Sun Protective Behaviors Associated With Family History of Melanoma

In this interview, Dr Manuel Valdebran discusses the association between sun protective behaviors (SPB) and family history of melanoma, along with the importance of recommending alternate SPB in addition to sunscreen use.

Manuel Valdebran, MD, is an assistant professor in the department of dermatology and dermatologic surgery at the Medical University of South Carolina.

The Dermatologist: What is the association between SPB and family history of melanoma?

Dr Valdebran: According to [our review of National Health and Nutrition Examination Survey data], those with a known family history of melanoma are more likely to use sunscreen. And in another part of the study, we found that they did not have higher odds to practice other sun protection behaviors, such as staying in the shade, wearing hats, or wearing long-sleeved shirts. Basically, people are understanding that [they need to use] sunscreen. However, we found that they were also more likely to have a sunburn during the past year. And we thought that this finding was very interesting. I think this relationship is something that clinicians should be aware of. It seems to be counterintuitive. We think that by recommending using sunscreen alone, people are getting a little bit more protected, and that may not be the case.

The Dermatologist: Can you elaborate on the importance of recommending alternate SPB in addition to sunscreen use?

Dr Valdebran: It is important to consult patients on different sun protection strategies and sunscreen use. However, it should be incorporated in a set of different recommendations. For example, seeking the shade alone may not be enough to provide sufficient sun protection for extended exposures. So again, it is important to educate people to combine multiple sun protection strategies and measures, such as protective clothing, hats, sunglasses, and sunscreen as well.

The Dermatologist: How does understanding the association between SPB and family history of melanoma affect decision-making for dermatologists?

Dr Valdebran: A single player does not make the difference; we have to incorporate other elements in our recommendations to patients. And sometimes, we underestimate our words. But perhaps a higher number of patients really listen to our recommendations in terms of sunscreen, and they apply it. Personally, I have incorporated in my practice education in both the UV index and some protection strategies via direct counseling to the patient and a handout, and I always keep a handout for every skin check. This handout includes the QR code with a link to a blog where I explain the topic a little bit further. And that helps me a lot, particularly in moments where procedures or all the things during the visit have consumed all my scheduled time.

The Dermatologist: What future research is needed to understand SPB and family history of melanoma?

Dr Valdebran: We need a real-life data collection of what people are using for some protection and the amount of UV radiation they are receiving, and the number sunburns and skin cancers that people are developing. And I think with the help of more widely-used wearables, this can be more easily performed in the future.

The Dermatologist: Is there anything else you would like to share with your colleagues about SPB and melanoma?

Dr Valdebran: I would like to encourage dermatologists to create systems to educate patients not only in using sunscreen, but to incorporate all sun protection strategies. Also, to counsel on the use of the UV index so patients can have an advantage of knowing the amount of solar radiation that they are being exposed to and the likelihood to develop sunburns. For example, if the UV index is 2 or below, people don't have to worry too much about sun protection. However, if the UV index is high or very high, which happens particularly during summer in the United States during the mid-day hours, then people will have to think twice about overexposing themselves and incorporating other sun protection strategies. It requires a collective effort to give people a visual and digestible information in a short period of time. But UV exposure is an important modifiable risk factor for skin cancer prevention. So, we should put an effort into making people aware of tools available to protect themselves.

Reference
Li AR, Valdebran M. Association between sun-protective behaviors and family history of melanoma: results from NHANES 2003 to 2004. JAAD Int. 2022;8:19-20. doi:10.1016/j.jdin.2022.04.001