Exposure to UV radiation is the main cause of the most common forms of skin cancer. Surfers can be ‘sun smart’ by simply taking some precautions to protect their skin:

• Protect your skin with clothing, and remember to wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses.
• Stay in the shade at peak UV radiation exposure times, typically between 11am and 3pm when it is sunny in Northern hemisphere locations. Step out of the sun before your skin has a chance to redden or burn.
• Apply plenty of broad-spectrum, water-resistant, SPF 30 or higher sunscreen 15 to 30 minutes before going out into the sun, and reapply frequently throughout the day and straight after coming out of the water and drying off with a towel.
• Remember, sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.
• Consider purchasing UV protective beach wear (i.e. boardshorts, rash vest, surf hat, etc.) which can particularly assist in protecting your skin.

Answered by Alex Kelleher, MD

Anyone can develop a skin cancer and this risk increases with time and cumulative exposure. However, some people are more likely to do so than others and these include those who have:

• Fair skin that burns easily
• Light coloured eyes, e.g. blue, grey, or hazel
• Naturally fair blonde or red hair
• Numerous freckles
• An outdoor occupation and/or intense sun exposure at present or in the past*
• An outdoor pursuit such as surfing, cycling, gardening, etc.*
• Frequent use of artificial sun lamps and/or sunbeds
• Experienced sunburnt skin
• A history of skin cancer
• An organ transplant recipient
• A compromised immune system, e.g. those who have a blood disorder such as leukaemia, or those who are taking immunosuppressive medications

*Note: Without the use of sunscreen

Answered by Alex Kelleher, MD

The commonest cause of skin cancer is exposure to UV radiation, e.g. from sunlight or sunbeds. Hence, protecting yourself from UV radiation exposure can drastically reduce your chance of getting skin cancer. Read the next question on how to stay safe.

Answered by Alex Kelleher, MD

Firstly, you should protect your skin with clothing, i.e. wear a hat that covers your face, neck, and ears, a pair of UV protective sunglasses for when you’re back on shore, and a UV protective rash vest and boardshorts.

Answered by Alex Kelleher, MD

Apply plenty of broad-spectrum, water-resistant, SPF 30 or higher sunscreen to exposed/uncovered skin 15 to 30 minutes before going out into the sun, and reapply frequently throughout the day and straight after coming out of the water and drying off with a towel. Remember, sunscreens should not be used as an alternative to clothing and/or shade, rather they offer additional protection. No sunscreen will provide 100% protection.

Answered by Alex Kelleher, MD

The Sun Protection Factor (SPF) is commonly thought of as how much longer skin covered with sunscreen takes to burn compared with unprotected skin. Let’s say you would typically start to burn after 10 minutes in the sun, then using a SPF 15 rated sunscreen, would imply that you can safely remain in the sun for 10 min x 15 = 150 minutes before burning. Or with an SPF 50 rated sunscreen, you can safely remain in the sun for 50 times as long as compared to no sunscreen. If you’d do the math, that would be 10 min x 50, which would result in 500 minutes. Just be aware that sunscreen wears off during surfing, sweating and due to other activities. So the 50x times only can be assumed if you re-apply your sunscreen regularly.

Another way of thinking about SPF, rather than as time extended in the sun, is in dose/exposure-related terms. If you spend a certain time in the sun, wearing sunscreen with a given SPF would reduce the UV dose to 1/SPF of that which you would experience by spending the same time in the sun but without sunscreen – e.g. applying an SPF30 sunscreen results in a UV exposure of one-thirtieth of that which you would have received had you not worn sunscreen. Of course, one caveat applies, this assumes perfect application, which is rarely achieved. Most people in real life apply less sunscreen than the amount required, and they typically apply it less uniformly leaving patches of skin without adequate protection. As a rule-of-thumb, the protection actually achieved is only about one-third to one-half of the labelled SPF!

Answered by Alex Kelleher, MD

Sure, from a sun protection perspective that’s ideal. Remember, it’s best to stay in the shade at peak UV radiation exposure times, typically between 11am and 3pm when it is sunny in Northern hemisphere locations. Make sure you step out of the sun before your skin has a chance to redden or burn.

Answered by Alex Kelleher, MD

Often the first thing noticeable on a bottle of sunscreen is the SPF rating on the front. If you turn over to the back label you can usually find the Star rating, typically ranging from one-to-five stars, as shown below.

