For years, Americans have largely been given a simple message: avoid the sun and put on sunscreen.
There is certainly wisdom to that advice. Excessive ultraviolet exposure unquestionably increases the risk of skin cancer, particularly melanoma. Severe sunburns, especially those acquired early in life, are a major risk factor and should be taken seriously. But the conversation has become oversimplified.
This May, as we recognize Skin Cancer Awareness Month, I invite you to learn more about the factors that influence skin health, how sunscreen actually works, and how you can take reasonable, preventative measures to protect your skin when spending time outdoors.
The Truth About Sun Exposure
At America’s HealthShare, we believe prevention starts with looking at the full picture rather than relying on oversimplified public health messaging. Contrary to popular belief, sunlight is not inherently bad for human health. You don’t need to fear the sun, but you do need to understand the risk factors involved with sun exposure and sunscreen products in order to make informed health decisions. For humans, sun exposure plays an important role in vitamin D production, circadian rhythm regulation, mood, immune signaling, mitochondrial function, and overall wellness. We were designed to interact with natural light! But the question is, how do we get healthy amounts of sun exposure while protecting ourselves from skin cancer?
How Skin Cancer Develops
According to the American Academy of Dermatology, approximately one in five Americans will develop skin cancer during their lifetime, making it the most diagnosed cancer in the United States. The most dangerous form is melanoma, which accounts for the majority of skin cancer related deaths. Fortunately, outcomes improve dramatically when melanoma is detected early.
Harmful sun exposure can certainly impact your skin health. Ultraviolet radiation damages DNA and increases the likelihood of mutations that can eventually become cancerous.[i] However, many people are surprised to learn that cancer risk is not determined by UV exposure alone. Two people can experience similar amounts of sunlight while having very different outcomes. Why? Because cancer development is influenced by many additional factors, including:
- Immune system function
- Chronic inflammation
- Oxidative stress
- Metabolic dysfunction
- Environmental chemical exposures
- Nutritional status
The skin is not simply a protective covering. It functions as an active immune organ. Whether damaged cells are repaired or allowed to progress toward malignancy depends heavily on the body’s overall biologic resilience.
A useful way to think about it is this: sun exposure may create the damage, but the body’s immune and repair systems help determine whether that damage progresses into cancer.
Chemical vs. Mineral: How Sunscreen Actually Works
To help protect their skin when going outside, many people automatically turn to sunscreen. However, while wearing the right type of sunscreen can definitely reduce ultraviolet damage and lower skin cancer risk, consumers are often unaware that there are major differences between sunscreen formulations.
Broadly speaking, sunscreens fall into two categories: chemical sunscreens and mineral sunscreens. Chemical sunscreens absorb ultraviolet radiation through synthetic compounds while mineral sunscreens primarily reflect and scatter UV radiation on the skin’s surface. Recently, scientists have begun questioning the safety of the chemicals used in many common sunscreen products and whether they are truly safe for long-term daily use.
Concerns have increased regarding several commonly used chemical sunscreen ingredients, including:[ii]
- Oxybenzone
- Octinoxate
- Octocrylene
- Homosalate
- Avobenzone
- Octisalate
Research has demonstrated that some of these compounds can be absorbed into the bloodstream – especially after repeated application. Some laboratory and animal studies have also shown hormone disruption and cellular effects associated with these chemicals.[iii]
Benzene Contamination
Another issue that has received significant attention involves benzene contamination found in some sunscreen products. Benzene is a known carcinogen associated with leukemia and other cancers. Importantly, benzene is not intentionally added as an active sunscreen ingredient. Instead, contamination may occur during manufacturing processes or through aerosol propellants. Multiple sunscreen products have been voluntarily recalled in recent years after independent testing identified benzene contamination.[iv]
Because of these concerns, many physicians and consumers are increasingly choosing mineral based sunscreens containing zinc oxide or titanium dioxide. These ingredients primarily remain on the surface of the skin and are generally regarded as having lower systemic absorption. Examples of commonly available mineral based sunscreens include: Blue Lizard, Badger, and ThinkSport.
Whatever type of sunscreen you decide to purchase this summer, we encourage you to consider the latest information available and be thoughtful as you make your selection.
