Many people who have had skin cancer still don't protect themselves adequately from the sun

A substantial number of people with a history of the most frequent kind of nonmelanoma skin cancers still get sunburned at the same rate as those without previous history, likely because they are not using sun protective methods correctly, a Johns Hopkins study suggests.

The results, researchers says, should urge skin doctors and health care providers to promote protective skin care practices, especially with patients who have a history of nonmelanoma skin cancer.

"It's important to look at how patients are currently practicing sun protection and what they are doing that is not very effective," says Anna Chien, co-director of the Cutaneous Translational Research Program in the Department of Dermatology at the Johns Hopkins University School of Medicine. "Only then can we make strides in helping patients improve their sun protective practices by ensuring they do them the correct way."

Sun exposure is the leading cause of nonmelanoma skin cancers. In the U.S., 13 million non-Hispanic white individuals have had at least one type of nonmelanoma skin cancer, and treatment is estimated to cost $4.8 billion annually. Patients with a history of nonmelanoma skin cancers have a higher risk of developing subsequent skin cancer lesions.

The findings, published in the Journal of the American Academy of Dermatology, were based on self-reported accounts of sun protective practices and incidents of sunburn collected by the National Health Interview Survey. The study focused on non-Hispanic white individuals—the population most affected by nonmelanoma skin cancer—and included 758 people with previous nonmelanoma skin cancer and 34,161 people without a history of skin cancer.

The researchers defined protective practices as using sunscreen when going outside on a sunny day for more than an hour, wearing long sleeves or a wide-brimmed hat, and staying in the shade when outside on a sunny day for more than one hour. They defined sun avoidance as not going out into the sun.

Overall, they concluded that 44.3 percent of people with nonmelanoma skin cancer history reported frequent use of shade, compared to 27 percent of people without a history of skin cancer, and that 20.5 percent of those with a history of nonmelanoma skin cancer wore long sleeves, compared to 7.7 percent of those with no history. Additionally, 26.1 percent of those with a history of nonmelanoma skin cancer said they wore a wide-brimmed hat when outside in the sun, compared to 10.5 percent of people without a history, and 53.7 percent of those with a history of nonmelanoma skin cancer said they wore sunscreen, compared to 33.1 percent of those without a history.

Although people with previous nonmelanoma skin cancer tend to report using one or all of the protective practices, there was not a significant difference in reporting of sunburn compared to those without a history—29.7 percent versus 40.7 percent. This means, Chien says, that although those with a history of skin cancer are using protective methods, they may not be doing so effectively, especially among younger patients.

"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 says. "Public health messages should also emphasize not only sun protection, but how to do it correctly,"