Update on Sun Protection and Early Detection of Skin Cancer

Thuzar M. Shin, MD, PhD Assistant Professor of Dermatology Penn Dermatology Oncology Center Sun Protection Fact or Myth: that contain insect repellent are as effective as using the two products separately 1) Fact 2) Myth Fact or Myth: Sunscreens that contain insect repellant are as effective as using the two products separately 1) Fact 2) Myth The American Academy of Dermatology recommends that these products be purchased and used separately • needs to be applied generously and often • Insect repellent should be used sparingly and much less frequently. • Apply sunscreen first, then the bug spray Fact or Myth: Nicotinamide, a B3 vitamin derivative, may help prevent non-melanoma skin cancer 1. Fact 2. Myth Fact or Myth: Nicotinamide, a B3 vitamin derivative, may help prevent non-melanoma skin cancer 1. Fact 2. Myth 23% reduction in BCC and SCC

• No long-term safety data • No data for melanoma prevention • Other vitamin studies in other cancers have had surprising results • Patients excluded from trial – immunosuppressed, history of invasive melanoma or metastatic cancer Nicotinamide = Niacinamide Cost: $4.39 and up on Amazon.com Nicotinamide: Take-home points • Discuss with your doctor before starting • Continue sun protective behaviors • Continue self-skin examinations • Continue regular follow up with your dermatologist Fact or Myth: The FDA has approved zero new sunscreen ingredients over the last decade 1. Fact 2. Myth Fact or Myth: The FDA has approved zero new sunscreen ingredients over the last decade 1. Fact 2. Myth Sunscreen Innovation Act (2014) • Intended to expedite sunscreen ingredient review – FDA must act on new drug applications in 16-20 months and pending applications within 1 year • 8 ingredients currently under review – Awaiting ‘GRASE’ (Generally Recognized as Safe and Effective) determination What are the 8 ingredients? • (Mexoryl SX) • Octyl triazone • • Diethlyhexyl butamido • Encamazene • (Mexoryl XL) • (Tinosorb S) • (Tinosorb M) Why are we interested in these sunscreen ingredients? US sunscreens block UVA poorly compared to European sunscreens

Diffey B. New Sunscreens and the Precautionary Principle. JAMA Dermatol. 2016 May 1;152(5):511-2.

US sunscreens transmit 3x the UVR of their European counterparts December 2017 SIA Update:

• FDA determined that additional safety data are needed before GRASE standard is met • None of the active ingredients are any closer to being marketed in the United States Early Detection of Skin Cancers Up to 88% of melanomas are detected by patients or their partners

Epstein DS et al. JAMA 1999;281:640-3 Geller AC et al. Cancer 2009;115:1318-272

https://www.allure.com/story/woman-discovered-skin-cancer-with-app

Fact or Myth: If you use a good skin cancer app, you don’t need to see a dermatologist 1. Fact 2. Myth Fact or Myth: If you use a good skin cancer app, you don’t need to see a dermatologist 1. Fact 2. Myth Skin cancer apps: Take-home points

• Skin cancer detection apps may seem promising – None are regulated – None have been rigorously tested – Much work still needs to be done! • Skin lesion mapping apps can be helpful – Penn Center for Innovation Grant (Dr. Chris Miller) • Continue sun protective behaviors, self-skin examinations, and regular follow up with your dermatologist Thank You “I’ve got so many moles, there’s no way I can remember if a spot is new or changing!” Total body photography: Provides a fixed reference point to detect new or changing lesions

www.skintography.com

Feit NE et al. British J of Derm 2004;150:706-714. A new tool: MelaSight • Developed by Andrew Marek, 3rd year medical student at Penn • Import existing professional skin exam photos • Secure photo viewing (username/password, encryption, on device storage) • Mole mapping (flag, create notes, and take close-up photos of suspicious spots) • Skin reference (how to perform a skin exam, what to look for) Other apps which may be helpful • Mole Mapper – Developed by dermatologists at OHSU – Available through the iTunes app store for $1.99 – Guides patients in taking their own total body photographs (with the help of a family member or friend) – Helps the user to map, measure, and monitor skin moles Sunscreen & Melanoma Prevention

No sunscreen ~50% Sunscre Studies have shown that regular en sunscreen use decreases the risk for squamous cell cancer and melanomadecrease

Green AC et al. J Clin Oncol Fact or Myth: Nicotinamide, a B3 vitamin derivative, may help prevent non-melanoma skin cancer.

1) Fact 2) Myth Fact or Myth: Sunscreens are regulated like OTC drugs in the United States 1. Fact 2. Myth Fact or Myth: Sunscreens are regulated like OTC drugs in the United States 1. Fact 2. Myth