Ask an expert: Can I develop skin cancer even if my skin doesn’t burn?

Answered by Brendan Curti, M.D., medical oncologist, co-director of the Providence Melanoma Program at Providence Cancer Institute, and director of genitourinary oncology research and cytokine and adoptive immunotherapy at the Earle A. Chiles Research Institute, a division of Providence Cancer Institute, at the Robert W. Franz Cancer Center.

I get a lot of questions about burning, tanning, skin color and skin cancer, and no matter which way you look at this question, the answer remains the same: Yes, you can still get skin cancer.

If you have naturally dark skin that doesn't seem to burn, can you still get skin cancer?

Yes. A sunburn may be less visible on naturally brown skin, but people of all skin types can get burned by UV radiation, whether from the sun or from tanning beds. And even a single sunburn increases the risk of skin cancer by damaging your skin's DNA. 

It's true that skin cancer is less common among people with darker skin, but when it does occur, the outcomes tend to be worse than in lighter-skinned people. One reason for the poorer prognosis may be the very fact that it is so unexpected that it tends to get overlooked until it has grown and spread. Skin cancer also tends to appear in less expected places in people of color, such as the palms and feet, the mouth, the genital area and beneath the nails. People of all ethnicities should follow the same guidelines for sun safety and should be aware of the specific risks related to skin of color.

If you lay down a base tan to prevent burning, can you still get skin cancer?

Yes, you can still get skin cancer. Tanning does not protect you from that. While it's certainly wise to avoid burns, a tan is your body's way of rallying its defenses to try to protect your skin from UV damage – but that protection is limited, and some damage is done anyway. That cumulative damage adds up to a higher risk of skin cancer than if you avoided tanning altogether and protected your skin. 

Tanning deposits melanin, or pigment, in the skin cells. Although melanin does have some UV-blocking properties, it's not a Superman cape. Every moment that you're out in the sun or lying in a tanning facility, you are absorbing UV radiation, and UV radiation is known to cause cancer. Chronic exposure to radiation and skin damage through tanning is neither a healthy nor an effective way to protect yourself from skin cancer. One measure of proof: People who use tanning beds are 74 percent more likely to develop melanoma – the deadliest form of skin cancer – than people who don't. Learn more about the dangers of tanning.

In some people, tanning can even become an addiction, leading the body to create feel-good endorphins. If you think that sporting a tan is worth the risk of skin cancer, I urge you to listen to this message from my former patient, Ashley Trenner.

If you never go out in the sun or use tanning beds, can you still get skin cancer?

Yes, unfortunately, even people who spend most of their time indoors can develop skin cancer. While UV radiation from the sun and from tanning beds is by far the leading cause of all types of skin cancer, it's not the only cause. That's why it's important not only to protect your skin with sunscreen, hats and protective fabrics when you're outdoors, but also to be aware of your skin and to get any changes examined by a doctor.

What to look for: The ABCDEs of skin cancer

Regularly examining the moles, freckles and other marks on your skin can help you recognize potential problems. Be on the lookout for the ABCDEs:

  • Asymmetry (uneven shape)
  • Border irregularity
  • Color variation
  • Diameter bigger than a pencil eraser
  • Evolving (changing in size, shape, color, thickness or texture; or bleeding, itching or crusting)

These are potential warning signs that should be checked out by a doctor. But beyond these signs, if something just looks odd or different to you, even if you're not sure about it, please ask your doctor to take a look at it. The earlier you catch a developing skin cancer, the easier it is to treat successfully.

Providence Cancer Center has been involved in many of the latest treatment breakthroughs for people with advanced skin cancer. We are fortunate to have a state-of-the-art, highly regarded melanoma program here, and we can treat people much better now than we could in years past. But prevention will always be far preferable to the treatments that people face with this diagnosis, and despite the very best that medicine can do, thousands of people still die from skin cancer every year.

So don't take chances. Keep an eye on your skin, don't skimp on the sunscreen, and find a nice shady spot to enjoy your summer.

Dr. Curti and Walter Urba, M.D., Ph.D., coauthored the chapter on Cancers of the Skin in the 2014 edition of the medical textbook Harrison’s Principles of Internal Medicine. Dr. Urba is co-director of the Providence Melanoma Program and director of cancer research at the Earle A. Chiles Research Institute, a division of Providence Cancer Institute, at the Robert W. Franz Cancer Center.

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