

Promoting sun safety in schools and workplaces

Staying safe in the sun starts when you are young; schools are a great place to spread information on skin health and skin cancer prevention, as this infographic shows:⁷ 

You spend a lot of time at work, so it’s important to look after your skin, especially when working outdoors. Simple ways to protect from skin cancers such as melanoma in the workplace include:⁷

Engaging in public campaigns

Public health campaigns are a great way to encourage collective action to support health and well-being. They can be creative, informative and collaborative, bringing people together for a shared cause. 

If you’re keen to support a melanoma skin cancer prevention public health campaign, here are some great examples. You might even want to start your own! 

1. Melanoma UK’s ‘National Melanoma Hunt’ 
2. American Academy of Dermatology’s ‘Spot Skin Cancer’ 
3. Euromelanoma’s annual campaign 

Summary

Melanoma is a skin cancer involving damage to melanocytes, cells that cause skin pigmentation. Melanoma is more common in those with fair skin and associated features and is caused by overexposure to UV radiation, particularly UV-A. Melanoma can be prevented through regular skin safety practices such as sun cream application and reapplication, shade seeking, covering up, and sunless tanning practices. These prevention methods are advised in public spaces such as schools and workplaces where skin safety programmes and public health campaigns can be used. Self-examinations of your skin once per month and yearly dermatologist visits are recommended to catch melanoma skin cancer early.