In the past 20 years, promoting the use of sunscreens has been the main focus of primary prevention for skin cancer together with photo-protective clothing and shaded areas. This summary demonstrates that health promoters across all settings, including primary care and hospital settings, need to re-think their sun protection promotion.

There is inadequate evidence in humans as to whether topical use of sunscreen has a preventative effect against cutaneous malignant melanoma and BCC of the skin and there is limited evidence for a protective effect against SCC of the skin. There is, however, good evidence that sunscreen prevents SCC of the skin induced in mice by solar-simulated radiation.

The review supports the hypothesis that the topical use of sunscreens reduces the risk of sunburn in humans and probably prevents SCC of the skin when used during intentional sunbathing. There is inconclusive evidence about the cancer preventive effects of topical use of sunscreens against BCC and cutaneous melanoma. It seems that sunscreen can extend intentional sun exposure (sunbathing and sun tanning) and that this increased exposure may subsequently increase the risk for cutaneous melanoma.

It is essential that the main educational message promoting long-term changes to attitude and behaviour in the sun should focus on the use of photo-protective clothing and shade; sunscreens should be promoted as an extra protective measure, after the use of clothing and shade. There should be very positive messages about the use of sunscreen including application and re-application at regular intervals. This will prevent individuals from having a false sense of security engendered by the use of sunscreens, particularly for intentional suntanning behaviour.

Promoting the use of photo-protective clothing and shade remains the most effective way to prevent against unintentional exposure. It is imperative that policy includes the development of shaded areas in communities and on beaches, even in temperate climes. Sunscreens may give a false sense of security about protection, putting individuals at increased risk for sun exposure and thus for cutaneous skin cancers.

Communication and appropriate efficacious delivery of messages intended to change behaviour remain the main goal point of long-term randomised studies across communities. This is very important as we face the threat of continued global warming. This will be a challenge for all in public health and health promotion.

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