Faculty Bibliography

BACKGROUND: Solid-organ transplant recipients (OTRs) with sun-sensitive skin, a history of sun exposure, and clinical signs of photoaging have an increased risk of developing squamous cell carcinoma. OBJECTIVE: The objective of this study was to compare the sun protection attitudes and behaviors of OTRs with those of the general public. METHODS: In spring 2003, a telephone survey of 200 OTRs and a random sample of 1091 U.S. residents were performed with standardized questions previously used in population surveys. RESULTS: Seventy-nine percent of OTRs and 69% of the U.S. public believe that the appearance of a tan is attractive. The attitude was expressed more often by men than by women and is not related to the education of the person. A greater proportion of OTRs believed that people looked 'healthier' with a tan and 88% of OTRs were not aware of their increased risk of developing skin cancer. Thirty-five percent of OTRs reported regularly using sunscreen, which is the principal form of sun protection used. Women report more regular use of sunscreen than men. OTRs wear less protective clothing and seek less shade when outdoors than the public. Sunburning was reported by 35% of OTRs, which is similar to the rate reported by the public. CONCLUSION: OTRs' attitude that people look 'better, healthier' with a tan inhibits effective sun protection. Although physicians who care for OTRs provide patient education in the hope that it increases their awareness of their risk of developing skin cancer and will promote change in their sun protection behaviors, the OTRs' perception of risk is influenced by many concerns. Interpersonal motives, particularly for OTRs, the self-presentational ones related to appearance and the social image or prototype of a tanned person being healthy, mitigate risk perception of the health problem. Risk perception does not always inhibit risk behavior; therefore, unprotected sun exposure occurs in OTRs

UV radiation exposure increases skin cancer risk. A substantial portion of a person's UV exposure occurs before the age of 18 years. We sought to determine UVB radiation exposure levels in high-school students during normal daily activity. Digital dosimeters were worn by 4 high-school students during 11 school days. Students were subjected to daily erythemal and suberythemal doses of UVB radiation. Programs to educate high-school students in sun-protective practices even during regular school activities are needed

BACKGROUND: Participation in outdoor alpine sports has been increasing over the last decade. Ultraviolet exposure levels for these activities can be extreme owing to the venue altitudes. The purpose of this study was to measure the levels of UV-A and UV-B radiation exposure incurred by performance skiers in a typical alpine venue and to determine the need for protection in that environment. OBSERVATIONS: Total UV-B exposure ranged from 12 to 185 mJ/cm(2) (0.5-7.6 times the minimum erythemal dose [MED] for individuals with type II skin). Ten percent of subjects received more than 1 MED/h at peak exposure times. Daily UV-A exposure ranged from 10.6 to 28 J/cm( 2) (daily average, 0.55 minimum melanogenic dose). CONCLUSIONS: Alpine skiers with skin types I and II are exposed to measurable erythemal and suberythemal levels of UV radiation repeatedly over the long term at levels that can cause photodamage to their skin and potentially increase their later risk for skin cancer. Programs should be developed to educate skiers regarding the need for UV protection. Given the high levels of exposure noted, skiers should use UV protective measures, including sun-protection factor 30 broad-spectrum sunscreen

Malignant melanoma continues to present a significant public health problem as its incidence is rising faster than that of any other cancer in the US. At current rates, 1 in 74 Americans will develop melanoma during his or her lifetime. Management of melanoma is a complex issue requiring a multidisciplinary approach. The most effective method of protection against the development of melanoma is minimization of ultraviolet exposure from sunlight. Early detection and treatment are critical and result in improved patient survival rates. Surgical excision remains the mainstay of treatment but many new promising therapies are being investigated. It is hoped that increased public and professional awareness and education in all areas relating to the prevention, detection, and treatment of malignant melanoma will contribute to decreasing trends in the incidence and mortality from this cancer in the future

BACKGROUND: Because an estimated 50% to 80% of the skin's lifetime sun damage is thought to occur in childhood and adolescence, it is during these critical periods that intense, intermittent sun exposure causing burning increases melanoma risk. METHODS: A 1997 telephone survey of 503 households evaluated parental attitudes about their child having a tan, and ease of practicing sun protection, sun protection methods used, and sunburning on 5 successive summer weekends. RESULTS: In a random sample of 1 child from each household, 13% of children sunburned during the past week or weekend, and 9% of their parents experienced a sunburn during the past weekend. Children's sunburn was significantly associated with sunburn in the adult respondent, increasing age of the child, having fair skin, being white, and using sunscreens. Duration and peak hours of sun exposure were associated for children and parents. Sunscreen with a sun protection factor of at least 15 was the predominant form of sun protection used. Sunscreen use in children was significantly associated with longer duration of sun exposure, sunny weather conditions, younger age, fair skin, a history of sunburns before this study, a family history of skin cancer, and a higher family income. Feeling that a tan appeared healthy was associated with male gender of the adult and increasing age of the child. Complimenting the child on the appearance of a tan was associated with male gender of the adult, older children, children with skin type reported as olive or dark, and lower educational levels. CONCLUSION: Although there has been a promising initial effort to alert parents to the need to protect their children from sunburns, many view a tan as healthy and do not effectively implement sun protection behaviors for their children, which results in sunburns. Sun protection that prevents sunburning could be achieved by more children seeking shade, wearing protective clothing, limiting exposure during peak hours, and effectively using sunscreen