Implications for clinical practice

• There is little good evidence that sunscreens reduce the risk of cutaneous melanoma.

• There is some evidence that sunscreen use may inadvertently increase risk because it may encourage longer periods in the sun.

• There is no clear evidence that sunscreen use decreases the incidence of BCC.

• There is some evidence that sunscreen use can decrease the incidence of actinic keratoses and SCC.

Educational messages are needed to ensure:

• that sunscreens are not used as the first or only choice for skin cancer prevention

• that sunscreens are not used as a means of extending total sun exposure (i.e. sunbathing and suntanning).

• that sunscreens are not used as a substitute for clothes on body sites that are not usually exposed, such as the trunk and buttocks.

• the daily use of sunscreen with a high SPF (> than 15) on areas of the body that are not usually exposed areas is recommended for those in areas of high isolation who work outdoors or undertake regular outdoor leisure pursuits

• daily use of a sunscreen can reduce actinic keratoses and SCC.

In addition:

• Protecting children against solar exposure during childhood is more important than at any time in life.

• Using photo-protective clothing, hats and shade is essential. Parents, carers, schools and leisure organisations need to encourage and promote knowledge about sun-protective behaviour.

• Primary prevention interventions should first and foremost promote hats with as wide a brim as possible to protect the head, neck and face (see Chapter 22).

• Shade should be promoted as protective whenever possible, including avoiding outdoor activities between 11 am and 3 pm.

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