WebMD Medical News
Louise Chang, MD
May 7, 2012 -- If you're young, fair-skinned, and have a doctor's appointment soon, here's a prediction.
Your doctor may give you a gentle lecture about sun protection. He or she may appeal to your vanity to reduce sun exposure now and the risk of skin cancer later.
The counseling sessions are a new recommendation from the U.S. Preventive Services Task Force. The independent group of experts reviews evidence and makes recommendations about preventive health services.
According to the new recommendation, doctors should conduct appearance-based behavioral counseling for their fair-skinned patients, 10 to 24 years old. They should warn them of the ill effects of too much sun on their appearance. They should encourage sun-safe behaviors such as wearing sunscreen and hats.
Why focus on appearance? "The outcome of skin cancer is so far down the road [for these age groups] it's not terribly relevant," says Virginia A. Moyer, MD, MPH, chair of the task force and professor of pediatrics at Baylor College of Medicine in Houston.
Why 10 to 24 and fair-skinned only? That's where the evidence is strong and the studies have been done, Moyer says.
"We certainly aren't telling other people to ignore this," she says of older and darker-skinned people.
The new recommendation is published in the Annals of Internal Medicine.
Skin cancer is diagnosed in more than 2 million Americans annually. It includes basal cell carcinoma and squamous cell carcinoma, and the more deadly melanoma.
The task force looked at studies published on the effects of behavioral counseling about sun protection since 2003. This recommendation is an update.
New evidence does suggest the interventions can moderately improve sun protection habits in fair-skinned young people, the task force concludes.
An effective strategy, they found, was to focus on skin-aging effects from the sun.
A doctor may show a patient photos taken with a UV camera, for instance, to demonstrate how much ultraviolet rays can damage the skin, even of a young person.
The task force found a variety of interventions, such as reading a booklet, watching a video, or having peer counseling, can work. The interventions studied showed results, such as a decrease in skin pigment a year later.
There is not enough evidence to recommend the counseling in those older than 24, Moyer says.
Doctors can determine if a person is fair-skinned by simply looking at the skin. Freckling and frequent burning are also signs of fair skin.
The task force recommendation is a good one, says Michele Green, MD, a dermatologist at Lenox Hill Hospital in New York.
She reviewed the recommendation for WebMD. She has cared for young patients with skin cancer, even those as young as 7, she says. Many of her patients don't use sun protection, she knows.
Appealing to a young person's vanity by talking about the effect on appearance works better than talking about skin cancer, she says.
"I tell patients, 'If you keep going [without sun protection] you are going to need Botox before you are 30, and you will be wrinkled like a prune,'" she says. They tend to listen to that, she says.
SOURCES:Moyer, V. Annals of Internal Medicine, published online May 8, 2012.Virginia Moyer, MD, MPH, chair, U.S. Preventive Services Task Force; professor of pediatrics, Baylor College of Medicine, Houston.Michele Green, MD, dermatologist, Lenox Hill Hospital, New York, N.Y.
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