Australia Sets 3 Skin Tones for Sun Safety, Cancer Risk

Australia, renowned for its high rates of skin cancer and ethnically diverse population, has introduced updated sun safety guidelines to better address the varying needs of its citizens, especially those with darker skin tones.

Key takeaways:

  • Australia has updated sun exposure guidelines to better reflect the diverse population and varying risks of skin cancer and vitamin D deficiency.
  • Three skin tone categories are defined: highest risk (pale skin), intermediate risk (olive/pale brown skin), and lowest risk (deeply pigmented skin).
  • Sun protection remains crucial for highest risk group, with routine sunscreen use and minimizing outdoor time during peak UV hours. Vitamin D needs can be met through supplements.
  • Intermediate risk group should also use sunscreen during high UV periods but can spend controlled time outdoors for vitamin D.
  • Lowest risk group doesn't need routine sunscreen but may need it for extended outdoor activities. They can safely spend time outdoors for vitamin D.
  • New modelling provides time recommendations for maintaining vitamin D based on skin tone, time of day, and location.
  • Focus on skin cancer prevention remains crucial, but new guidelines allow for personalized advice and address vitamin D concerns.

Why revised advice?

  • Growing research highlights sun exposure benefits beyond vitamin D production.
  • Vitamin D deficiency is common in Australia, despite abundant sunshine.
  • Confusion existed about balancing sun protection with vitamin D needs.
  • Lack of awareness about skin color variations in sun safety advice.

The revised advice, developed by cancer researchers and published in the Australian and New Zealand Journal of Public Health, aims to provide more tailored recommendations for sun exposure based on individual skin types and associated cancer risks. The initiative follows a summit held in 2021, where experts from various fields collaborated to produce a new position statement on sun exposure risks and benefits for Australian adults.

The updated guidelines categorize individuals into three broad groups pictured below:

  1. Highest Risk (Pale Skin): This includes individuals with pale, very sun-sensitive skin that burns easily and rarely or minimally tans. For this group, sun protection is recommended at all times, especially when the UV index is forecast to reach 3 or higher. Vitamin D requirements should be discussed with a doctor, and outdoor time in the early morning can offer mood and circadian rhythm benefits, although it's not effective for vitamin D synthesis.
  2. Intermediate Risk (Olive/Pale Brown Skin): This category includes individuals with darker white or olive skin that sometimes burns but tans to light brown, or light brown skin that burns minimally and tans to moderate brown. Sun protection is recommended, particularly when the UV index is forecast to reach 3 or higher. If outdoors for longer than needed to maintain vitamin D, they should protect themselves using the five sunsmart steps. Obtaining vitamin D can be met by spending time outdoors, and the time required varies depending on several factors such as skin color, location, time of day, and season.
  3. Lowest Risk (Deeply Pigmented Skin): This group comprises individuals with deeply pigmented brown to black skin that rarely or never burns. Routine sunscreen application is generally not needed, except perhaps during extended periods outdoors when the UV index is high. Sunglasses should be used to protect the eyes.

Australia adaptive approach to skin types and cancer risk

Vitamin D Sun Exposure Time Recommendations by Skin Tone in Australia:

New modelling has estimated the amount of time outdoors required to maintain existing 25(OH)D concentration (i.e. to meet the daily spend requirements) under different clothing conditions that expose 10% and 35% of the body surface area according to the month of the year and the time of the day for capital cities and selected locations in Australia

New guidelines categorize people into three groups based on skin tone and offer tailored advice for outdoor time needed to maintain sufficient vitamin D levels:

Highest Risk (Pale Skin):

Time outdoors in the early morning can deliver the benefits of exposure to the non-UV wavelengths in sunlight, but this will not lead to adequate vitamin D production.

  • Avoid peak UV hours (9 am - 5 pm) outdoors.
  • Prioritize sun protection with clothing, shade, and sunscreen whenever outdoors.
  • Vitamin D needs met through supplements due to limited safe sun exposure.

Intermediate Risk (Olive/Pale Brown Skin):

People in this risk group should aim to spend sufficient controlled time outdoors to obtain a vitamin D-effective dose of UV radiation on most days of the week but should take precautions

  • Use sunscreen during high UV periods (index 3 or above).
  • Aim for controlled outdoor time to get a vitamin D-effective dose most days.
  • Take precautions (shade, clothing) if spending more time outdoors than needed for vitamin D when UV is high.
  • Time needed for vitamin D varies by location, season, and clothing:
    • Summer: < 10 minutes outdoors, 4+ days/week (35% body exposure - e.g. wearing shorts and a short-sleeved t-shirt)
    • Winter (North): Similar to summer with some adjustments.
    • Winter (South): Around 30 minutes midday with 35% body exposure, longer needed outside these times.

Lowest Risk (Deeply Pigmented Skin):

Where possible, people with deeply pigmented skin should regularly spend sufficient time outdoors to achieve and maintain adequate vitamin D status.

  • Routine sunscreen not necessary, but may be needed for extended outdoor activities with high UV.
  • Regularly spend sufficient time outdoors to achieve and maintain vitamin D.
  • Time needed for vitamin D is around 20 minutes between 10 am - 4 pm in summer, increasing to 20-30 minutes midday in winter (North) and up to an hour in winter (South).

The revised guidelines aim to provide a balanced view of the risks and benefits of sun exposure, taking into account the latest research findings. Vitamin D, crucial for bone health and calcium absorption, has been a particular focus, with the recommendations seeking to clarify how Australians can achieve safe sun exposure while minimizing the risk of skin cancer.

This update comes in response to evolving evidence about sun exposure's health impacts, public confusion over vitamin D deficiency and sun safety, and a previously noted gap in medical professionals' confidence in treating patients with darker skin tones. It reflects a growing understanding that the balance of risks and benefits from sun exposure varies significantly across different skin types.

By offering tailored advice, the new guidelines aim to support clinicians in providing personalized care and help individuals make informed choices about their sun exposure, ensuring both skin cancer prevention and adequate vitamin D levels across Australia's diverse population.

For more detailed information and advice, the full publication can be accessed in the Australian and New Zealand Journal of Public Health under the title "Balancing the risks and benefits of sun exposure: A revised position statement for Australian adults."