Alternative Methods of Sun Protection
For those who prefer not to use any sunscreen but still wish to be active outside during daylight hours, there are a variety of methods to choose from. Some safe and effective strategies include:
- Consider getting morning or late afternoon sun exposure and avoid being out when the sun is directly overhead
- Wear protective clothing and remain in the shade when appropriate
- Support your immune and metabolic health
- Make anti-inflammatory lifestyle choices
- Participate in routine skin examinations to ensure early detection
Perform Routine Self-Examinations
Did you know that you can examine your own skin for potential signs of cancer? One of the most important educational tools available to individuals remains the ABCDE Rule for identifying potentially dangerous skin lesions. When checking your skin for unusual moles or spots, remember:
A stands for asymmetry, where one half of a mole does not match the other.
B stands for border irregularity, including jagged or poorly defined edges.
C stands for color variation, especially multiple or uneven colors within the same lesion.
D stands for diameter, particularly lesions larger than 6 mm, although smaller lesions can still be dangerous.
E stands for evolving, meaning any lesion changing in size, shape, color, or symptoms.
The “E” for evolving is especially important – if a mole is changing, it should be evaluated by a healthcare professional.
The future of skin cancer prevention relies on transparency, balanced science, informed consumers, and a more complete understanding of what truly drives long term skin health. However you choose to spend your time in the sun, I hope you have a great summer and stay healthy out there!
In Health,
Dr. John Oertle
Chief Medical Officer
Sources:
[i] Green AC, Wallingford SC, McBride P. Childhood exposure to ultraviolet radiation and harmful skin effects: epidemiological evidence. Prog Biophys Mol Biol. 2011 Dec;107(3):349-55. doi: 10.1016/j.pbiomolbio.2011.08.010. Epub 2011 Sep 3. PMID: 21907230; PMCID: PMC3409870.
[ii] Ruszkiewicz JA, Pinkas A, Ferrer B, et al. “Neurotoxic Effect of Active Ingredients in Sunscreen Products, a Contemporary Review.” Toxicology Reports. 2017;4:245 to 259. doi:10.1016/j.toxrep.2017.05.006.
Matouskova K, Bartos J, Flamant F, et al. “Exposure to Low Doses of Oxybenzone During Perinatal Development Alters Mammary Gland Morphology in Mice.” Reproductive Toxicology. 2020;96:269 to 277. doi:10.1016/j.reprotox.2019.12.005.
Santander Ballestín S, Luesma Bartolomé MJ. “Toxicity of Different Chemical Components in Sun Cream Filters and Their Impact on Human Health: A Review.” Applied Sciences. 2023;13(2):712. doi:10.3390/app13020712.
Jaskulak M, Grobelna B, Kaczmarek K, et al. “Endocrine and Reproductive Health Considerations of Organic UV Filters: A Review.” International Journal of Molecular Sciences. 2025;26(15):7155. doi:10.3390/ijms26157155.
Onyango DO, Tietge JE, et al. “Comparison Between Endocrine Activity Assessed Using In Vitro Assays and Human Exposure Estimates for Organic UV Filters.” Toxicological Sciences. 2023;196(1):25 to 39. doi:10.1093/toxsci/kfad080.
Lorigo M, Cairrao E. “Exposure to UV B Filter Octylmethoxycinnamate and Human Health: Environmental and Toxicological Considerations.”Chemosphere. 2024;364:143131. doi:10.1016/j.chemosphere.2024.143131.
[iii] Matta MK, Zusterzeel R, Pilli NR, et al. “Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients.” JAMA. 2019;321(21):2082 to 2091. doi:10.1001/jama.2019.5586.
Matta MK, Florian J, Zusterzeel R, et al. “Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial.” JAMA. 2020;323(3):256 to 267. doi:10.1001/jama.2019.20747.
[iv] Nicole W. Skin Protection Dilemma: Testing Detects Benzene in Some Sun Care Products. Environ Health Perspect. 2022 May;130(5):54002. doi: 10.1289/EHP11423. Epub 2022 May 17. PMID: 35580036; PMCID: PMC9113541.