Many people think that skin cancer isn't a risk after a certain age, but a lifetime of sun exposure can catch up to you at any age. Skin cancer comes in a number of forms, including basal cell and squamous cell carcinomas and the more deadly Merkel cell carcinoma, while melanoma causes the most deaths. What advice should seniors take to protect themselves? We spoke to experts about how to reduce the risks.
As people live longer, the chance of skin cancer appearing rises. "The average lifespan in the industrial world has been rising steeply," says Dr. Robert Norman of the Skin Cancer Foundation. "By 2020, 25 percent of the U.S. workforce will be composed of older workers — sometimes called the Silver Tsunami — and epidemiological, biological and molecular data all point to skin cancer as predominantly a disease of the elderly."
It's never too late to reduce your skin cancer risk. Research shows that most of us will have substantial UV exposure through most of our lives with the majority of exposure after age 40. "Suffering just five sunburns over your lifetime more than doubles your chances of developing melanoma, and each successive tan or sunburn raises the risks further," says Dr. Robert Norman of the Skin Cancer Foundation. "We never know exactly how much damage will trigger a skin cancer, but studies show that one bad burn in older age may be the straw that broke the camel's back."
Fair-skinned folks should be aware their skin type can mean a greater chance of developing skin cancer and other problems. If you have light-colored eyes and hair you are also at greater risk for glaucoma and cataracts. But brunettes should also seek the shade, as every skin tone is susceptible to sun damage to the skin and eyes. Go to the Skin Cancer Foundation website to determine your skin type and get recommendations for protection.
When planning activities, the hours between 10 a.m. and 4 p.m. are when the UV index is at its highest intensity. If vitamin D levels are low, make time for a short (no more than 20 minutes) trip outdoors to absorb the sun. However, the rest of the time sunscreen is still recommended by many doctors along with oral supplements if vitamin D levels are on the low side.
Even as medicines heal, some can make you more sensitive to the harmful effects of the sun. The list includes some chemotherapy medications, diabetes meds, diuretics and heart meds, according to dermatologist Anna D. Guanche, M.D. "There are many medicines that exacerbate sun sensitivity," Guanche says. Lists of these are available online, or talk to your pharmacist. "If you are taking one of these medications, seeking shade and high SPF sunscreens are advised," she says. "In case of severe sensitivity, sun avoidance altogether may be necessary."
Knowing the average UV index where you live can help you make smarter decisions about sun exposure. "Check the UV index daily," says Lakelyn Hogan, M.A., a gerontologist and caregiver advocate for Home Instead Senior Care. "You can log in your zip code using the Environmental Protection Agency's website and get the current UV rating for your area along with an explanation of what it means. Also, a friend or relative can remind you to take good care of yourself when in the summer heat or you can hire a professional caregiver who can help."
As the days get warmer, we need to be aware that frail elderly patients are particularly vulnerable. Geriatric specialist Dr. Nodar Janas says, "Thirst may not be perceived normally and cognitively impaired patients may not be able to tell us they are thirsty. Access to water and fluids may be a problem in dependent patients and oral intake may be inadequate. Also, diuretics force the body to lose salt and water."
Watch for signs that an elderly person in care needs to be moved to a cool area. "Observe carefully for signs of heat stroke," says Dr. Nodar Janas. "Remove unnecessary clothing, including shoes and socks, and give cool liquids to drink if possible. Place cold, wet cloths on skin, especially in the armpits and groin area. Assess for signs of dehydration, mental status changes, or unstable vital signs and if needed, with medical supervision."
Seniors have thinner skin and less cushion and protection from sun damage. The threat to tears and ulcerative skin lesions for this fragile skin is worsened as well. The Mayo Clinic recommends the physical barrier of clothing over sunscreens and sunblocks. Those who drive may want to always wear long-sleeved shirts, as car windows do not protect skin from UVA rays, and even opt for lightweight gloves to mitigate sun spots, too.
Finding the right protection is critical for seniors "Sun protection is for everyone," says Dr. Anna D. Guanche. "Although we accumulate most of our sun damage before age 15, more damage can definitely be done later in life when we can no longer generate new elastin and the skin does not recover well from the damage. We generally recommend that you look on the label for broad spectrum sunscreen, SPF 30 or higher for sun protection, and SPF 40 or higher for prevention of sun damage."
When you do go outside, seek shade from the direct sun, and wear sun-safe clothing. Timing is an important consideration. "Apply sunscreen 20 to 30 minutes before sun exposure and reapply every two hours, especially in the most sun-damaged areas. After swimming reapply the sunscreen," says says Dr. Anna D. Guanche. "Physical clothing barriers are recommended for fragile skin areas like forearms, neck, decolletage, and hands. Hands, neck, chest, and face get the most damage over the years. Hats and sunscreen are still necessary for seniors."
When skin shows signs of uneven pigmentation, waxy or crust-like edges of a spot, a mole or freckle that changes shape, or anything unusual that suddenly appears including lesions in areas that normally do not get sun exposure, make an appointment at your doctor or dermatologist right away to get checked.
The monitoring of your skin, along with a regular dermatological whole-body scan, is recommended annually. The CDC urges that if you tick the boxes for risks and observe any changes occur in existing spots, moles or freckles, it's best to immediately have them checked by a professional.