1. Risk factors for melanoma and non-melanoma skin cancers
Skin types, sun safety and evidence for preventative strategies

2. Skin Types
Fitzpatrick skin types chart- classification system for skin typing
based on a person's complexion and responses to sun exposure
Important indicator of Skin cancer risk
Also used to determine suitability for certain cosmetic procedures etc.
Determined using a survey

3. Fitzpatrick Skin Type i- vi
TYPE 1: Highly sensitive, always burns, never tans. Example: Red hair with freckles
TYPE 2: Very sun sensitive, burns easily, tans minimally. Example: Fair skinned, fair haired Caucasians
TYPE 3: Sun sensitive skin, sometimes burns, slowly tans to light brown. Example: Darker Caucasians.
TYPE 4: Minimally sun sensitive, burns minimally, always tans to moderate brown. Example: Mediterranian type Caucasians.
TYPE 5: Sun insensitive skin, rarely burns, tans well. Example: Some Hispanics, some Blacks
TYPE 6: Sun insensitive, never burns, deeply pigmented. Example: Darker Blacks.

4. Risk Factors- Melanoma
Sun exposure and UV radiation  
Although a direct causal relationship between solar ultraviolet (UV) radiation and melanoma cannot be demonstrated experimentally, the evidence from indirect studies is overwhelming and leaves little doubt that UV exposure is a major risk factor
higher rates of melanoma in people with extensive or repeated intense exposure to sunlight
The majority of melanomas develop on sun-exposed skin, particularly in areas that are more susceptible to sunburn
Individuals with naturally dark skin or whose skin darkens easily upon sun exposure have lower rates of melanoma, supporting the concept that greater penetration of UV light into the skin results in a higher risk
Adjusted for skin type, the geographic incidence of melanoma is highest in equatorial areas and decreases proportionately with distance from the equator, with its correspondingly lower level of UV exposure

5. Timing and Type of UV exposure
Ultraviolet B radiation (UV-B) appears more closely associated with the development of melanoma than UV-A. However a causal link to UV-A exposure is also supported by data from patients using tanning beds
Intermittent exposure and sunburn, particularly in adolescence or childhood are strongly associated with an increased risk of melanoma, while occupational exposure do not confer an increased risk. These findings support the hypothesis that melanoma risk is affected primarily by intermittent intense sun exposure

6. Other Risk Factors for Melanoma
Skin type and hair colour, the number of naevi
Occupation…. But only in the sense of increased sun exposure…
Diets rich in vitamin D and carotenoids and low in alcohol may be associated with a reduced risk for melanoma
Smoking
Family History – Genetics BAF, P16
-Familial atypical multiple mole and melanoma (FAMMM) syndrome
Atypical mole syndrome (AMS), also called dysplastic nevus syndrome (DNS)
Personal History of melanoma or nonmelanoma skin cancer
Immunosuppression

7. Risk Factors of non-melanoma skins cancer
Essentially the same as for melanoma
radiotherapy, phototherapy, male gender
number of blistering sunburns
Clinical signs of chronic skin damage, especially solar keratoses
Most important difference
Nonmelanoma cancers are associated with cumulative sun exposure and occur most frequently in areas maximally exposed to the sun (eg, face, dorsal hands, forearms). ie. Occupation more significant RF
melanomas tend to be associated with intense, intermittent sun exposure and sunburns and they frequently occur in areas exposed to the sun only sporadically

8. Sun Safety- Slip, Slop, Slap
Slip on sun protective clothing  Choose clothing that:
Covers as much skin as possible e.g. long sleeves and high necks/collars.
Is made from close weave materials such as cotton, polyester/cotton and linen.
Is dark in colour to absorb UV rays. White and lighter colours reflect UV onto skin.
If used for swimming, is made from materials such as lycra, which stays sun protective when wet.
Slop on SPF 30+ sunscreen  Make sure your sunscreen is broad spectrum and water resistant.  Sunscreen should not be used to increase the amount of time you spend in the sun and should always be used with other forms of protection. Apply sunscreen liberally to clean, dry skin at least 20 minutes before going outside and reapply every two hours. 
Slap on a hat  A broad brimmed, legionnaire or bucket style hat provides good protection for the face, nose, neck and
ears, which are common sites for skin cancers. Caps and visors do not provide adequate protection. Choose a hat made with closely woven fabric – if you can see through it, UV radiation will get through. Hats may not protect you from reflected UV radiation, so also wear sunglasses and sunscreen to increase your level of protection. 
Seek shade  Make use of trees or built shade structures, or bring your own!
Staying in the shade is an effective way to reduce sun exposure.
Whatever you use for shade, make sure it casts a dark shadow and
use other protection (such as clothing, hats, sunglasses and sunscreen)
to avoid reflected UV radiation from nearby surfaces. 
Slide on some sunglasses  Sunglasses and a broad brimmed hat worn together can reduce UV
radiation exposure to the eyes by up to 98 per cent. Choose close-
fitting wrap-around sunglasses that meet the Australian Standard
AS Sunglasses are as important for children as they are
for adults. 

