Once considered healthy and a way to ensure vitamin D synthesis, sun exposure and tanning carry serious consequences. Acute sunburn is painful, but chronic sun exposure in those with outdoor occupations like farming, fishing, and roofing can have significant detrimental effects. Basal cell carcinomas are the most common skin cancer associated with sun exposure, and while cosmetically objectionable, do not carry the serious effects of squamous cell carcinoma or the more rare melanoma. Basal cell carcinomas appear as nodules with dilated capillary vessels, depressed skin lesions with rolled borders, or frank ulcerations, and can be found on persons who tan outdoors or in tanning beds.
Squamous cell carcinomas appear as non-healing scales, crusts, ulcers, or masses. Melanomas appear as areas of altered pigment (red, white, brown, black, and blue) with irregular outlines, diameters greater than 6mm, and occasional ulceration.
Appropriate clothing should be worn to protect the skin from damaging UV radiation. Sun-blocking lotions and lip balms of SPF 35 or greater must be included on areas not covered by clothing. The lips are covered by oral mucosa that extends to and merges with perioral facial skin. Sun exposure is evidenced by the loss of a distinct vermillion border on the lip. Dryness, fissuring, scaling, erosion, and ulceration can also be noted. Anyone with persistent chapping, fissuring, scaling, and bleeding of the lips requires a biopsy to assess the extent of the UV damage and whether malignant transformation has occurred. This is often noted in the dental office, particularly when the lips are stretched during an oral exam, and scaling, crusting, and ulceration are more evident. When actinic cheilitis is diagnosed, the lips should be protected by large brimmed hats and lip balms of SPF 35 or greater. Blue-eyed, blondes, redheads and fair-skinned persons of Irish ancestry are particularly prone to damaging sun effects, but everyone needs to be aware of the effects of sun damage, e.g., loss of skin elasticity and wrinkling. So cover up, wear your sunscreen, and “be careful out there”.
–Bobby M. Collins, DDS, MS
Section Chief, Oral and Maxillofacial Pathology
ECU School of Dental Medicine