Two in three Australians will develop cancer before the age of 70 but with the right advice, pharmacy can help more people protect themselves from the harmful effects of UV rays. By Leanne Philpott

There are more than 12,000 cases of melanoma diagnosed every year in Australia. As one of the most accessible and frequently visited healthcare destinations, pharmacy is in a prime position to educate customers on the risk of skin cancer and advise on the best ways to achieve optimal sun protection.

Associate Professor Chris Baker, president of the Australasian Collegeof Dermatologists, explains that skin type can be used to determine how prone a person is to sunburn.

“Fitzpatrick Type 1 skin is highly sensitive. They will burn easily and are at high risk of skin cancer. However, we all have different risk factors, from skin type, family history and past history, so we should try not to individualise skin protection.” He says it’s more a case of “ you’re either going to sun protect or you’re not”.

Dermatologist and member of the Dermatology Institute of Victoria Dr Anina Fitzgibbon says, “We know fair skin burns quickly in the sun, but skin redness that develops due to prolonged sun exposure may go unnoticed during time spent outdoors. It’s often not until later that it becomes obvious, when the level of redness becomes stronger and there is discomfort in the sunburnt areas.

“Even people who have the capacity to tan get sunburnt if they spend prolonged periods in the sun without protection. It’s imperative to protect the skin daily against both UVA and UVB rays, as both contribute to skin cancer and skin ageing.

“It’s also good to remind people that UVA penetrates window glass and car windscreens. Many individuals don’t realise this and so underestimate their daily exposure to ultraviolet light.

“Another factor to highlight is that multiple sunburns are associated with higher risk of melanoma. Also, severe sunburn in childhood is linked to an increased chance of melanoma later in life.

“The overall message is that the Australian sun is very strong; simply running errands and commuting to and from work will already lead to significant sun exposure most of the year round, without seeking out the sun.”

One of Australia’s leading experts on skin cancer prevention and director of the World Health Organisation’s (WHO) Collaborative Centre for UV Radiation, Craig Sinclair, says it is the cumulative effect of UV exposure that we tend to forget about.

“The pharmacy has a really important role in helping educate consumers on sun protection and emphasising the importance of sunscreen use. UV intensity in Australia is extremely high, as such we need to be protecting ourselves against the sun all year round.

“We can still go outdoors and enjoy a healthy and active lifestyle but when the UV Index is higher than 3 we need to be applying sun protection.”

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Sunscreen guidance

Dr Fitzgibbon says, “The best way to achieve efficient protection against UVA and UVB rays is to choose an SPF 50+ broad-spectrum sunscreen.

“Pharmacists and their staff have a role in advising customers to apply sunscreen liberally to all exposed
areas, including the neck and behind the ears. Recommend getting someone to help apply sunscreen to
the back and shoulders to ensure it’s applied appropriately.

“Men have melanoma on their back more frequently than women; while women have melanoma on the lower legs more frequently than men. It is important to protect all areas of the body, not only when going to the beach but also when playing sport or gardening.

“Remind people that water reflects UV radiation strongly. Sunscreen should be applied 20–30 minutes
before going outside and again a few hours later and after swimming.

“Pharmacists can advise younger customers to choose a sunscreen with a lighter, non-comedogenic base, while older customers may prefer a creamier product. For those with sensitive skin, highly fragranced products are best avoided.”

Sinclair says, “The really important thing when helping customers select a sunscreen is to encourage them to choose a product they find cosmetically appealing. We know people in general don’t apply enough sunscreen; in fact they apply half of what’s recommended, so they’re clearly not getting the full
benefit of the product.

“Part of the reason why people don’t apply an appropriate amount of sunscreen is that they don’t like the
look or feel of the products. Yet, if they choose a sunscreen they like the feel of they’re more likely to apply and re-apply.”

Heather Walker, chair of the skin cancer committee, Cancer Council Australia, says we should apply one
teaspoon of sunscreen per limb. In total seven teaspoons are required; this covers the arms, legs, front of the torso, back of the torso and the face, neck and ears.

“Our advice is to apply your sunscreen 15-20 minutes before you go outside to give the formula time to
settle onto the skin, re-apply every two hours and after swimming.

