Skin cancer is the most common form of cancer in the United States. CDC has categorized skin cancer as an epidemic (CDC, 2013). It has been reported that more than a million cases are reported each year in the US, with approximately 120,000 cases of melanoma, the deadliest among all forms of skin cancer. The incidence of skin cancer has shown to be rising most rapidly in young adults between the ages of 18-29. It has been hypothesized that this increase in the incidence of skin cancer is due to change in behavior of young adults, including, exposure to indoor tanning and sunbathing. Exposure to UV irradiation through indoor tanning and outdoor exposure to the sun has been demonstrated to contribute significantly to skin cancer incidence (Ting et al., 2007). Melanoma, the deadliest form of skin cancer is preventable as it is caused by exposure to ultraviolet light (UV light). UV light is a known carcinogen (Melanoma education foundation) and the world health organization has classified sun-beds or tanning beds as type 1 carcinogen.
There have been a number of epidemiological studies that have shown a direct correlation of exposure to ultraviolet rays from either direct sunlight or tanning beds to increased incidence of skin cancer. A study published in Journal of clinical oncology that involved 73, 494 nurses over a 20-year period showed a direct dose response relationship between the risk of development of skin cancers and usage of tanning bed, especially among nurses who were between 25-35 years of age (Han et al., 2012). A more recent study published in the British journal of dermatology demonstrated that nine out of 10 tanning beds had an emission level of the UV rays, which exceeded the value deemed safe by European standard. The authors of the study also conclusively showed that exposure to tanning beds had an effective irradiance (measured in tanning units) double that observed following exposure to direct sun rays at noon (Tierney et al., 2013). Young women between the ages of 18-29 are the group most frequently diagnosed with skin cancer and melanoma specifically (Centers for disease and prevention, 2013). One of the biggest reasons for tanning and sunbathing is the perceived belief that a tan appears attractive and healthy. It was shown that many women were aware of the risks associated with tanning and sun exposure but still continued with high risk behavior due to the need for attractiveness. It has also been shown that many young adults know the significance of prevention based on the use of skin protection; however do not adequately know how to protect their use and properly use sunscreen. Nurses are in an excellent position to teach their patients about the importance of skin cancer prevention. Parents of small children and other patients should be reminded of appropriate skin protection behavior, including application of sunscreen (SPF 30 or more) at least 30 minutes prior to going outside, wearing protective clothing and sunglasses, avoiding the sun between 10am and 3pm, and, most importantly, avoiding tanning sessions (Siegel, 2010).
It has also been shown that 70% of all skin cancer starts in or around a mole or dark spot on the skin. Some groups of people, including people with red hair, freckles and lighter skin, who tend to get sunburn more easily than others, are at a greater risk of developing skin cancer (American Academy of Dermatology, 2013). Nurses should play a role in shifting the perception to sun exposure and tanning and offering screening procedure to these high risk groups. Additionally educating children the significance of wearing skin protection and avoiding tanning at an impressionable age can result in developing healthy lifelong habits. An analogy that can be useful in emphasizing the risk associated with tanning is comparing the role of tanning beds in skin cancer to role of cigarettes in causing lung cancer (Melanoma Education foundation, 2010). The parental attitude toward skin tanning and sunburn prevention has to be factored while designing prevention program for skin cancer (Bandi et al., 2010).
While screening for breast, cervical, prostate, ovarian and colon cancer is routinely administered and recommended, screening for skin cancer is not routinely performed or recommended. Self-screening or total body skin exam performed by a health care provider are inexpensive and easy to perform. However, it was shown that, in their role as health educators, 60% of nurses taught skin cancer prevention to patients but did not adequately examine the patients. Furthermore, 50% of them did not teach proper protection behavior to patients (Johnson et al., 1997). One challenge associated with regular screening is the recommendation that was published by the United States Preventative Services Task Force (USPSTF). According to the guideline, “current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population” (Wolff et al., 2009). However, it is also known that detecting skin cancer early is associated with better long term outcome. It has been shown that health care providers’ including nurses can detect thinner melanomas that are earlier stage of melanomas that cause lower morbidity and mortality.
