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As dermatologists and skin cancer researchers, we are dedicated to the health of our patients and, by extension, the larger community we serve. With this responsibility in mind, we became involved in the discussion on the use of certain sunscreens and have reviewed the scientific data on the potential impact on the coral reefs we value in our community.

As this discussion has continued, we strongly feel that we must set the record straight on certain facts. To that end, we were disturbed to see incorrect information and statements printed in the Sept. 23 Community Voice commentary, “How To Avoid Skin Cancer Without Harming Marine Species.”

The Community Voice piece tried to suggest that sunburns have nothing to do with skin cancers. This is completely false and dangerously inaccurate information. We treat patients suffering from skin cancer and address the risks for the disease which is predominately caused by overexposure to ultraviolet radiation.

Sunburns are precursors to skin cancers caused by UV rays, which is cumulative over a lifetime and can lead to melanoma and non-melanoma cancers. Research shows that having doubles the risk for melanoma, which kills 20 people a day in the US.

Hawaii has the caused by UV radiation compared to other U.S. states according to an article in the International Journal of Cancer.

The August 2022 report from the National Academies of Sciences, Engineering and Medicine confirms that consistent use of broad-spectrum, SPF 30+ sunscreens has been shown to reduce the risk of skin cancer, sunburn, and photoaging.

We encourage people to use sunscreen as part of a comprehensive plan for overall skin protection, every day, to reduce the risk of skin cancer, but unfortunately many people are still not using sunscreen often enough or to the degree recommended.

The NASEM’s report clearly states that there is currently insufficient evidence to conclude that sunscreens are harming the marine environment. In fact, few environmental studies have been done to determine the effects of UV filters in aquatic environments. The results of these few studies conducted have inconsistent results, with many showing a “non-detect” or very low concentrations of UV filters in the ocean.

Some research done on UV filters on corals has been conducted in labs at concentrations 100 to 1,000 times higher than what is generally found in the ocean. We recommend that people take a moment to review the that the EPA conduct a full ecological risk assessment of all sunscreens and support modeling studies on the potential effects of changes in sunscreen usage on skin cancer risks.

The NASEM report also casts doubt on whether mineral sunscreens are, in fact, “reef safe” — something that sunscreen ban proponents and lawmakers have assumed was true. In fact, there showing that zinc oxide and titanium dioxide may be hazardous to marine life.

The NASEM report reviewed studies that showed that mineral UV filters can be toxic to marine life at concentrations that are even lower than those of chemical UV filters. In other words, mineral sunscreens may not necessarily be safer for the environment.

Moreover, the term “reef safe” does not currently have a regulated or standardized definition, so products labeled as “reef safe” vary in composition and ingredients.

The authors of the previous Community Voice piece misinterpret the Food and Drug Administration’s ruling by claiming that only two ingredients are considered as safe and effective for sunscreens. This is simply not true.

In its most recent 2021 ruling, the FDA encouraged the continued use of all sunscreens — both organic UV filters (chemical) and inorganic UV filters (mineral) as important skin cancer prevention tools.

Only the FDA has the final authority over which active ingredients are allowed in sunscreens and Maui County (and soon to be Hawaii County) could be overstepping its authority by taking away FDA-approved sunscreens from consumers.

Mineral sunscreens may not necessarily be safer for the environment.

It is important for everyone to remember that sun safety is a comprehensive package and should include practices like wearing UV protective clothing and seeking shade when possible. But sun-safe practices must also include using broad-spectrum, SPF 30+ sunscreen on exposed skin whenever you are outside (not only at the beach).

We see skin cancers in people who rarely go to the beach, but spend much time working outside or commuting back and forth in the sun. The public health risk of skin cancer is real and it’s clear that more study on any potential risks of sunscreen products to the environment is needed.

We can do better to protect both public health and the environment.