Skin cancer prevention

Barcelona, Spain - Recent developments in tanning bed restrictions as well as improved sunscreen testing and labeling have raised the stakes in the ongoing battle against melanoma.

Measures and initiatives addressing primary and secondary skin cancer prevention are always in flux, and while dermatologists readily support and promote secondary prevention methods including early and frequent skin cancer screenings, one expert says that still more can be achieved in primary skin cancer prevention.

“Though much has been accomplished in primary prevention of melanoma, there is still need for improvement including the mechanisms of educating the public in sun protection, the current state of sunscreen regulation and use, and the current state of tanning bed regulation and use,” says Allan C. Halpern, M.D., chief of the dermatology service at Memorial Sloan-Kettering Cancer Center, New York, who spoke at the sixth World Meeting of Interdisciplinary Melanoma in Barcelona.

The public health messaging in the United States is largely done by a loose network of nonprofit organizations, and by professional organizations, such as the American Academy of Dermatology, and specialists.

More than 10 years ago, a coalition known as the National Council for Skin Cancer Prevention (NCSCP) was founded, with the central purpose of increasingly aligning messages and building on opportunities for public awareness regarding skin cancer and its prevention. In line with its common goals, the NCSCP has tried to raise awareness of melanoma and other types of skin cancer and instituted “Don’t Fry Day” (the Friday before Memorial Day), similar to the AAD’s initiative “Melanoma Monday” (the first Monday in May).

“The hope is to raise public awareness of melanoma and teach the public effective strategies for melanoma prevention. Fortunately, through the coordination of the efforts of many organizations, public health messages for melanoma awareness have become more effective and increasingly consistent,” Dr. Halpern says.

Advances in sunscreens

In sunscreens available today, SPF is mainly a UVB measurement. Nearly all sunscreens claim UVA protection or broad-spectrum coverage, but the degree of UVA protection is unknown, and most sunscreens offer incomplete - if not inadequate - UVA protection.

Industry is in the process of initiating compliance with the Food and Drug Administration’s rules regarding labeling and testing for sunscreen products. The FDA has devised a standard for sunscreen labeling as relates to UVA protection, Dr. Halpern says, and it has adopted an in vitro pass/fail test (critical wavelength test) for broad-spectrum sunscreens in order to help ensure that products have adequate UVA protection.

According to the June 2011 FDA ruling, any sunscreen with an SPF of over 15 and a critical wavelength of over 370 nm may claim “if used as directed with other sun protection measures, sunscreens decrease the risk of skin cancer and early skin aging caused by the sun.” Sunscreens that meet these two criteria can also include “broad-spectrum” as well as the appropriate SPF on the packaging.

A randomized clinical trial recently performed by an Australian group looked at whether the long-term application of sunscreen could decrease the risk of cutaneous melanoma. The researchers found that sunscreens do play a crucial role in melanoma prevention, as the study data suggests that melanoma may be preventable by regular sunscreen use in adults. (Green AC, Williams GM, Logan V, Strutton GM. J Clin Oncol. 2011;29(3):257-263).

“Even though there is only one study that indicates the efficacy of sunscreen in reducing the incidence of melanoma, the data is significant and cannot be ignored,” Dr. Halpern says. “Physicians should help patients better understand the new labeling of sunscreens and encourage patients to be more compliant with using enough sunscreen consistently, as well as a higher SPF product.”

Tanning bed controversy

Some of the reasons to support the regulation of the tanning industry and tanning bed use are that tanning beds have very little supervision and guidelines, the UV radiation levels far exceed what is found in natural sunlight, and the side effects of their use are not monitored or regulated.

Measures to restrict the use of tanning beds, particularly in minors (i.e. younger than age 18) have increasingly been adopted by several countries worldwide, a motion that is widely viewed as a wise step towards skin cancer prevention. Despite tanning beds’ increasing association with skin cancer, Dr. Halpern says the United States is still lagging behind in instituting legislation on the restriction of the devices.

Although 32 states have enacted tanning bed legislation and have imposed some form of restriction on tanning facilities access to minors, Dr. Halpern says the restrictions themselves vary considerably and their enforcement is not uniform, underscoring the need to do more.

“There is mounting compelling evidence on the risk of using tanning beds as it relates to melanoma development. The use of tanning beds are even more of a critical issue in those individuals who adopt tanning bed use at an early age, particularly in female teens where the practice has become near epidemic,” he says.

Physician counseling can play a role in addressing the use and abuse of tanning beds, and according to Dr. Halpern, dermatologists are a critical component of the advocacy, both on state and the federal levels, to achieve restricted use of tanning beds and a ban on their use by minors.

“It is a very exciting era in both the primary and secondary prevention of melanoma, and with recent clinical trial data indicating that sunscreens can dramatically decrease melanoma incidence, the labeling of sunscreens and their regulation becomes ever more important,” Dr. Halpern says. “In addition, as we increasingly realize how big a problem tanning beds are in terms of contributing to melanoma risk, strict regulations on their use must also be instated.”

Disclosures: Dr. Halpern reports no relevant financial interests.