9. Other SunSmart Tips
Take extra care between 10am and 3pm when UV radiation is most intense. 
Look out for the SunSmart UV Alert which tells you the time period in which you need to be SunSmart – it appears on the weather page of most daily newspapers
Check you skin regularly and see a doctor if you notice any unusual skin changes.  If you have a lesion that doesn’t heal, or a mole that has suddenly appeared, changed in size, thickness, shape, colour or has started to bleed, ask your doctor for a skin examination

10. Evidence for preventative strategies - do they prevent cancer?
The International Agency for Research on Cancer has issued a consensus statement saying that,
“although sunscreens reduce the likelihood of sunburn, and are therefore likely to reduce squamous cell carcinoma, the evidence regarding the effect of sunscreens on basal cell carcinoma or melanoma is inconclusive. This organisation warns that use of sunscreens to extend the period of intentional sun exposure may increase the risk of melanoma.”
statement also suggested that “sunscreens of sun protection factor 15 or greater and a star rating for ultraviolet A light protection of 3–4 may have a role if used appropriately to reduce ultraviolet exposure, rather than being used to prolong the time spent in direct sunlight.”
data concerning modern sunscreens that have higher sun protection factor values and increased ultraviolet A blocking will not be available for several years
Conclusion: Sun avoidance is best.

11. Issues with Sunscreen Studies
Unethical to conduct RCT
individuals apply significantly less than the 2 mg/cm2 (approximately 30 to 35 mL/ body application) of sunscreen, used to determine the SPF
People who wear sunscreen are often those who do spend more time outside, so some studies find sunscreen use increased melanoma risk…..

12. Questions What is your skin type?? Part I: Genetic Disposition
Your eye color is:
Light blue, light gray or light green = 0
Blue, gray or green = 1
Hazel or light brown = 2  
Dark brown = 3
Brownish black = 4
Your natural hair color is:
Red or light blonde = 0
Blonde = 1
Dark blonde or light brown = 2
Black = 4

13. Total score for genetic disposition: _______
Your natural skin color (before sun exposure) is:
Ivory white = 0
Fair or pale = 1
Fair to beige, with golden undertone = 2
Olive or light brown = 3 
Dark brown or black = 4
How many freckles do you have on unexposed areas of your skin?
Many = 0
Several = 1
A few = 2
Very few = 3
None = 4
Total score for genetic disposition: _______

14. Part II: Reaction to Extended Sun Exposure
How does your skin respond to the sun?
Always burns, blisters and peels = 0
Often burns, blisters and peels = 1
Burns moderately = 2
Burns rarely, if at all = 3
Never burns = 4
Does your skin tan?
Never -- I always burn = 0
Seldom = 1
Sometimes = 2
Often = 3
Always = 4

15. Total score for reaction to sun exposure: _______
How deeply do you tan?
Not at all or very little = 0
Lightly = 1
Moderately = 2
Deeply = 3
My skin is naturally dark = 4
How sensitive is your face to the sun?
Very sensitive = 0
Sensitive = 1
Normal = 2
Resistant = 3
Very resistant/Never had a problem = 4
Total score for reaction to sun exposure: _______

16. Add up your genetic disposition and sun exposure totals to find your Fitzpatrick Skin Type: 
0-7 I
8-16 II
17-25
III
25-30 IV
over 30
V -VI

17. Question 2. Who has a greater risk of melanoma?
a office worker who gets a blistering sunburn every christmas
a builder who maintains a deep tan year round