Key points

• There is limited evidence from systematic reviews of population, epidemiological, randomised, observational and case-control studies that primary prevention interventions have had some impact on sun-related behaviour in the short term.

• This is substantially weakened by the design of research studies and the lack of published long-term RCTs. This suggests lack of both funding and commitment to long-term multistrategy outcome measure studies within communities.

• There is no evidence that the development and implementation of public health policy for sun protection has improved intervention design or improved the implementation of long-term trials following effective pilot or short-term studies.

• There is no evidence that funding followed this development either. Australia has used public policy to reduce tax on clothing, hats and sunscreens but there is only very limited evidence that this has changed behaviour (i.e. use of these protectors).

• There is a need for policies to be reviewed and a further consideration of how they can drive intervention development in the long term. There is a need for multi-methodological evaluation of such policy implementation and effect.

• There is some evidence from case-control, observational and epidemiological population studies that primary and secondary prevention programmes may be associated with reduced incidence of skin cancers in specific populations and age groups.

• There is some evidence (weakened by study design and short-term studies) that protective clothing messages are successful in encouraging reduced solar exposure in specific populations and target groups: particularly females and children (by definition of carers' actions and role modelling).

• There is some evidence from surveys that schools have begun to address solar protection education and information giving, but little evidence of behaviour change for solar protection from the sustained use of clothing, especially hats, and shaded areas.

• There is some evidence that information about skin self-examination (signs of change in the skin) is an effective strategy for encouraging specific target groups to seek early diagnosis (more females seek early diagnosis than males).

• There is no evidence that regular screening for skin cancer in general practice settings is a cost-effective prevention strategy for melanoma and NMSCs.

• There is very limited evidence that dermoscopy is a more effective diagnostic tool than the naked eye for diagnosis for melanoma and skin cancers.

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