Primary prevention refers to the interventions designed to prevent skin cancer from occurring for the first time. Interventions for primary sun protection aim to change risk behaviour in order to reduce new skin cancers. Studies that evaluate such interventions usually use behaviour change as a surrogate for decrease in melanoma incidence, because of the difficulties in following up very large populations over decades in order to document such incident tumours. Proxy measures such as knowledge and attitudes may also be used. The main sun-protection strategies are the wearing of wide-brimmed hats, staying out of the sun between 11 am and 3 pm, and the use of shade. Sunscreens are a popular prevention strategy; the evidence of their effectiveness in reducing the risk of skin cancers is considered in Chapter 23.
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