Concern Persists for Sunburn Among Non-Melanoma Skin Cancer Patients

A large proportion of people with a history of non-melanoma skin cancer were found to get sunburned at the same rate as those who do not have prior history.

It is reported that approximately 13 million white non-Hispanic individuals in the United States have a history of at least 1 type of non-melanoma skin cancer, including basal cell and squamous cell cancers, which puts them at a well-documented higher risk for subsequent non-melanoma skin cancer.

For a study published in the Journal of the American Academy of Dermatology, researchers analyzed self-reported survey results from 758 people with a prior history of non-melanoma skin cancer, and from 34,161 people without a history of skin cancer, on sun protective practices.

Of the 34,161 patients without a history, 18,933 were female and 15,228 were male. For those with a history, 390 were female and 368 were male. The primary focus of the study was on non-Hispanic whites, a population most affected by non-melanoma skin cancer.

In the study, protective practices were defined as the use of sunscreen when going outside on a sunny day for more than an hour, staying in the shade when outside on a sunny day for more than an hour, and wearing long sleeves or a wide-brimmed hat for protection. Sun avoidance was defined as not going out into the sun.

The results of the study showed that overall, 44.3% of individuals with a history of non-melanoma skin cancer reported the frequent use of shade, compared with 27% of people without a history of skin cancer. Of those with non-melanoma skin cancer history, 20.5% wore long sleeves, compared with 7.7% who had no history of cancer.

Researchers also found that 26.1% of individuals with a history of non-melanoma skin cancer reported wearing wide-brimmed hats when outside in the sun, compared with 10.5% of people without a history. Furthermore, 53.7% of people with a history of non-melanoma skin cancer reported wearing sunscreen, compared with 33.1% of people without a history.

Of 44.7% of people with a history of non-melanoma skin cancer, they reported using more than 1 form of sun protection, compared with 19.4% of people without a history. Additionally, multimodality — multiple skin protective practices at one time – was associated with a lower risk of sunburn, and offers a highly beneficial approach for those with a history of non-melanoma skin cancer, the study indicated.

The most significant findings, however, showed that although people with a history of non-melanoma skin cancer tended to use 1 or all of the protective practices, there was still not a significant difference in sunburn compared with those without a history, at 29.7% versus 40.7%, respectively.

The findings suggest that, although people with a history of skin cancer are proactively using protective methods, they may not be doing so effectively, especially in younger patients. According to the results of the study, about two-thirds (66.9%) of people between the ages of 18- to 39-years-old reported having sunburn.

“It is important to look at how patients are currently practicing sun protection and what they are doing that is not very effective,” said researcher Anna Chien, MD. “Only then can we make strides in helping patients improve their sun protective practices by ensuring they do them the correct way.”

Although sunscreen was the most common form of sun protection reported by participants, it was not associated with lower rates of sunburn in patients with a history of non-melanoma skin cancer.

“These results suggest that physicians need to go the extra step in educating patients on the most optimal way of utilizing sun protection methods,” Chien said. “Public health messages should also emphasize not only sun protection but how to do it correctly.”

Authors warned that non-melanoma skin cancer tends to be considered less important than melanoma, and is underreported. Furthermore, although data were the study was collected from a national survey, the results were self-reported, and therefore may have some bias.

“The bottom line is that people should be using multiple forms of skin protective practices,” Chien said. “That means incorporating shade or sun avoidance into a daily routine, or wearing a wide-brimmed hat while also applying sunscreen correctly.”