Prevention Efforts: Where We Stand

As clinicians, we are data-driven. We rely on it every day in the clinic when we prescribe medications or diagnose skin disease. But sometimes the data are not there (or at least reliable data). For instance, when it comes to one of the most important functions of our clinical duty—increasing awareness for UV avoidance and protection—we have very little tangible evidence on the efficacy of our efforts. We can instruct every patient that comes through our practice doors to apply sunscreen, and we can try new tricks and methods to increase adherence to sun protection efforts, but it’s hard to know if these efforts have any effect.

Often, the only evidence we can look to for guidance is either broad survey data or non-interventional data drawing links and associations. Nevertheless, regarding UV avoidance and prevention, every bit of data counts and can help inform us in our counseling efforts to patients. In particular, concerning recent findings regarding melanoma incidence and sunscreen awareness indicate that awareness efforts are needed now more than ever. They also highlight the role for both primary and secondary prevention in melanoma detection and awareness efforts.

Secondary Prevention Efforts
Found Effective

Results from a Danish study have shown an increase of in situ melanoma incidence over a nearly 30-year period.1 Reviewing data from 1985 and 2012, the researchers found that the incidence of malignant melanoma increased in men by 4.5 percent during that time and in women by 4.3 percent. The incidence of superficially spreading malignant melanoma also increased, with estimated annual percentage changes of 5.2 percent for men and 4.7 percent for women. Of particular note, the increase in incidence was especially prominent in patients over 60 years of age.

The researchers concluded based on the data that secondary interventions, such as early detection and treatment, are effective, which is particularly notable in light of the persistent criticism that skin cancer screening may not be effective. The researchers recommended that secondary prevention efforts are especially beneficial for older patients.

Sunscreens Still Poorly Understood

Although secondary prevention can play a role in the early detection of melanoma in certain patients, primary prevention remains the gold standard for this. And yet, a new study published last month finds that consumers lack understanding of one of the most important tools of primary prevention: sunscreen. Specifically, investigators recently found that consumer understanding of sunscreen labels is low.

In the study, fewer than half of the participants were able to correctly identify the terminology that indicated how well the sunscreen protected against skin cancer, photoaging, and sunburns.2 Moreover, only 43 percent of those surveyed understood the definition of the SPF value. While most participants in the survey grasped that sun protection increases with the SPF value, only about half correctly identified the amount of sunscreen needed to cover the entire body in order to achieve the advertised level of sun protection, according to the researchers. Also poorly understood was the star system for UVA labels.

The investigators concluded that sunscreen labels may foster confusion and misconceptions about sunscreen. They suggest that a new metric may be needed to better reflect the performance of current sunscreens.

Prevention: Primary vs. Secondary

Although the findings suggesting that secondary prevention could have a positive impact is encouraging, we cannot dismiss the significance of the sunscreen consumer data. As sunscreen formulations become more nuanced and consumers have access to more products, it is essential that consumers understand not only what sunscreen labels mean, but, more importantly, the need for UV protection in preventing malignant melanoma, as well. As dermatologists, we should take every opportunity both inside and outside the clinic to educate patients, colleagues, and the public at large. n

Jonathan Wolfe, MD is an Associate Professor of Dermatology at the University of Pennsylvania.

1. Helvind, NM. Et al. JAMA Dermatol. 2015. Published online June 10.

2. Kong, BY. Sheu, SL. Kundu, RV. JAMA Dermatol. 2015. Published online June 17.