The higher the number of stars, the more balanced protection offered, i.e. blockade of UVA and UVB radiation. The star rating represents the ratio of UVA-to-UVB protection afforded. You may sometimes see an encircled UVA logo (refer below) on the label, this indicates that the product has been approved by the EU. In practice, it is an equivalent way of saying that the product provides good balanced protection against both UVA and UVB.

Answered by Alex Kelleher, MD

Some researchers have raised concerns that, despite being an unquestionably important tool in reducing the risk of skin cancer development, the formulation of sunscreen may need to be improved to contain safer ingredients.

In 2019 the US Food and Drug Administration (FDA) – one of the two main global regulators of sunscreen ingredients along with the European Commission – removed 14 of the 16 chemicals found in sunscreens from its’ GRASE (generally accepted as safe and effective) category.

Answered by Alex Kelleher, MD

There are two types of UV filters employed in sunscreens. Inorganic UV filters, like titanium dioxide and zinc oxide, are broadly considered safe. Organic sunscreen filters such as oxybenzone and octinoxate have become controversial due to environmental concerns.

In 2018, the Environmental Working Group (EWG) reported that two‐thirds of the commercially available sunscreens in the US contained chemicals, namely predominantly organic filters, that were deemed to be harmful to the environment. The deleterious environmental effects of these filters relate to their impacts on coral reefs, as well as their prevalence in the water supplies and in aquatic wildlife. Furthermore, organic filters have been reported to have negative hormonal effects in animal models. There effects in humans continue to be examined.

For those concerned about the environmental impact of organic UV filters, zinc oxide and titanium oxide containing sunscreens could be used. Note: Zinc oxide and titanium oxide are most often used in combination to provide broad-spectrum UV protection.

Answered by Alex Kelleher, MD

Risk assessment before going into the water

• Before getting into the water, let someone know! Ideally, you should always go surfing with a partner, especially if you are not a very experienced surfer. But this isn’t always possible, in which case make sure you tell someone that you’re going surfing, including the location and the time you expect to be back.
• When choosing a surf spot, make sure to inform yourself about the local weather and surf forecast and before paddling out, give yourself some time while standing on the shore to observe the current conditions. Be honest with yourself regarding the suitability of the conditions for your skill level.
• Factors you should consider include, but are not limited to: familiarity with the surf spot, especially with regards to possible local hazards (e.g. potentially dangerous rock formations, shallow reef, occurring rips), suitability of your equipment (board, leash and wetsuit) for sea and weather conditions, compatibility of your surfing skill level AND fitness for the wave conditions, time of day (how much daylight is left), UV exposure and sufficiency of current UV protection, etc.
• Also, when surfing at an unfamiliar spot, asking locals about surfing conditions and potential hazards can give you a big heads up and make your surf experience safer and a lot more fun.
• These simple steps may seem trivial, but constitute basic measures of precaution you can take before going surfing.

Risk assessment while in the water

• The best surfer in the water is the one having the most fun AND keeping safe!
• Sea and wave conditions can rapidly change, so make sure you stay observant of your surroundings during your session.
• Things you should be looking out for include, but are not limited to: constantly changing tide levels and the possible exposure of low lying sea bed e.g. reef and rocks, changing daylight levels, rapid change in size or power of waves, rip tides and currents, surrounding fellow surfers and their skill levels (do you trust them to behave safely around you?!), marine threats (jellyfish, urchins, men in grey suits), and remember to also assess yourself, especially regarding your own personal health and well-being – How are you feeling? Are you having fun? Are you feeling tired or fatigued? How long since you last had something to eat and drink? Are your muscles starting to cramp up? Could you be suffering from low blood sugar, dehydration, hypo- or hyperthermia? Do you feel safe?
• We all love pushing ourselves to our limits, but unnecessary, avoidable accidents can overshadow even the perfect surf day, so it is therefore important to know when you’ve had enough and consequently head back to shore, when the current conditions start to make you feel unsafe.

Emergency plan for an accident during the session

• Hopefully you will never need to use an emergency plan, but it is very important to have one ready at hand. It goes without saying that an emergency plan should be organised before entering the water and that various precautionary measures should therefore be taken in advance.
• Things you might want to incorporate in your emergency plan include, but are not limited to: Someone knows where and when you are going surfing at all times, you have identified the best way to exit the water safely by yourself or while helping someone else, you know how to perform basic CPR (ideally you have already mastered and internalized the BSLS (Basic Surf Life Support) and/or ASLS (Advanced Surf Life Support) course J), you have a first aid kit nearby, you have a phone handy, you know the local emergency contact numbers and the location to the nearest hospital.