Objective: To measure and compare the casemix and diagnostic accuracy of excised or biopsied skin lesions managed by mainstream general practitioners and doctors within primary care skin cancer clini...

Background: Outdoor workers are at high risk of harmful ultraviolet radiation exposure and are identified as an at risk group for the development of skin cancer. This systematic evidence based review provides an update to a previous review published in 2007 about interventions for the prevention of skin cancer in outdoor workers. Results: This review includes interventions published between 2007-2012 and presents findings about sun protection behaviours and/or objective measures of skin cancer risk. Six papers met inclusion criteria and were included in the review. Large studies with extended follow-up times demonstrated the efficacy of educational and multi-component interventions to increase sun protection, with some higher use of personal protective equipment such as sunscreen. However, there is less evidence for the effectiveness of policy or specific intervention components. Conclusions: Further research aimed at improving overall attitudes towards sun protection in outdoor workers is needed to provide an overarching framework.

Exposure of the skin to sunlight can cause skin cancer and is also necessary for cutaneous Vitamin D production. Media reports have highlighted the purported health benefits of Vitamin D. Our aim was to examine attitudes and behaviours related to sun protection and Vitamin D. A cross-sectional study of 2,001 residents in Queensland, Australia, aged 20–70 years was undertaken. Information collected included the following: skin cancer risk factors; perceptions about levels of sun exposure required to maintain Vitamin D; belief that sun protection increases risk of Vitamin D deficiency; intention, and actual change in sun protection practices for adults and children. Multivariate models examined predictors of attitudinal and behavioural change. One-third (32%) believed a fair-skinned adult, and 31% thought a child required at least 30 min/day in summer sun to maintain Vitamin D levels. Reductions in sun protection were reported by 21% of adults and 14% of children. Factors associated with the belief that sun protection may result in not obtaining enough Vitamin D included age of ≥60 years (OR = 1.35, 95% CI 1.09–1.66) and having skin that tanned easily (OR = 1.96, 95% CI 1.38–2.78). Participants from low-income households, and those who frequently used sun-protective clothing were more likely to have reduced sun protection practices (OR = 1.33, 95% CI 1.10–1.73 and OR = 1.73, 95% CI 1.36–2.20, respectively). This study provides evidence of reductions in sun protection practices in a population living in a high UV environment. There is an urgent need to refocus messages regarding sun exposure and for continued sun protection practices.

Survival from melanoma is inversely related to tumour thickness and is less favorable for those in lower socioeconomic (SES) strata. Reasons for this are unclear but may relate to a lower prevalence of skin screening. Our aim was to examine the association between melanoma thickness, individual‐level SES and clinical skin examination (CSE) using a population‐based case‐control study. Cases were Queensland (Australia) residents aged 20–75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 cases (77.7%) and 3,824 (50.4%) controls. Thickness was dichotomized to thin (≤2 mm) and thick (>2 mm). Compared with controls, the risk of thick melanoma was significantly increased among men [relative risk ratio (RRR) = 1.56, 95% CI = 1.22–2.00], older participants (RRR = 1.76, 95% CI = 1.10–2.82), those educated to primary level (RRR = 1.70, 95% CI = 1.08–2.66), not married/living as married (RRR = 1.47, 95% CI = 1.15–1.88), retired (RRR = 1.39, 95% CI = 1.01–1.94) and not having a CSE in past 3 years (RRR = 1.45, 95% CI = 1.12–1.86). There was a significant trend to increasing prevalence of CSE with higher education (p < 0.01) and the benefit of CSE in reducing the risk of thick melanoma was most pronounced among that subgroup. There were no significant associations between cases with thin melanoma and controls. Melanoma thickness at presentation is significantly associated with educational level, other measures of SES and absence of CSE. Public health education efforts should focus on identifying new avenues that specifically target those subgroups of the population who are at increased risk of being diagnosed with thick melanoma.