Recommendations for future research

• Future research should seek to understand the role of sunscreens in the prevention of skin cancers and the role of UVR in the causation of these diseases, the dose-response relationship, the dose rate and pattern of delivery on risk and the action spectrum for each effect.

• RCTs should be conducted in adults to evaluate whether a reduction in late-stage exposure to UVR can reduce the incidence of cutaneous melanoma and precursor lesions such as clinically atypical naevi.

• In children, studies are needed to evaluate whether a reduction in early-stage exposure to UVR can reduce the prevalence of acquired naevi, the precursor of cutaneous melanoma and SCC.

• Trials should ideally include a quantitative assessment of solar exposure and an evaluation of the various methods for reducing solar exposure - sunscreens, clothing and sun avoidance.

• As sunscreens are increasingly used on children, an evaluation of their safety for long-term use is needed.

• There is a need to evaluate whether the qualitative rating of the potential function of sunscreens against UVR, such as low, medium, high and ultra-high, rather than SPF, would promote appropriate use of sunscreens.

• There is a need to better understand the role of the mechanisms of skin cancer aetiology and how sunscreens might affect this. Intermediate endpoints (for example, naevi and biochemical markers of carcinogenesis such as DNA damage and p53 mutations) could be studied to assess their relationship to sunscreen use.

• Researchers in health promotion need to develop qualitative and quantitative methods for measuring sunscreen use in order to identify major confounding variables such as sun sensitivity and sun exposure.

• There is a need to be able to measure, in the field, how much protection is provided by sunscreens at various sites on the skin.

• There is a need to understand how efficiently individuals use sunscreen. This would enable manufacturers to develop sunscreens that achieve adequate protection against UVR when in common use.

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