The U.S. Preventive Services Task Force (USPSTF) has concluded that there's not enough evidence to make a recommendation for or against routine screening, using a total-body examination, for the purpose of early detection of any of the three types of skin cancer: cutaneous melanoma or basal cell or squamous cell carcinoma. It also notes that the practice of conducting skin examinations on all people must be validated by studies determining how many lives were saved, how it improved their health, and whether it was cost effective. Yet the USPSTF also points out that one screening strategy is to assess for risk factors and refer high-risk patients for total-body examination.

It's hard to convince people that what they do today will affect their lives 10, 20, even 30 or more years from now. But sun protection measures, when begun at an early age and used consistently and correctly, can help prevent skin cancer. And although the benefits of screening are as yet unproved, there are guidelines that you can use to help your patients understand what skin cancer is and how they are at risk. It's vital to convey the message that exposure to the sun's ultraviolet rays appears to be the single most important factor in the development of skin cancer. Educating patients and facilitating change in high-risk behaviors may help prevent the development of skin cancer.

Most people know what to do to protect themselves from too much sun exposure: avoid the sun between 10 am to 2 pm, wear protective clothing (such as a wide-brimmed hat and long-sleeved shirt) to block the sun, apply sunscreen (rated SPF 15 or higher) to exposed skin before going outside in the morning and every two hours thereafter, and avoid the use of sunlamps and tanning salons. Keeping children protected is essential, as receiving two or more severe sunburns during childhood increases one's risk of all skin cancers. 1 Yet people are often either reluctant to adopt these behaviors or to be consistent in performing them.

Of the three types of skin cancer, melanoma, the most serious, is increasingly found in people under the age of 40. 2 This is generally attributed to sociocultural changes (for example, many people think tans "look healthy"; many wear less clothing and spend more time in the sun today than did previous generations) and to the depletion of the ozone layer. People at increased risk for melanoma include those who are fair skinned with light hair and eye color, have a family history of melanoma, burn easily, or have unusual or numerous moles (more than 50). Melanoma tends to be diagnosed at a more advanced stage in older people and is therefore often more difficult to treat. Basal cell carcinoma, once considered a disease of the elderly, is now often seen in younger people, especially teenagers. People at increased risk for it include those who are fair skinned with light hair and eye color, have freckles, or endured repeated sunburn in childhood. 3

The National Cancer Institute (http://www.nci.nih.gov) and the American Cancer Society (http://www.cancer.org) are just two of many organizations that can provide nurses with patient education pamphlets at little or no cost. The most useful pamphlets are easy to read, contain identifying photographs of the different types of skin cancer, and offer protection and prevention guidelines. It's often helpful to review pamphlets with patients. Encourage patients to be aware of any moles or unusual patches of skin they may have and to seek medical advice if they notice any changes. Check that your patients and their children know how to apply sunscreen correctly and how often to do so; it's more difficult to change established behavior than to learn good habits early.

The Task Force on Community Preventive Services (http://www.thecommunityguide.org), an independent, multidisciplinary group, is now conducting a systematic review of studies of selected population-based interventions aimed at reducing ultraviolet light exposure in order to prevent melanoma and other skin cancers. The task force expects to release its recommendations sometime this summer.

Changing patients' behavior will require teaching, reinforcing the information provided, and evaluating both what they've learned and what they're doing as a result. Providing information alone isn't enough. Skin cancer, an all-too-common and often avoidable disease, can be prevented, and you can help patients take steps to prevent it.

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