Despite the increased awareness surrounding skin cancer prevention the incidence of this disease is on the rise. Research suggests that counseling in the primary care setting, avoidance of tanning beds and proper skin coverage are the most effective methods in reducing a person’s risk of skin cancer. As one of the most common forms of cancer, skin cancer continues to be a public health issue due to its high rate of occurrence therefore continues to require preventative actions (CDC, 2020). According to the American Cancer Society (2020), the estimation of new cases of skin cancer for 2020 is 4,410 in Pennsylvania and 8,750 in Florida with 60,190 new male cases and 40,160 new female cases.
“Skin cancer rates are elevated in states such as Florida, where the level of ultraviolet radiation (UVR) is among the highest in the country (Arutyunyan et al., 2017).” According to the US Preventive Services Task Force (USPSTF), risk factors that have been reported to play a role in skin cancer include; male sex, fair skin and hair, freckling, history of sunburn, common or atypical nevi, personal or family history of melanoma, and UVR exposure from sunlight or tanning beds (USPSTF, 2016). In the state of Florida, the annual age-adjusted rate of newly diagnosed melanoma is 24.6 to 100,000 residents in comparison to the state of Pennsylvania the annual age-adjusted rate of newly diagnosed melanoma is 24.3 to 100,000 residents (CDC, 2020). Increased efforts at early skin cancer detection in the primary care setting play such a pivotal role to reduce the morbidity and mortality associated with skin cancer.
There are two different classifications of skin cancer nonmelanoma skin cancer (NMSC) and melanoma. Under the NMSC it is broken down into basal cell carcinoma, most common type of skin cancer, and squamous cell carcinoma in which 2 out 10 skin cancers are classified under (ACS, 2020). Out of the three types of skin cancer, melanoma is the one that is most harmful because if not caught early and removed it may spread to other parts of the body. The American Cancer Society (2020) notes that 6,850 people are estimated to die from melanoma in which is 20 times more common in whites and increases with age. As a continued growing health concern, a recommendation statement for screening for skin cancer was published in the Journal of American Medical Association in 2016.
In reviewing the clinical practice guideline for screening for skin cancer there is currently no recommendations as there is insufficient evidence to support the benefits and harms of a visual skin inspection by a provider to screen for skin cancer. The USPSTF (2016) does recommend that individuals aged 10 to 24 years old who have certain risk factors be educated by their providers to minimize their risk of developing skin cancer. Thankfully, if skin cancer is detected there is a variety of treatments available from radiation to surgery. Additionally, in 2014 the Office of the Surgeon General released The Surgeon General’s Call to Action to Prevent Skin Cancer which included five goals for skin cancer prevention: increase sun protection in outdoor settings; educate individuals on making healthier choices about UV radiation exposure; reduce health consequences related to indoor tanning; strengthen research, surveillance, monitoring, and evaluation related to skin cancer prevention; and promote policies that advance the national goal of preventing skin cancer (HHS, 2018). Despite the implementation of different approaches for skin cancer prevention, the United States, particularly Florida and Pennsylvania, can still find room for improvement.
The Social Determinants of Health; the conditions in which people are born, live, work, and age are primarily responsible for health inequities according to the World Health Organization (WHO, 2017). Social Determinants of Health that may affect the mortality and morbidity of skin cancer include family, peers, media and culture. Studies suggest that wealthier people have more access to tanning beds, increasing a person’s exposure to UV light- an environmental factor for skin cancer. In addition, lack of sunscreen is sometimes a learned behavior modeled by our parents. If our parents didn’t use sunscreen, we as adults, are less likely to apply it correctly it at all. Furthermore, the media portrays the “sun-kissed” skin as a portrayal of beauty and increased confidence. Lastly, Padovese and colleagues (2017) state that “Education level is the strongest predictive factor of skin cancer awareness, whereas cultural behavior’s and personal experience of sunburns are the main factors determining sunlight avoidance.” Importantly, individual behavior as well as the physical and social environment someone surrounds themselves with affects their risk for developing skin cancer. So, although Floridians expose themselves to more natural UV light than others, tanning beds in non “sunshine states” continue to remain popular.
Appalla and colleagues (2017) address the reasons for increased skin cancer incidence which include, significantly older populations and increased occupational and recreational UV radiation. With the recent COVID-19 pandemic, and a majority of Americans forced on unemployment a large number of individuals spent their time outside. In addition, Florida is a place where many Americans consider a “retirement” location, thus the people in Florida are getting older, placing them at an increased risk for skin cancer development.
In order to address this disease, prevention strategies are needed. Including strategies divided into two different approaches, encourage behavioral changes to lower subsequent skin cancer risk and to enhance early detection (Appalla et al., 2017). Buy-in from primary care providers surrounding skin cancer prevention education is necessary. Interventions must be focused on reinforcing the use of sunscreen, education on the “ABCDE” detection algorithm and reducing sun exposure. Additionally, perceived barriers were identified by Noels and colleagues (2019) as to why primary care providers may not “buy-in” on providing skin cancer prevention education; lack of confidence in own skills to perform skin cancer care, a lack of trust from both patients and dermatologists and limited time and financial compensation.
In addition to primary care providers education their patients on sun-safe behaviors it is also important for pediatricians to educate new parents on such. It is noted that, “sun-safe behaviors instituted from a young age may help reduce the risk for future skin cancers (Bray et al., 2017).” In both Florida and Pennsylvania skin cancer prevention education should start immediately. Although education is just one piece to this puzzle it may provide other useful interventions on how to improve risky sun exposure behaviors. There is still additional insight needed to target at risk populations more effectively aiming to reduce the development of skin cancer. Public education about disease awareness coupled with visual exams from trained and educated providers may help reduce the risk of skin cancer or reduce the risk of mortality.