What is the outlook (prognosis)

Almost all BCCs can be treated and cured, mostly with a simple operation or other simple technique. They rarely spread. Most SCCs can also be treated and cured as most are treated before there has been any spread to other parts of the body. Treatment is less likely to be curative if there has been any spread to other parts of the body. Note: people who have one skin cancer have an increased risk of developing another one in the future.

Can skin cancer be prevented?

Most skin cancers (non-melanoma and melanoma skin cancers) are caused by excessive exposure to the sun. We should all limit our sun exposure in the summer months (or all year when in hot countries nearer the equator) by:

• Staying indoors or in the shade as much as possible between 11am and 3pm.
• Covering up with clothes and a wide brimmed hat when out in the sunshine.
• Applying sunscreen with a sun protection factor of 15 or more to all exposed areas of skin.

In particular, children should be protected from the sun. Sunburn or excessive exposure to the sun in childhood is thought to be the biggest risk factor to the developing of skin cancer as an adult.

See separate leaflet called 'Skin Cancer - Prevention' for details.

Sun and skin damage

About 9 in 10 non-melanoma skin cancers, and about 6 in 10 melanoma skin cancers (the most serious form of skin cancer) are thought to be caused by excessive exposure to the sun. In particular, episodes of sunburn greatly increase the risk. It is the ultraviolet (UV) radiation in the sunshine which does the damage. Skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Sun damage can also cause other skin problems to develop such as premature skin aging and actinic keratoses (benign warty growths on the skin).

All people of all ages should protect their skin, but it it is even more vital to protect children. Although skin cancer is rare in children, the amount of sun exposure during childhood is thought to increase the risk of developing skin cancer in adult life. Therefore, take extra care with children, and keep babies out of the sun completely.

How can I protect skin from the sun?

Avoid the sun as much as possible when the sun is strong
In the UK, stay in the shade or indoors as much as possible between 11 am and 3 pm in the summer months (May to September). This applies all year round in hotter countries nearer to the equator. This middle time of the day is when the sun's ray's are the strongest. Trees, umbrellas, canopies, etc, provide good shade.

Cover up
Cover up the body as much as possible when you are out in the sunshine.

• Wear wide brimmed hats with a brim that goes all around the hat to protect the face and neck. These are the areas most commonly affected by sun damage. Baseball caps are not so good as they shade the face but not the neck, lower face and ears. Young children should wear hats with neck protectors too.
• Wear loose baggy T-shirts (or even better - long sleeve tops) and baggy shorts. The material should be tightly woven which blocks sunlight.
• Wear wrap around sunglasses (your eyes can get sun damage too). Make sure the sunglasses are ones which protect against UV light.

Use factor 15+ sunscreen (sunblock) liberally
You should apply sunscreen with an SPF (Sun Protection Factor) of at least 15. Be sure to cover areas which are sometimes missed such as the lips, ears, around eyes, neck, scalp if hair is thinning, hands, and feet. You should not think of sunscreen as an alternative to avoiding the sun or covering up. It is used in addition. No sunscreen is 100% effective and so it provides less protection than clothes or shade. Ideally:

• Apply 20-30 minutes before going out into the sun (it takes a short time to work).
• Re-apply frequently, at least every two hours, and always after swimming or towelling (even those that say they are waterproof).
• Reapply to children even more often.
• Use a 'broad spectrum' sunscreen to protect against UVA and UVB.

Some things that you might not realise

• Sunscreens less than factor 15 do not give much protection. Always use factor 15 or above.
• Sunscreens can 'go-off' and not work after a time. Therefore, do not use out of date sunscreen (see the 'use by' date on the packet). Most have a shelf-life of 2-3 years.
• Some experts think that the increased use of sunscreen lotions and creams may give a false sense of security. This may encourage people to go into the sun more, and as a result, cause an increase in your risk of developing skin cancers. It has to be emphasized that sunscreen only partially protects your skin. Using sunscreen does not mean that you can sunbathe for long periods without harm. If you tan - you have done some damage to your skin.
• Reflected light can damage too. On sunny days, even if you are in the shade, sun can reflect onto your skin. Sand, water, concrete, and snow are good reflectors of sunlight.
• Wet clothes let through more UV light than dry clothes. Take spare clothes with you if you expect to get wet.
• Clouds may give a false sense of security. Most of the UV radiation from sunshine still comes through thin cloud. Thick cloud provides some protection, but you still need protection when there is thin cloud.
• Many clothes worn in hot weather (thin T-shirts etc) actually allow a lot of sunlight through. You need to wear tightly-woven clothes to protect from the suns rays. If you can see light through a fabric, damaging UV rays can get through too.
• The suns rays are more powerful at higher altitudes. It may be cooler up a mountain but you will need more skin protection.
• Fair-skinned people who sunburn easily are at particularly high risk of developing skin cancer and should be most careful about protecting their skin.
• There is no such thing as a healthy tan. A tan is the skin's response to the sun's damaging rays.
• Artificial tanning from sun-ray lamps and 'tanning parlours' are probably just as damaging as sunshine - so avoid them.
• It's not the heat that does the damage but the UV radiation in sunlight which is present all year. You can get a lot of exposure to UV doing winter sports such as skiing as it is often done in sunny weather and at high altitudes. In particular, when out in ice and snow which reflects a lot of sunlight, wear a hat, sunscreen, lip balm, and sunglasses.

The UV index

The met office provide information called the 'Solar UV index' with their weather forecasts. The index is given as a figure in a triangle over the maps they use when giving forecasts. Basically, the higher the index (from 1 to 10), the greater the risk from the sun, the more care you should take of your skin when outside. See their website (given below) for details.

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