Sunburn Isn’t Just Temporary. A Dermatologist on the Damage That Stays

Most people think about sun protection for a beach day or a weekend hike, not as something tied to their job. But for farmers, agricultural workers, construction crews and anyone else who spends their workday outdoors, sun exposure isn’t occasional, it’s constant. James Ulery, M.D., a Michigan-based dermatologist and spokesperson for The Skin Cancer Foundation, says outdoor workers can accumulate 40 to more than 80 hours of UV exposure a week, compared with roughly 10 to 20 hours for someone working indoors. That gap, he says, is exactly why occupational sun exposure deserves to be treated as a workplace safety issue, not an afterthought.

We spoke with Ulery about why that cumulative exposure matters so much, what to prioritize when reapplying sunscreen every two hours just isn’t realistic on the job, and why he says it’s never too late to start building better sun-safety habits, even after years of unprotected exposure.

Most people think about sun protection for the beach or a day outside, but not as an everyday work hazard. Why is occupational sun exposure, day after day, year after year, one of the biggest skin cancer risk factors people overlook?

James Ulery, M.D.: Farmers and agricultural workers are some of the hardest-working people that we know. Often their working hours are sunup to sundown, which may exceed the common eight-hour working day we often think of. Their commute to work or different work sites also permits additional UV exposure through the windows of their vehicle or work equipment. Weather factors such as cool temperatures or cloud cover often do not result in substantially decreased UV exposure. This means that many of these workers experience at least 40 to more than 80 hours of UV exposure per week, compared with an office worker whose exposure driving to work and enjoying the weekend may result in 10 to 20 hours of UV exposure per week. That cumulative exposure matters because UV radiation damages the DNA in our skin cells and, as that damage adds up over time, outdoor workers increase the risk of developing skin cancers.

The World Health Organization and International Labour Organization estimate that 1.6 billion working-age people globally are exposed to solar UV radiation through their work, and occupational exposure is associated with a 60% higher risk of developing nonmelanoma skin cancer.

That’s why outdoor workers should think about sun protection as part of workplace safety. If you’re spending your workday outdoors, protecting your skin should be part of your daily routine.

If someone’s job means they can’t always reapply sunscreen, take shade breaks, or cover up as much as they’d like, what should they prioritize? What matters most if they can only do one or two things consistently?

JU: If you can only consistently do one or two things, prioritize covering your skin and protecting the areas you can’t cover with sunscreen. Many outdoor workers do not realize how much exposure their back, neck and hands get when working. Some fabrics may provide more sun protection — such as densely woven long-sleeved shirts, pants and accessories like bandanas or gaiters. Clothing with a UPF rating of 50 or higher can provide an added layer of protection, particularly for workers who spend hours outdoors. These fabrics are often lighter-weight and breathable, which decreases some risks of heat injury. A densely woven or UPF 50 wide-brimmed hat that shades the face, ears and neck offers the most coverage but may not shield the face as well when the sun is at a low angle. UV-blocking sunglasses and other protective accessories, when permitted by the job, can also help reduce the amount of exposed skin.

For areas that can’t be covered, use a broad-spectrum water-resistant sunscreen with an SPF of at least 50. For many outdoor workers, mineral-based sunscreens are less likely to burn or irritate the eyes when sweating, compared with chemical sunscreens. Reapplying sunscreen every two hours isn’t always practical during a work shift, so focus on what you can control. Apply sunscreen before your shift, keep it accessible for reapplication when you have an opportunity, such as lunch or bathroom breaks, cover up when possible and use shade during breaks. Sun protection works best when you combine several strategies, rather than relying on sunscreen alone.

A lot of outdoor workers assume sunburn is just a temporary, annoying part of the job. What’s happening to the skin every time that happens, and why does it matter so much over the years?

JU: Think of sun damage like stacking wooden blocks, with each exposure adding one (mild exposure) or several blocks (significant exposure). As the stack of blocks gets taller, they eventually will fall over (skin cancer). Skin cells acquire UV damage with each exposure, over time. As you accumulate damage, eventually, you acquire enough to form a precancer or skin cancer. Longer exposures permit greater accumulated damage in a shorter time period. In this case, a sunburn is not simply a temporary annoyance; it is a visible sign that UV radiation has injured your skin and damaged DNA within your skin cells. The redness, pain and peeling are your body’s response to that injury, but the underlying UV damage doesn’t simply disappear when the sunburn fades. Some of that damage can accumulate over time and contribute to mutations that increase the risk of skin cancer. And you don’t need to have a dramatic, blistering burn for UV damage to occur. The Skin Cancer Foundation notes that having five or more sunburns more than doubles your risk of developing melanoma. For someone who works outside, repeated sun exposure can add up over an entire career.

What are the warning signs someone should be checking for during a monthly self skin-check, and what specifically should send them to a dermatologist sooner rather than waiting for their annual visit?

JU: I recommend a head-to-toe skin self-examination once a month. You should look for a new mole or growth, a spot changing in size, shape or color, or something that looks noticeably different from the other spots on your skin. Also pay attention to anything that repeatedly itches, hurts, crusts, scabs or bleeds, or a sore that doesn’t heal.

If you see anything new, changing or unusual, make an appointment with a dermatologist immediately. Skin cancer is generally easier to treat when detected early. The five-year survival rate for melanoma, the deadliest form of skin cancer, is 99% when detected early.

For someone who’s spent years working outside with little to no sun protection, is it too late for habits to make a difference now, or does starting sun-safety practices later still meaningfully lower their risk?

JU: It is never too late to start protecting your skin. We can’t undo the UV exposure that has already happened, but we can reduce additional exposure going forward, and that matters.

If you have already had substantial sun damage, beginning good sun protection habits may not stop all future skin cancers from forming but may reduce the total number you experience over your lifetime or slow the development of them.

Start sun-safe habits now. Cover exposed skin, wear a wide-brimmed hat and UV-blocking sunglasses, seek shade when possible, and use broad-spectrum sunscreen with an SPF of 50 or higher during extended outdoor exposure.

For someone who has spent years working outdoors, consistency is really the goal. You don’t need to completely change your lifestyle overnight. Adding even a few protective habits to your daily routine can help limit further UV damage. The important thing is to start today and be aware of the many good options available.