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Skin cancer stands as the most prevalent form of cancer in the United States, presenting a pressing public health concern. Every year, millions are diagnosed with non-melanoma skin cancers, while tens of thousands face melanoma, the most severe type of skin cancer. The financial burden of treating skin cancer in the U.S. is estimated at around $8.9 billion annually.
Individuals with lighter skin tones, histories of extensive sun exposure—particularly from tanning beds—and specific genetic predispositions are at an elevated risk of developing this condition. Several obstacles prevent effective skin cancer prevention, such as a general lack of awareness, cultural trends favoring tanned skin, and insufficient access to protective measures against sun exposure.
A notable study conducted by researchers at Florida Atlantic University’s Charles E. Schmidt College of Medicine analyzed the correlation between the frequency of sunburns and various sociodemographic characteristics. This research also assessed the prevalence of protective skin behaviors within a nationally representative adult sample in the U.S. The American Academy of Dermatology underscores the danger of sunburns, indicating that five or more blistering sunburns experienced during adolescence significantly increase the risk of melanoma by 80% and nonmelanoma skin cancer by 68%.
The study leveraged data from the U.S. National Cancer Institute’s 2022 Health Information National Trends Survey 6 (HINTS 6), focusing on participants’ confidence in managing their health, their perceived cancer risk, and their concerns regarding skin cancer, alongside their sunburn experiences over the past year. Researchers examined various sociodemographic factors including age, gender, employment status, marital and educational backgrounds, Hispanic origin, race, and income, due to their potential associations with skin cancer risk.
Results from a survey of 6,252 participants revealed that a majority (44%) expressed high confidence in their ability to take care of their health, while 27.3% felt completely confident. The findings, published in the American Journal of Lifestyle Medicine, indicated that many respondents were moderately concerned about skin cancer. Just 9.1% reported being extremely worried, while the bulk of participants showed either slight (25.6%) or moderate (26.6%) levels of concern.
In terms of sunburn occurrences, 67.6% reported experiencing no sunburns in the past year, while 30.3% indicated having 1-5 sunburns. Interestingly, 6.4% reported having consumed alcohol while sunburned, which is known to increase the likelihood of sunburn. Common activities linked to reported sunburns included outdoor work and swimming.
Using multinomial regression analysis, significant associations were revealed between the number of sunburns and sociodemographic characteristics. Participants over 40 years old and women reported lower incidences of sunburn. Conversely, those who were disabled, unemployed, or engaged in multiple occupations specified fewer sunburns. The data showed that married or partnered individuals had a higher propensity for sunburn compared to their divorced or single counterparts. Furthermore, individuals with higher education, and those identifying as Hispanic, Black, Asian, or mixed race reported lower sunburn rates. In contrast, people from higher income brackets noted significantly increased sunburn risks, with the highest income group being more than four times more likely to report a sunburn.
“Social determinants such as race/ethnicity, sex, income, and employment status are integral to understanding sunburn and skin cancer risks,” stated Lea Sacca, Ph.D., the study’s senior author and an assistant professor in the Department of Population Health and Social Medicine at Schmidt College of Medicine. “While lower rates of sunburn are often reported among Hispanics and Black Americans, Hispanics frequently perceive greater advantages of UV exposure, inadvertently increasing their risk. Factors like sex, education, and income also create disparities in sunscreen usage, which is lower among Black and Hispanic individuals. Notably, women within these demographics with elevated education and income levels tend to utilize sunscreen more effectively. Paradoxically, higher income correlates with an increased occurrence of sunburns.”
Skin cancer can primarily take three forms: basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinoma, the most frequent and least aggressive variant, typically manifests as a shiny, pearly bump or a pinkish patch on sun-exposed skin. Squamous cell carcinoma appears as red, scaly patches or open sores, which can spread if treatment is delayed. Melanoma, the most lethal type, arises from pigment-producing melanocytes and may present as a new mole or changes in an existing one. It has a tendency to rapidly spread to other organs if not detected promptly.
Madison Etzel, the first author and a second-year medical student in the Schmidt College of Medicine, emphasized the importance of understanding risk perceptions and protective behaviors. “Acknowledging how sociodemographic factors are intertwined with the incidence of sunburn is crucial in mitigating skin cancer development, especially among at-risk groups,” she remarked. “Our findings advocate for heightened awareness regarding skin cancer susceptibility, inviting further research into how additional social determinants influence both incidence of sunburn and preventative behaviors, which is fundamental for addressing the widespread impact of skin cancer on U.S. adults.”
Health organizations, including the American Cancer Society, advocate for vigilance and safety concerning sun exposure as vital preventive measures against skin cancer. Regularly applying broad-spectrum sunscreen with an SPF of 30 or higher is essential, particularly during outdoor activities, alongside reapplication every two hours. Further preventive measures include avoiding direct sunlight during peak hours from 10 a.m. to 4 p.m., seeking shade when necessary, and wearing protective clothing like long sleeves, wide-brimmed hats, and sunglasses with full UV protection. Additionally, it is crucial to refrain from using tanning beds, as their use markedly elevates skin cancer risk.
Conducting routine self-examinations for suspicious moles or changes in the skin, coupled with professional evaluations by dermatologists, enhances early detection. It’s important to remember that reflective surfaces such as water, sand, and snow can intensify UV exposure, necessitating more frequent application of sunscreen in these settings. Lastly, maintaining proper hydration supports skin health and fortifies it against UV-related damage.
Co-authors of the study include Nada Eldawy, Sahar Kaleem, Austin Lent, Adrienne Dean, Ayden Dunn, Paige Brinzo, and Samantha Jimenez, all medical students from the Schmidt College of Medicine.
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