New guidelines issued to thwart skin cancer in fair-skinned people

The U.S. Preventive Services Task Force recommends that physicians talk to such patients 10 to 24 years old about minimizing exposure to ultraviolent radiation.

By Christine S. Moyer, amednews staff. Posted Nov. 23, 2011.

In the latest effort to help reduce new skin cancer cases, an expert panel is urging physicians to discuss the importance of minimizing exposure to ultraviolet radiation with fair-skinned patients ages 10 to 24.

The U.S. Preventive Services Task Force issued the draft recommendation statement Nov. 8 and is accepting public comments on the proposed guidelines until Dec. 6.

The draft updates the expert panel's 2003 guidance that says there is insufficient evidence to recommend for or against primary care physicians' routinely talking to patients about skin cancer prevention. The new guidelines focus on a narrow group of patients, because the panel found insufficient data to assess the benefits and harms of counseling people older than 24 and younger than 10 on ways to prevent skin cancer.

"Nobody said upfront, '[Let's] just look at young people and people with fair skin.' But most of the research is done in that area, because people with fair skin have a far higher risk than anybody else" of developing skin cancer, said Virginia Moyer, MD, MPH, task force chair and professor of pediatrics at Baylor College of Medicine in Houston.

The American Academy of Dermatology applauded the task force's guidelines, but said they did not go far enough.

"There is no known safe level of unprotected sun exposure. ... We recommend photoprotection for all individuals," said Suzanne M. Connolly, MD, vice president of the American Academy of Dermatology.

Skin cancer is the most common form of cancer in the U.S., according to the Centers for Disease Control and Prevention. In 2007, 58,094 people in the U.S. were diagnosed with melanomas, and 8,461 died of the disease, according to the CDC's most recent data.

This year, the American Academy of Dermatology estimates that there will be 123,590 new cases of melanoma skin cancer diagnosed in the U.S.

Policies against tanning

In making its recommendation, the task force reviewed studies published between 2001 and 2010 that looked at how counseling patients about sun protection affects their likelihood of getting a sunburn or skin cancer (www.uspreventiveservicestaskforce.org/draftrec6.htm#clinical). The task force also examined reports on the link between behavior change and incidence of skin cancer and the adverse effects of sun-protective behavior changes.

"No one is telling doctors not to talk about skin cancer prevention to people" who are not included in the task force's recommendation, Dr. Moyer said. But she said data show that physicians should pay particularly close attention to their adolescent and young adult patients who have fair skin.

Rising skin cancer rates among young people have prompted physician organizations, such as the American Academy of Pediatrics and American Medical Association, to issue policies warning against tanning and excessive ultraviolet radiation exposure.

In February, the AAP recommended that doctors advise patients to take precautions against harmful exposure to ultraviolet radiation and support state-level legislation to ban minors from indoor tanning salons.

The AMA adopted policy in 2006 to develop model legislation prohibiting minors from indoor tanning facilities.