How to Ensure Outdoor Workers Use Sun Protection

How can dermatologists approach managing sun exposure-related melanoma risk for outdoor workers for whom advice to avoid the sun is simply not practical? Joel Schlessinger, MD, president of skin care retailer LovelySkin.com and CEO of Schlessinger MD, both in Omaha, Nebraska, gave Dermatology Times ® insights into current usage of sunscreen and sun protection among outdoor workers and unique challenges in educating this patient population, based on a recent study.

Be patient. My impression has always been that it is unfortunate that even with encouragement of sunscreen use and protection, and even making it more readily available, there just isn't a desire on many people's parts to do the right thing. Having said that, I think it is a great thing that healthcare providers try. And over time, you may win the battle, even though you might have lost it initially. So you have to do these types of things and educate, educate, educate. And if you can, you will end up eventually winning their hearts over.

While sun protection can be a difficult issue to convince some patients to pay attention to, the conversation is reaching them. It’s the same as in most areas—people do not see the value of sunscreen. They do not understand. And since it's not an immediate benefit—you don't develop skin cancer immediately from sun exposure—oftentimes the benefit isn’t appreciated initially. Now, having said that, we did see in this study some uptake in usage, although it was a very modest uptake, but it was an uptake all the same. So that that part is good. It just would have been nice if the uptake had been a little bit more so.

Understand that a patient population who chooses outdoor work has a different perspective on sun exposure.People who work outdoors generally have a different viewpoint of sun exposure because their job requires them to be exposed to the sun. So, for example, we tend to see people who self-select to be lifeguards. They’re going to be inclined to enjoy the sun. They're going to be inclined to be out in the sun. They didn't choose to be a lifeguard in order to be inside. They chose to be a lifeguard because they have a particularly positive viewpoint of being in the sun, for the most part. So it's going to be a tough sell to change their attitudes to realize that what they're doing is putting them in harm's way. We do see some benefits with some people. But in general, those that choose to be outdoors for their vocation have chosen that pathway for a reason, and it's not to stay inside and be away from the sun.

Unfortunately, some patients may wait until they or a loved one has had a health scare. There are always opportunities to reach these individuals. But usually it takes one or 2 scares close to them to bring the message home. And those scares could be a relative or friend who has had skin cancer, or obviously it could be that individual. But as we know, it takes somewhere around 20 years from the first time with exposure to develop skin cancer or melanoma from that exposure. So it takes a while to develop the impetus that would potentially change their attitudes and affect their approach to sun.

Patients may not be aware of the risk of melanoma on skin normally covered by clothing. That is probably most unheralded and unknown factoid that we have among our patients, because they'll say, for example, “well, I always cover my skin. I don't need to be examined for unusual moles or melanoma.” And those are the people that you'll almost invariably see something on their undergarment areas or areas that are covered. Clearly, there is the chance that they received sun exposure as a child. And the sad part is that with repeated sun exposure events, such as sunburns that could have happened when they were babies, they would never remember it. But they perhaps suffered sunburns or severe sun exposure experiences during those times that 20-30 years later are catching up to them.

Persistence pays off. Dermatologists are probably the most motivated and particularly vocal about these issues. And it always amazes me that dermatologists, despite the challenges and despite the lack of public enthusiasm for sun exposure limitation, still get out there and try to do their best to change public attitudes. It sometimes seems like a voice crying in the wilderness. But at the same time, you have to continue to do what you believe in and say what you what you think people ought to be told, or nobody will embrace it.

In Australia, to the positive side, there has been a great deal of effort expended, and attitudes have changed. Australians that I see are extraordinarily aware of the concerns about melanoma. Now that's because they have such a dramatically higher risk of melanoma than the general population in most other countries. But there has been a public groundswell attitudinal change that has related to their exposure to the sun, how they protect themselves from the sun. The public messages about it really could be a blueprint for the United States and other areas where education and public dissemination isn't as effective.

Disclosures:

Schlessinger reports no relevant financial interests.

Reference:

Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Stimulating sunscreen use among outdoor construction workers: a pilot study. Front Public Health. 2022;10:857553. Published 2022 Apr 1. doi:10.3389/fpubh.2022.857553