BSF skin cancer/moles question

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talkhealth
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by talkhealth on Tue Feb 18, 2020 10:30 am

BSF skin cancer/moles question

Dear expert

Are there any studies demonstrating that sunscreen reduces all causes mortality/morbidity?

If not is it sensible to advise people to use sunscreen?


Thanks

Steve Hayes
talkhealth team

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Dr Anton Alexandroff
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by Dr Anton Alexandroff on Thu Feb 20, 2020 6:26 pm

Re: BSF skin cancer/moles question

Dear Mr Hayes,

Thank you for your very interesting question. Following your question
I did a literature search and found only 2 publications directly relevant to your question in my opinion so far. In Australia, where the sun exposure is high in a small study there appears to be a trend for a protective effects of sunscreen on overall mortality (https://www.ncbi.nlm.nih.gov/pubmed/30885518 ). However in a Swedish publication there appears to be a negative effect of avoiding sun exposure on overall mortality in women, arguably due to vitamin D deficiency ( https://onlinelibrary.wiley.com/doi/ful ... joim.12251).
It is possible that I missed important /relevant publications during this quick search or it is possible that the effects might be different depending on what country people live in or e.g. life style - people chronically exposed to sun light e.g. employed in building industry or agriculture benefiting more from sun protection. I would be very interested to know what my colleagues would think about this important question.


With Best Wishes,

Dr Anton Alexandroff FRCP(UK) PhD CCT(Derm) FRSM FAAD
Consultant Dermatologist and Honorary Senior Lecturer
The British Skin Foundation Spokesperson
London, Cambridge, Leicester and Bedford

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Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD

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Dr Vishal Madan
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by Dr Vishal Madan on Thu Feb 20, 2020 6:40 pm

Re: BSF skin cancer/moles question

Very good question, thanks for asking.

the issue remains contentious but the body of evidence is still very much in favour of sunscreen use for skin cancer prevention.

Study by Green et al, (Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal‐cell and squamous‐cell carcinomas of the skin: a randomised controlled trial. Lancet 1999; 354: 723–729.) showed beneficial effects of sunscreens on Squamous cell carcinoma prevention. Role in Basal Cell Carcinoma prevention was equivocal.

Role of sunscreens in prevention of melanomas is even more controversial. (Westerdahl J, Ingvar C, Mâsbäck A, et al. Sunscreen use and malignant melanoma. Int J Cancer 2000; 87: 145–150.)

A recent follow up study by the same authors (Green et al) however, was more conclusive in that the number of melanomas and importantly invasive melanomas were fewer in sunscreen arm of the study as compared to the control arm. (Green AC, Williams GM, Logan V, et al. Reduced melanoma after sunscreen use: randomized trial follow‐up. J Clin Oncol 2011; 29: 257–263.)

In sum, I would still recommend sun cream use to my patients who are at risk of developing skin cancers.

Best wishes

Vishal

Dr. V Madan, M.B.B.S (Hons), M.D, FRCP, CCT Dermatology
President, British Medical Laser Association
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Everything Skin Clinic
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Dr Vishal Madan
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Dr Kapil Bhargava
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by Dr Kapil Bhargava on Thu Feb 20, 2020 10:45 pm

Re: BSF skin cancer/moles question

Good evening,

Thank you for your important question.

Whilst sun exposure is often discussed as the significant risk factor for the development of skin cancer, it is important to remember that there are other significant risk factors such as skin type, the number of moles, immune status and genetic factors that may play an equal or greater role.

In addition behaviour of people who use sunscreen may change in favour of exposing themselves to more sun, in the belief that they are protected.

Therefore in designing a definitive study to demonstrate that skin cancer related mortality is reduced by sunscreen, would require a very long follow-up and control for all of the above (and other) factors. Thus it will be very difficult to get this data, and hence why the question still open.

Sunscreen should be one element of skin cancer prevention advice but the other elements in prevention (including behaviour) needs to be discussed, especially on an individual basis.

Best wishes,
Dr Kapil Bhargava MBBS, FRCP(UK), FRCP(Derm), CCT Derm
Consultant Dermatologist & Dermatologic and Mohs Surgeon
London, UK

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