Nurses can take the initiative in emphasizing the importance of sun protection, application of sunscreen and educating the patients about danger associated with tanning. Performing routine skin exams in all patients and specifically in patients seeking treatment for sunburn is a practice that has been recommended. Nursing faculty should be actively involved in teaching and advising their students regarding practices in prevention and screening for skin cancer. Use of EBP should be practiced in various aspects of skin cancer prevention, protection, screening and care. Nurses can also educate their patients in recognizing the symptoms and sign associated with early skin cancer detection. Another practice that has been demonstrated to be useful in educating younger patients regarding the danger of tanning is the use of UV filtered photography. UV filtered photography can be used to show the negative impact of tanning on health of skin, which is usually invisible (Siegel, 2010). Nursing faculty can also use the method of UV filtered photography to emphasize to their students’ the harm associated with use of tanning beds that they would use in their clinical practice.
It is imperative to realize the role of nurses in screening and educating their patients’ regarding skin cancer prevention, protection and treatment. Failure to use various evidence-based tools can result in increased burden of skin cancer diagnoses among the general population and greater morbidity and mortality. Nurse managers can train nurses in counseling for proper skin protection and performance of cancer screening in high risk groups. The use of UV-filtered photography can be made to communicate the risk associated with tanning beds in causing cancer. Nurses can also be evaluated for their own biases associated with tanning and concept of beauty and emphasized the role of tanning beds in causing preventable skin cancer.
Summary
The role of nurses in educating the patients in prevention of diseases and maintenance of good health is evident. Marlenga, in 1992, published the significant impact nurses made in reducing the incidence of skin cancer by screening, advocacy and education. Nurses are involved in all aspects of health care and routinely educate parents and other patients about the benefits of immunization, safety, screening and medication. However, it has been demonstrated that one important aspect of health safety, which is protection of skin from the ultraviolet rays is not adequately addressed by nurses or other health care providers.
Additionally, it has also been shown that many people, especially women, are aware of the risks associated with tanning, yet place a high value on the beautification benefits associated with tanning. Many people are aware of the dangers but do not know how to protect their skin properly. Screening for skin cancer, which is easy to perform and inexpensive, is also not routinely offered.
Nurses can play a vital role in educating their patients’ about prevention and protecting themselves from sunburn and skin cancer. The role of nurses in screening, advocacy and education in lowering the epidemic of skin cancer is critical. Nurse administrators can provide training opportunities and guidance for the staff nurses to become experts in the field of skin cancer protection advocates and use evidence that is provided by research in protecting skin cancer and sunburn.
References
American Academy of Dermatology. (2013). Prevention and Care: Indoor Tanning. Retrieved from American Academy of Deermatology : http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/indoor-tanning
Bandi, P., Cokkinides, V., Weinstock, M., & Ward, E. (2010). Sunburns, sun protection and indoor tanning behaviors and attitudes regarding sun protection benefits and tan appeal among parents of U.S. adolescents-1998 compared to 2004. Pediatric Dermatology, 27(1), 9-18.doi:10.1111/j.1525-1470.2009.01074.x
CDC - Success Story: Data for Indoor Tanning and Melanoma (n.d.). Retrieved from http://www.cdc.gov/cancer/skin/what_cdc_is_doing/success/mn1.htm
Center for Disease and Prevention. (2013, November 6). Skin Cancer:Indoor Tanning. Retrieved from http://www.cdc.gov/cancer/skin/basic_info/indoor_tanning.htm
Johnson, L.B., Murphy, H., Fine, J.D., & Smith, J.L. (1997). Skin cancer prevention and early detection. Presentation at the CDC Conference, Atlanta, GA, September 1997
Marlenga, B. (1992). A description of the health beliefs and skin cancer prevention practices of Wisconsin farmers. Dissertation from the University of Wisconsin-Milwaukee
Melanoma Education Foundation (2008). Melanoma education foundation. Retrieved from http://www.skincheck.org
Siegel, V. (2010). Exploring the role of the nurse in skin cancer prevention. Dermatology Nursing, 22(6), 18-22.
Tierney, P., Ferguson, J., Ibbotson, S., Dawe, R., Eadie, E., & Moseley, H. (2013). Nine out of 10 sunbeds in England emit ultraviolet radiation levels that exceed current safety limits. British Journal of Dermatology.
Ting, W., Schultz, K., Cac, N., Peterson, M., & Walling, H. (2007). Tanning bed exposure increases the risk of malignant melanoma. International Journal of Dermatology, 46(12), 1253-1257.doi:10.1111/j.1365-4632.2007.03408.x
Wolff T, Tai E, Miller T. Screening for skin cancer: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 150:194-8.
