Beyond the Burn: 3 Populations Left Behind in the Skin Cancer and Sunscreen Conversation

Summer has officially begun, and unfortunately, so has the yearly crusade against my favorite skincare product, sunscreen. TikTok has been buzzing with new and old myths alike—drinking water prevents sunburns, sunscreen causes skin cancer, sunscreen contains endocrine disruptors, sunscreen is responsible for Vitamin D deficiency, and more. I know I can’t be the only one who spit out my water after hearing that first one, but sadly, even the most outrageous misinformation does harm.

This survey from the Orlando Health Cancer Institute found that 23% of adults under the age of 35 believe that drinking water or staying hydrated protects them from getting a sunburn. This same survey found that 14% of people 35 and younger believe that sunscreen is more harmful than sun exposure.  How can there possibly be so much hate toward a product that helps prevent skin cancer AND signs of aging caused by sun damage? It blows my mind, y’all. In the U.S., skin cancer is the most commonly diagnosed cancer; anybody with that glorious organ sack we call skin can get it. Especially in light of ongoing sunscreen misinformation, it’s crucial to produce equitable education about sunscreen and skin cancer risks.

​Here are three populations that may not be aware of their risk of skin cancer, with action steps and talking points for public health and health care professionals.

People of Color

Melanin is magic y’all, but melanin, and therefore skin, can still get damaged! It’s true that white people and those with lighter skin tones are more often diagnosed with skin cancer; however, Black people and folks with darker skin tones are more likely to die of it. This rate of mortality is due to a later diagnosis. Other than Black Girl Sunscreen, a Black woman owned brand, I can’t think of sunscreen ads featuring people of color, can you? Organizations such as the Skin Cancer Foundation and the National Cancer Institute have information on their websites about skin cancer risk and people of color, but one would have to seek out this education specifically. With this in mind, it should come as no surprise that Black and Brown people are left unaware of the benefits of sunscreen as it relates to skin cancer prevention. When sunscreen is discussed, it usually revolves around skincare, such as benefiting those with vitiligo and melasma and preventing skin darkening. Hispanic and Latin populations typically only worry about skin cancer if they have a family history, and even then, if their occupations are indoors, it’s out of mind. What can we do to encourage sunscreen use amongst POC?

Skin Cancer and Sunscreen Action Steps and Talking Points for People of Color

1. ​Educate on the risk of morbidity from skin cancer: “It’s important to know that everyone, regardless of skin tone, can get skin cancer, but People of Color are more likely to die from skin cancer. Ask your provider about your risk factors.” 
2. Teach that skin cancer is more likely to be found on areas such as the bottoms of feet, palms of the hands, and under the fingernails in Black, Asian, and Pacific Islander folks: "For Black, Asian, and Pacific Islander individuals, skin cancer is often found in less obvious places like the bottoms of your feet, palms of your hands, and under your fingernails. Make sure to check these areas regularly."
3. Remind that damage to melanin can happen during leisure activities, not just work: "Remember, sun damage can occur during any outdoor activity, not just when you're at work. Whether you're at the beach with family, playing sports with friends, or taking your dog on a walk, make sure to protect your skin."
4. ​​Encourage doing regular self skin checks and regularly seeing a dermatologist who is confident in diagnosing cancer on different skin tones: "Learn to do regular self skin checks. Schedule regular visits with a dermatologist, especially one who is experienced in diagnosing skin conditions on different skin tones."

Men

Men of all races and ethnicities are at a higher risk of dying from skin cancer than women, regardless of age. Furthermore, after the age of 50, a higher percentage of men are more likely to develop skin cancer than women of the same age. Excuse me while I go schedule a dermatologist appointment for my father. Several factors contribute to this outcome: men typically do not receive the amount of education on sunscreen or skin cancer that women do, men are less likely to go to a doctor regularly where they might get a referral to a dermatologist, men are not likely to know to do regular skin checks, and they may have different attitudes about sunscreen. I can’t say this surprised me; I don’t personally know too many men who wear sunscreen often, if at all. What can we do to rectify this lapse in education?

Skin Cancer and Sunscreen Action Steps and Talking Points for Men

1. Inform on the incidence of skin cancer in men: “Skin cancer is one of the most common types of cancer among men, and it can be deadly. Learn how to protect yourself today.”
2. Inform on the morbidity of skin cancer in men: “Men, particularly over 50, have a higher risk of getting and dying from skin cancer than women. Talk to your provider about getting a skin check.”
3. Educate about forms of sun protection other than sunscreen: “Wearing wide-brimmed hats, long sleeve clothing with added sun protection (labeled UPF), and sunglasses and staying in the shade can help you stay protected from sun damage.”

People who are Immunocompromised

This group of people includes transplant recipients, cancer patients, cancer survivors, those living with HIV, those who take immunosuppressants, and others. Folks who are immunocompromised have a much higher risk of skin cancer than those with normal immune systems. It would be easy to assume that this group of people is educated by their healthcare providers about their risk of skin cancer and are encouraged to use sunscreen along with other sun protection methods. But that would be doing this population a disservice. How can we communicate about skin cancer and sunscreen use among this group?

Skin Cancer and Sunscreen Action Steps and Talking Points for People who are Immunocompromised

1. Teach about the increased risk of getting and dying from skin cancer: “Having an organ transplant, going through cancer treatment, having survived cancer, and those with HIV are at a significantly higher risk of getting skin cancer.”
2. Teach about the increased risk of getting and dying from skin cancer: “Skin cancer can be extremely dangerous for people who are immunocompromised. You may be immunocompromised if you’ve had an organ transplant, have or have had cancer, have HIV, are on immunosuppressants, or have other autoimmune conditions.”
3. Inform about forms of sun protection other: “Staying in the shade, covering up with clothing, and wearing sunglasses and wide-brimmed hats can further protect your skin.”
4. Remind about the importance of early detection: “Early detection is key! Regularly check your skin and inform your primary care provider if you notice something.”
5. Encourage regular dermatology appointments: “Dermatologists are trained to look for early signs of skin cancer. Find a dermatologist you feel comfortable with and schedule a yearly appointment.”

Skin Cancer and Sunscreen Talking Points for the General Public

​Use these talking points to share how people should apply sunscreen for maximum protection:

1. "When applying sunscreen, use a generous amount—about a shot glass full for your entire body. Don't forget areas with less melanin, such as the bottoms of your feet and your palms."
2. “Choose a sunscreen that is at least 30 SPF and broad spectrum. Water-resistant sunscreen is best.” 
3. “Apply sunscreen 15 minutes before going outside and reapply every 2 hours.”
4. “Reapply sunscreen every 2 hours. If you are sweating or in water, put on more every hour and a half.”

By: Melissa Goetz