Because sun protection and sunscreen use are so heavily associated with summer, patients often neglect their skin health as the weather gets colder. Ultraviolet radiation is just as dangerous in the winter as in the summer, and patients concerned about skin cancer risk can be educated on how to protect their skin all year.
When discussing skin cancer with patients, what are some winter-specific risk factors you can bring up to stress the importance of taking year-round skin care seriously?
- Skiing without sunscreen
Patients who ski are at increased risk for sun damage due to the extended time spent outdoors and at high altitudes. Solar ultraviolet radiation also reflects off the snow, adding further risk. Dermatologists have been stressing the importance of sun protection during skiing for many years; a 2003 study in Archives of Dermatology concluded that alpine skiers are exposed to enough erythemal and suberythemal levels of ultraviolet radiation to cause lasting skin damage and increase skin cancer risk.¹ Patients who are going skiing should, in addition to wearing protective masks and goggles, be using sunscreen with a sun protection factor (SPF) of at least 30 and reapplying it every 2 hours.
- Working outdoors
It is not just people visiting ski resorts who are at risk. A study published in the Journal of Skin Cancer in 2020 that examined the prevalence of skin cancer in the outdoor workers of ski resorts found the presence of actinic keratosis in 14.62% of participants.² The researchers claimed that this was actually not as high a nonmelanoma skin cancer prevalence as they found in studies about other outdoor workers, such as mountain guides and farmers.
Outdoor workers, as they spend so much time in the sun, have a unique risk of skin damage. However, they may underestimate their risk level, as found in a 2016 study in Journal of the European Academy of Dermatology and Venereology that reported more outdoor workers were not only less likely to use sunscreen than indoor workers but were more likely to have additional outdoor hobbies.³
- Tanning bed use
Use of tanning beds tends to increase in the winter when people are less likely to get extended time outside in the sun. The US Food and Drug Administration (FDA) has described sunlamp products like tanning beds as “hazardous” and warned that they expose people to risks that include skin cancer.⁴ Patients should be educated that although not directly from the sun, this form of ultraviolet radiation can still be detrimental to the skin.
- Extended time outside in snow
Though skiers are spending time outdoors at high altitudes, those who are spending time outside for other reasons remain at risk when ultraviolet rays from the sun are reflecting off snow. Patients who plan on doing an outdoor activity like hiking while there is still snow on the ground should be protecting their skin. Even those who will be shoveling snow may be spending more time outdoors than they anticipate and should protect themselves accordingly with protective gear and sunscreen.
- Failing to protect lips
When discussing skin cancer prevention with patients, something that’s worth educating them on are the more sensitive, often ignored parts of the skin that also need protection. The lips are a particularly important example. Cold temperatures can cause dry skin. If patients use lip moisturizer and will be spending extended time outdoors, they should use a moisturizer with an SPF of at least 15. If they don’t use lip moisturizer, they should be including lips in their sunscreen regimen.
- Rigel EG, Lebwohl MG, Rigel AC, Rigel DS. Ultraviolet radiation in alpine skiing: magnitude of exposure and importance of regular protection. Arch Dermatol. 2003;139(1):60–62. doi:10.1001/archderm.139.1.60
- Gilaberte Y, Casanova JM, García-Malinis AJ, et al. Skin cancer prevalence in outdoor workers of ski resorts. J Skin Cancer. 2020;2020:1-7. doi:10.1155/2020/8128717
- Trakatelli M, Barkitzi K, Apap C, Majewski S, De Vries E. Skin cancer risk in outdoor workers: a European multicenter case-control study. Journal Eur Acad Dermatol Venereol. 2016;30:5-11. doi:10.1111/jdv.13603
- Sunlamps and sunlamp products (tanning beds/booths). US Food and Drug Administration website. https://www.fda.gov/radiation-emitting-products/home-business-and-entertainment-products/sunlamps-and-sunlamp-products-tanning-bedsbooths. Updated September 28, 2020. Accessed January 27, 2021.