Counseling children about skin cancer important, but rarely done

More pediatricians should counsel children and their parents about preventing skin cancer, according to dermatology researchers from Wake Forest University Baptist Medical Center. A review of research literature confirmed that prevention should begin in childhood, yet found that the topic is discussed at less than 1 percent of well-child visits.

“Children should be encouraged to use sunscreen, wear appropriate clothing and avoid both the strongest midday sun levels and indoor tanning,” said Mandeep Kaur, M.D., instructor in the Department of Dermatology. “Skin cancer is the most rapidly growing cause of cancer deaths in the United States, and childhood sun exposure increases the risk.”

The researchers reviewed the research literature on ultraviolet (UV) light and skin cancer in order to familiarize pediatricians with the magnitude of the skin cancer problem and the evidence that exposure to UV light, particularly indoor tanning, is a risk factor. Their article appears in the current issue of Pediatric Dermatology.

“Pediatricians can play an important role in counseling patients and educating them about skin cancer,” said Steven Feldman, M.D., Ph.D., senior researcher. “There is strong evidence for the relationship between UV exposure and non-melanoma skin cancer and growing evidence for the relationship between indoor tanning and melanoma.”

UV light occurs naturally in sunlight and is responsible for the tanning and burning effects of the sun. Artificial UV light is used in tanning beds and sunlamps. There are two types of UV light – A and B. UVB is several orders of magnitude stronger in producing sunburns, tanning and damage to cells than UVA.

The composition of natural sunlight on a sunny day is about 90 percent to 95 percent UVA and 5 percent to 10 percent UVB. Newer sunlamps and tanning beds (manufactured after 1970) typically emit 0.5 percent to 5 percent UVB radiation. Older units can produce 22 percent to 44 percent UVB. Studies indicate that both types of ultraviolet light may be responsible for melanoma formation.

Research strongly points to a link between natural sun exposure and melanoma, the most deadly type of skin cancer. According to the American Cancer Society, melanoma accounts for about 4 percent of skin cancer cases, but causes 79 percent of skin cancer deaths. Some investigators have proposed that sun exposure during childhood has a greater impact on melanoma risk than sun exposure during adulthood.

The research on whether indoor tanning is related to melanoma formation is mixed, Feldman and colleagues found. They said the inconsistency of results may be explained by the variable intensity of tanning beds and the inability of participants to correctly recall their levels of tanning exposure. The most recent study, from Norway and Sweden, eliminated both problems and found that women in the study had a 10-fold increase in the occurrence of melanoma.

The authors said the review points to the importance of educating children and their parents about the dangers of sun exposure and indoor tanning.

“Our review clearly showed that the prevention of both melanoma and non-melanoma skin cancer needs to begin in childhood,” said Kaur. “Reduction in childhood sun exposure and tanning will hopefully stem the rise of skin cancer.”

Previous research has shown that skin counseling is provided at less than 1 percent of pediatrician visits.

“Children and their parents should be counseled on prevention measures, including avoiding tanning, especially as they reach adolescence and appearance becomes a larger issue,” said Kaur.

Other co-researchers were Farah Abdulla, B.S., Phillip Williford, M.D., and Daniel Krowchuk, M.D., all with Wake Forest’s Center for Dermatology Research.