From the Journals

Counsel children and young adults on skin cancer prevention

Publish date: March 20, 2018

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Terminology and counseling logistics must evolve to be effective

The term “fair skin types” as used in the USPSTF recommendations is not necessarily helpful in identifying individuals who could benefit from skin cancer prevention counseling, June K. Robinson, MD, and Nina G. Jablonski, PhD, wrote in an accompanying editorial (JAMA. 2018;319[11]:1101-2). Hair and eye color do not predict sun sensitivity, and in general, men and individuals with darker skin don’t think they are at risk for skin cancer even when they sunburn, they noted.

“The terminology that is used by investigators and then incorporated into the USPSTF evidence base needs to evolve to include all persons at risk, without disenfranchising portions of the diverse U.S. population,” they said. In addition to skin type, physicians need to evaluate a patient’s melanoma risk based on lifestyle factors, such as time spent outdoors, photosensitizing medications, and sun protection habits, they added, but primary care clinicians often lack the time to offer personalized sun protection counseling.

“It would be better to encourage people to check the UV Index daily – or consider a mobile application that automatically provides it – and plan outdoor activities, especially physical activities, to be sun safe,” they said. In addition, individuals may be more likely to manage skin cancer risk with a mix of supportive messages via social media to augment in-person counseling from a clinician; furthermore, “normative approval by friends and peers can have a strong reinforcing influence on sun safety behaviors, particularly among youth, who are at a vulnerable age for acquiring melanoma risk,” they emphasized.

Dr. Robinson is a research professor of dermatology at Northwestern University, Chicago, and is the editor of JAMA Dermatology. She is supported in part by the National Cancer Institute. Dr. Jablonski is a professor of anthropology at Pennsylvania State University, University Park. Dr. Robinson had no financial conflicts to disclose; Dr. Jablonski has served on the scientific advisory board of the L’Oreal Group.


 

FROM JAMA


“Small to moderate effects of behavioral interventions on increased sun protection behaviors were observed in studies of all age groups, though overall, adult trial results were mixed and fewer studies demonstrated an intervention effect,” the researchers said.

The evidence review was limited by several factors including a focus on primary care intervention only and an exclusion of skin cancer survivors, the researchers noted. Although evidence does not show that sunburns are less frequent as a result of interventions, behavioral intervention can improve sun protection behavior, they said. However, intervention in adults “may lead to increased skin procedures without detecting additional atypical nevi or skin cancers,” they noted.

The recommendations are consistent with the draft recommendations published in 2017 and expand the recommendations from 2012 that advised counseling for individuals aged 10-24 years.

The research was funded by the Agency for Healthcare Research and Quality. The authors had no financial conflicts to disclose.

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