While an apple a day may keep the doctor away, grapes, chocolate and watermelon probably won't please the dermatologist – so make sure to still wear the right sunscreen or clothing. As senior health educator for the University of Arizona Cancer Center Skin Cancer Institute, Lisa Quale has faced many sun safety myths, but most fall short of proper protection.

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"I tell people that it's not a matter of fearing the sun: It's about fearing the tan and the burn," Quale said. "Tans and sunburn are signs your body is trying to protect itself from UV radiation. If you have a tan or a burn, you've done damage to your skin."

Avoiding tans and burns may seem simple, though Quale admits it's not always easy to stay safe in the sun given all the information (and misinformation) to sort through about skin care. 

As summer heats up, Quale is helping to fill in the blanks on sun safety and translate emerging research into practical insight for everyday life.

Soaking in sunrays

In a world of pop-science cures and social media trends, Quale thought it best to begin with the basics: What actually happens to skin cells under sunlight? As it turns out, it's not a pretty sight. 

In a cascading effect, those cells detect radiation and begin to distort – and that mutation alerts the rest of the body "to something funky going on," Quale said. That reaction leads to the production of melanin, the body's natural pigment that blocks out as much of the sun as possible – a process widely known as a tan. 

Even with a tan, Quale warned those cells are still mutating. Best case scenario, that damage ends up as wrinkles, sagging skin and age spots. Worst case? Those cells begin to mutate to the point where they turn into skin cancer.

Sunburns occur when the skin can't tan or the ability to block ultraviolet radiation is overwhelmed. Considered permanent damage, a burn is blood coming to the surface to sweep away dead cells, which leads to peeling skin. 

"That damage will last a lifetime," Quale said. "In those cells that were affected by UV radiation and didn't die off, mutations may still exist. All of a sudden, you may not have healthy skin cells making new cells, you have mutated ones making mutated ones. That is what can end up as various types of cancer, including deadly melanoma."

Sleeves down, sunscreen on

Quale understands that altogether avoiding the sun is next to impossible. When it comes time to go outside, she said it is best to do so under proper protection by covering up, avoiding peak daylight hours and staying in the shade as much as possible. Also remember to apply sunscreen, namely spray and lotion sunscreens, that absorb or reflect UV radiation. 

Organic and inorganic products work in different ways, Quale said. Organic sunscreen, which contains carbon molecules, settles into the top layers of the skin to absorb and neutralize ultraviolet energy before harm can occur. Inorganic products, which contain no carbon molecules and are also called "physical sunscreen," instead contain minerals like zinc oxide or titanium dioxide and lay on the top layer of skin to absorb and reflect radiation.

Quale emphasized a crucial phrase, "broad spectrum," which means the product protects against both types of ultraviolet radiation: UVA and UVB. Combining this coverage with a sun protection factor – also known as SPF – of at least 30 will ensure that the chosen sunscreen will provide adequate protection for about 90 minutes. Sweating, swimming and toweling off will require a reapplication.

Zinc oxide, titanium dioxide and avobenzone are the only three ingredients available in the U.S. that protect against both UVA and UVB radiation, though the FDA is currently reviewing bemotrizinol – also known as Tinosorb – which is available in Europe and Asia. If approved, Quale expects to see sunscreen containing bemotrizinol hit the market next year.

For those uncomfortable with sunscreen, Quale sympathizes and has advice: Wear proper long-sleeve tops and pants, though there are several factors that determine the ultraviolet protection rating for clothing, also known as UPF. 

Both bright and dark colors absorb sunlight, while densely woven materials like denim, wool and synthetics offer better protection versus sheer materials. More than a choice of fabric, fit also matters when it comes to sun safety. Tight clothing can stretch across the skin and reduce the level of protection, while loose-fitting clothes provide more consistent coverage. 

Quale added that no sun-safe outfit is complete without a hat and sunglasses, and she concedes that sunscreen on the face is still probably the best choice.

Prevention is the best cure

The Skin Cancer Institute provides guidelines, outreach and seed grant opportunities to help keep people safe from the sun. One of the center's longest enduring safety messages is the ACE initiative: Avoid UV rays, Cover up, and Examine your skin.

The institute also hosts the Community Ambassador Program to train people in delivering safety messages, as well as Project SASS, also known as Students Are Sun Safe, which partners U of A students with local schools to discuss sun safety with children. Quale and her colleagues can also be found at large community events like Cyclovia, the Tucson Festival of Books and the Tucson Folk Festival, and the Baby Hat Program provides affordable, sun-safe hats for babies and children.

"I would love to see a society that just instinctively protects and takes care of their skin and understands the sun's power," she said. "While it gives our planet life, it can be very harmful to humans. The sun plays the long game when it comes to skin aging, and more importantly, skin cancer. You might get away with the tan or burn now, but you will pay for it later."