ReachMD

As we enter the coldest months of the year, many patients aren’t taking the same precautions as they did in the summer to avoid the risk of skin cancer. But with outdoor activities and winter sports still at-large, what are some ways we can continue to limit the risk of skin cancer for our patients in the winter months?

We sat down with Dr. Matthew Keller, ReachMD host of DermConsult, Associate Professor and Director of the Jefferson Psoriasis Center at Jefferson University, to talk about what we need to know about our patients’ risk of skin cancer during these winter months—and how we can prevent it.

Climate Considerations

Many patients all around the world are forced to face frigid temperatures and snowy conditions, but the extent of these conditions and their impact depends on one key component: climate.

Patients living in northern climates at sea level have a relatively low risk of skin cancer—but how much does that change for patients living at elevations?

“So, it’s been reported that basically, an increase from sea level to around 10,000 feet is a 50 percent increase in UV,” said Dr. Keller. “So, you take a lower level … you increase that by half, then you put yourself on snow, [and] about 90 percent of the UV rays are gonna get reflected back at you. So, now you’ve taken what is a pretty small risk, increased it by 50 percent, and then doubled it for someone who’s spending time on the snow.”

Clinicians often caution patients about the risks of being near water for an extended period of time throughout the summer due to the fact that water can reflect up to 25 percent of UV rays. But according to Dr. Keller, snow is by far the greater threat since snow can reflect up to 90 percent of UV rays.

And for patients going on vacation, traveling to warmer climates without giving their bodies time to prepare or adjust could be more of a risk than if they were traveling to the beach in the summer.

“[Patients’] risk of burning is much higher because they’re taking it when they have very little innate color in their skin and exposing themselves to a specific amount of sun exposure,” explained Dr. Keller.

The Risk of Wintertime Activities

The blazing heat of summertime often forces patients to seek shade, but without that need in the winter, they spend more time directly exposed to UV rays. Beyond what the snow can reflect back on to them, the risk of skin cancer can come from exposure to more sensitive areas, such as their face and their eyes.

But this risk goes beyond the winter months, and even into March and April, well into ski season, where patients are likely to shed a few layers amid the warmer weather. But with more exposure, direct reflection from the snow, and higher elevation, the risk of skin cancer can be much higher.

Dr. Keller recommends advising patients to cover up when they can and wear sunblock, lip balm, a pair of polarizing sunglasses. But when it comes to sunblock, he recommends a specific kind.

“I think that this is a great time of year to use physical block sunscreens,” Dr. Keller explained. “There are two advantages you get there. Yes, chemical blockers are slightly better at that broad-spectrum protection, but the physical blockers are gonna give you a little bit of protection from the wind. And I think wind along with sun is something we often don’t think enough about. And that’s because it physically traumatizes your skin and probably increases your risk of burning and inflammation associated with it.”

Educate, Protect, & Counsel

What is the number one thing providers can do to limit their patients’ risk of skin cancer? Educate them. Patients participating in high-altitude activities are going to come into contact with strong UV rays and may not understand that higher elevations and all of the snow are going to significantly increase their risk.

“So, though the UV rating might only be at 3 or a 4 in many of these locales, the fact that they’re at elevations, especially above 10,000 feet, that’s gonna add a 50 percent increase, so that’ll take a 4 and put it to a 6,” Dr. Keller said. “And then if we double the amount of sun exposure, you’re gonna get because you’re gonna reflect 90 percent of it, that’s gonna increase their UV rating even higher.”

Talking to patients about protecting is a vital component, too. Goggles with UV protection, helmets, face masks, all of those can help limit the risk of skin cancer. But an area that’s often ignored: the lips.

“I think it’s also really important to think about your lips because I think that’s an area that takes a significant beating,” Dr. Keller explained. “You know, it’s out there, it’s exposed, it doesn’t really tan effectively, so this is an area that tends to be much more able to be burned and I think windburn is important there. So, wearing a lip balm with sunblock in it and using physical blockers.”

According to Dr. Keller, dermatologists should really prioritize asking patients about the activities they participate in, where they go on vacation, or what kinds of holiday traditions they have could help you get a better understanding of what you need to advise them about, and how you can better prepare them to limit their risk of skin cancer throughout the year.

“I think one thing that’s important always to talk to patients about is, we often get lackadaisical at the end of the summer because regardless of whether we’ve worn sunblock or not, there is a certain base that we build up, especially if you’re exposed to a significant amount of sun over the summertime,” Dr. Keller explained. “But much of that has faded by the time ski season comes around in most areas of the United States. So, by January or February, we’re really getting deep into it.”