Telling your patient to avoid Sun exposure is medical malpractice
Discussion
This is very serious actually.......I used to have melasma on my skin.....not the worst you've seen but still.......horrible thing. Took a few years......but barely noticeable now.
The sun heals.
Agreed, Dr. Berry. Any thoughts on sun exposure for those of us with light skin and history of melanoma…what’s the fine line to walk?
Melanoma isn’t caused by the sun. All research papers pre-diagnosis show low Vitamin D. We know the UVB spectrum (315-325nm) produces Vitamin D from cholesterol. Squamous, Basal-cell, and melanoma skin cancer patients *should* have high vitamin D if they’re getting lots of full spectrum sunlight. But they’re not... So raw sunlight *isn’t* the problem. I’d bet a couple million sats most are blocking UVB with sunscreen, makeup, sunglasses, and glass windows.
Not having dug deep into this subject, I think the first sentence is misleading. The way I think about it is in terms of exposure. Not everyone can tolerate the same amount of exposure to the sun at any given time. Overexposure to the sun can lead to cell/dna damage that can contribute to cancer. This is not to say the sun in a vacuum is to be avoided. People with fair skin should gradually increase the time they spend in the sun to make sure their skin can adapt to the stimulus (sunlight) without getting harmed (burnt).
Fair point about the first sentence. More accurately I could’ve said full spectrum sunlight doesn’t cause melanoma. There is more nuance to your cell/dna damage claim. Including melatonin. (No, I didn’t mean melanin.) A cancer contribution pathway would likely involve at least of handful of other dysregulations, some caused by lots of artificial light at night. 
Interesting about melatonin.
That aside, overexposure can lead to bad outcomes even if you’re healthy otherwise.
I think of it the same as exercise. There is an effective dose. Too much stimulus will have more side effects than benefits.
Don't burn.
So is telling them to use sunscreen. Most derms are ignorant about UVB and endogenous Vit D.
They should advise shade, hats, or loose/thin clothing
Sometimes.
Some kids literally blister if they're exposed to sunlight or touch. They need perpetual care. Of those, some survive long enough to become young adults, Your advice goes against that goal for these patients though. 🤷‍♂️