Ask Dr. Mike: How Can I Tan Safely?

Mike Cirigliano, aka Penn’s Dr. Mike, who explains sunscreen, skin cancer, and whether there’s any safe way to get a tan

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained. And he’s been named a Philadelphia magazine Top Doc every year since 2008. Now, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at victor@phillymag.com.

Dr. Mike, given that it’s been ridiculously hot and the sun is blazing, I thought that there was no better time to talk about sunscreen and sun exposure.
I love it!

Do you wear sunscreen everywhere you go?
Well, my solution is that I don’t really go anywhere. If you saw my legs, you would be afraid, like many young children are at the beach when I (rarely) go there. They think I’m something that washed up. I’m told that my skin, even though I’m getting older, looks pretty good. But if you go out in the sun, you should have some form of protection.

We’ve talked to before about how colon cancer is on the rise. How do we stand when it comes to skin cancer?
The incidence continues to rise. Since 1975, it’s gone from eight percent to 28 percent, in 2022. That’s per 100,000 people.

I recently took the kids out strawberry picking at the fabulous Strawberry Mansion. We were outside for maybe 30 minutes. Should I have been wearing sunscreen even for that short period of time?
If you look at the data, UV radiation is the number one cause of melanoma, and it’s the most preventable cause. The number one way to prevent skin cancer is to avoid UV radiation. Everything depends on the amount of exposure. Thirty minutes in the morning — your risk is probably lower than it is at noon. For children, however, the best way to prevent problems down the road is to get them into the habit of wearing sunscreen. And actually, sun-protective clothing outperforms sunscreen. You can’t go out covered in clothing from head to toe, obviously, so you want to apply sunscreen on the areas that are exposed.

If I’m going to be outside all day, like at the beach, how often do I need to apply sunscreen?.
The rules of engagement are to apply it every two hours, and more frequently if you’re doing a lot of sweating or there’s water exposure. But a lot of people really don’t follow that recommendation. That’s why I like the protective clothing.

What exactly does sunscreen do?
So, there are organic/mineral sunscreens and then there are chemical sunscreens. They all prevent UV radiation, but there are differences in how they work. The organic ones tend to absorb UV radiation, but they take about 15 minutes to start working, and there are theoretical concerns about absorption into the skin and into the body, and they do have some effects on endocrine disruption.

Then there are chemical sunscreens. These are the ones I remember my gym teacher using when I was in elementary school. He would have this white stuff on his nose, and that’s usually zinc oxide or titanium oxide. These not only absorb UV light, but they also scatter and reflect it, and they work immediately. For people that have rosacea, eczema, or even open lesions, that’s the way to go. And then there’s a third one that is tinted. Those contain iron oxides and prevent hyperpigmentation — they’re especially good for people with darker skin.

I usually use SPF 15. Is that good enough?
The American Academy of Dermatology recommends an SPF greater than 30 — one that’s broad spectrum, to cover UVA and UVB radiation. And some say they’re waterproof, but to be honest with you, if you’re in the water a lot, they’re going to wash off, so you have to reapply.

I hate spray sunscreen. When people use it anywhere near me — which they inevitably do when I am downwind from them — it’s all I can taste all day. I take a bite of my hoagie from White House Subs, and I taste sunscreen.
I’m not a fan of the sprays. A lot of organizations recommend not using it near the face, and avoiding it with small children. And you’re not gonna get the same level of even application, which is critical. Have you ever seen somebody who has missed a couple of spots and they’re burned in the patch they missed? Again, that’s why I really like the clothing.

Are there other concerns you have about me not using sunscreen other than melanoma?
It’s not just the risks of things like melanoma or any other cancers, like basal cell or squamous cell. In my practice of 30 years, the people who smoked and got sunburned a lot looked… not well. Almost in a reptilian kind of way.

If I want to look like George Hamilton, are you OK with me using tanning sprays and bronzers and things like that?
As long as there’s no sun and no UV radiation involved, absolutely!

I’m 52 and one of the only places I can find peace is at the beach. How often should I be seeing a dermatologist?
I like the idea of once a year unless you have high risk, like a family history of melanoma. And if you have very fair skin and lots of moles, maybe more frequently than that. A lot of people don’t go to the dermatologist. My favorite line is, “Dr. Mike, why do I have to see a dermatologist?” And my answer is: “You have skin!” What the hell?! Skin is an important organ, man!

My problem is that my wife is from South India and is super dark. Our kids are mixed, so they have a beautiful “tan” year round. So, when I see family photos, I’m just like, man, I really need to get a tan.
Just do the sunless tanning! I think you’re handsome personally, but that’s me. People searching for the perfect tan, the cost down the road is just not worth it.

I blame it all on the always beautifully tanned Kim Kardashian.
Listen, as John Legend said, “I love you with all your imperfections.” And as Billy Joel said, “Don’t go changing!” People need to be much more accepting of how they look, and if people don’t like the way you look, they can kiss your butt.

My glaringly white butt.
Love you.