She says, “To minimise the risk of being burnt you must use sunscreen correctly and re-apply. It’s also
important to note that sunscreen is not a suit or armour.

“Sunscreen won’t protect you from 100 per cent of ultra-violet light. This is why it should be used alongside clothing, shade, hat and sunglasses. By doing this you know that you’ve given
yourself the best protection against harmful UV rays.”

When it comes to concerns over the chemicals in sunscreen, Walker advises, “We know sunscreen prevents cancer. This is the most important message that pharmacy staff can give to people concerned over the chemicals in sunscreen.

“Sunscreen prevents all kinds of skin cancer but, importantly, it offers protection against the deadliest
cancer, which is melanoma.

“Secondly, there’s no evidence that sunscreens are harmful. They are rigorously tested and regulated by
the TGA, which keeps a close eye on new developments.

“Australia has one of the strictest levels of regulation because our UV is so high, so essentially people should be reassured that these products are carefully regulated.”

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A/Prof Baker says, “Some people will discover a sensitivity to a particular component of the sunscreen or a certain chemical, but unless you know which factor it is it can be difficult to advise on the best sunscreen.

“As a rule, if you have a patient with a history of eczema who reports stinging after using sunscreen you
can suggest a low-irritant sunscreen.

A physical sunscreen, that’s zinc or titanium dioxide based, rather than one with absorbing chemicals,
might be preferred. Additionally opt for one that’s free from perfume and fragrance.

“If you have someone that appears not to tolerate any sunscreen, they should be referred to a dermatologist and might benefit from patch testing.”

While sunburn is better prevented than treated, in the instance where sunburn does occur pharmacists
are in an ideal position to offer treatment advice.

Dermatologist Dr Victoria Mar says, “An anti-inflammatory, such as aspirin, can be used for discomfort and help reduce the inflammation caused by sunburn. An anti-inflammatory in the form of a topical steroid, such as hydrocortisone cream, can be applied directly to the sunburnt area. Cool compresses can also help with the discomfort. A simple moisturiser may help provide symptomatic relief and keep the skin hydrated. If burns and blisters are extensive referral to a GP may be required.”

Sun protection for infants and children

Walker says, “It’s not recommended that sunscreen be used on infants under the age of six months due to the sensitivity of their skin. We suggest protecting babies against UV exposure, so if the baby is going out indirect sunlight all other forms of sun protection should be used.

“For infants over six months of age and young children, we suggest choosing the sunscreens that are
formulated for this age group. Similarly you might recommend doing a patch test to ensure no immediate reaction.”

Dr Fitzgibbon says, “There are a number of sunscreens available specifically for children. They frequently
contain physical UV filters such as titanium dioxide and zinc, as well as safe chemical filters. Sunscreen should be applied liberally before children go out to play and protective clothing, hats and sunglasses should be worn also.”

Walker adds, “It’s also very important that children learn from a relatively young age (3+) how to apply
their own sunscreen. Don’t forget to role model too. Parents can often forget to apply sunscreen or hats
themselves. Ensure children see you practising what you preach when it comes to sun protection.”

Skin checks

Alongside educating people on the importance of optimal sun safety, pharmacists can help remind of the
need to look out for early warning signs of skin cancer.

“A red flag would be a person with a lot of obvious evidence of sun damage—solar keratosis (rough, scaly
patches on sun-exposed areas such as the head, face, backs of hands) and signs of melanoma (the ABCDEs),” explains A/Prof Baker.

Healthcare professionals and patients can be encouraged to use the ABCDE method to identify potential
warning signs of melanoma:

A Asymmetry. A mole that’s not asymmetrical if you draw a line through the centre.

B Border irregularity. A mole or spot with an uneven border such as scalloped or notched edges.

C Colour variation. A mole that is varied in colour (different shades of tan, brown, black or becomes red,
white or blue).

D Diameter. Malignant moles are usually more than 6mm in diameter.

E Evolution. A mole that has changed in shape, size, colour or elevation

“If a patient raises concern over a mole or you notice signs of sun damage you could surmise the patient
is at risk of skin cancer. Ask if they’ve had a formal skin check and if not be proactive in suggesting they get one,” says A/Prof Baker.