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Solar Protection Policy in School Children: Proposals for Progress

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Practical Pediatric Dermatology

Abstract

Children are especially susceptible to the deleterious effects of UV radiation, making childhood a critical period for a solar protection policy and its implementation. Sun-protective behaviors established early in life are likely to persist into adulthood. Limiting exposure to both artificial and natural UV radiation during childhood and adolescence lowers the risk for the development of skin cancer. A comprehensive approach to solar protection, including skill-based health education, supportive school environments, extensive family and community involvement, mass-media coverage, and sun-safety legislation, is essential. This chapter provides recommendations for sun protection in school children, discusses current controversies regarding sunscreen use and vitamin D deficiency, and summarizes current knowledge on pathophysiology, risk factors, as well as prevention of skin cancer.

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References

  • Aalborg J, Morelli JG, Mokrohisky ST, Asdigian NL, Byers TE, Dellavalle RP, Box NF, Crane LA. Tanning and increased nevus development in very-light-skinned children without red hair. Arch Dermatol. 2009;145(9):989–96. doi:10.1001/archdermatol.2009.193.

  • Autier P, Boniol M, Dore JF. Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer. 2007;121(1):1–5. doi:10.1002/ijc.22745.

    Article  CAS  PubMed  Google Scholar 

  • Azfar RS, Schwartz RA, Berwick M. Primary melanoma prevention in children. G Ital Dermatol Venereol. 2004;39:1–6.

    Google Scholar 

  • Baade PD, Green AC, Smithers BM, Aitken JF. Trends in melanoma incidence among children: possible influence of sun-protection programs. Expert Rev Anticancer Ther. 2011;11(5):661–4. doi:10.1586/era.11.28.

    Article  PubMed  Google Scholar 

  • Balk SJ, Council on Environmental Health; Section on Dermatology. Ultraviolet radiation: a hazard to children and adolescents. Pediatrics. 2011;127(3):e791–817. doi:10.1542/peds.2010-3502.

    Article  PubMed  Google Scholar 

  • Banks BA, Silverman RA, Schwartz RH, Tunnessen Jr WW. Attitudes of teenagers toward sun exposure and sunscreen use. Pediatrics. 1992;89(1):40–2.

    CAS  PubMed  Google Scholar 

  • Berneburg M, Surber C. Children and sun protection. Br J Dermatol. 2009;161 Suppl 3:33–9. doi:10.1111/j.1365-2133.2009.09447.x.

    Article  CAS  PubMed  Google Scholar 

  • Bukhari MH, Niazi S, Khaleel ME, Sharif MA, Ghani R, Mehmood MT, Tahseen M, Chaudhry NA, Hasan M. Elevated frequency of p53 genetic mutations and AgNOR values in squamous cell carcinoma. J Cutan Pathol. 2009;36(2):220–8. doi:10.1111/j.1600-0560.2008.01006.x.

    Article  PubMed  Google Scholar 

  • Buller DB, Borland R. Skin cancer prevention for children: a critical review. Health Educ Behav. 1999;26:317–43.

    Article  CAS  PubMed  Google Scholar 

  • Buller DB, Buller MK, Reynolds KD. A survey of sun protection policy and education in secondary schools. J Am Acad Dermatol. 2006;54(3):427–32. doi:10.1016/j.jaad.2005.11.1030.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burnett ME, Wang SQ. Current sunscreen controversies: a critical review. Photodermatol Photoimmunol Photomed. 2011;27:58–67. doi:10.1111/j.1600-0781.2011.00557.x.

    Article  CAS  PubMed  Google Scholar 

  • Cui R, Widlund HR, Feige E, Lin JY, Wilensky DL, Igras VE, D’Orazio J, Fung CY, Schanbacher CF, Granter SR, Fisher DE. Central role of p53 in the suntan response and pathologic hyperpigmentation. Cell. 2007;128(5):853–64. doi:10.1016/j.cell.2006.12.045.

    Article  CAS  PubMed  Google Scholar 

  • Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor tanning facilities by white adolescents in the United States. Arch Pediatr Adolesc Med. 2003;157:854–60.

    Article  PubMed  Google Scholar 

  • Dennis LK, Vanbeek MJ, Beane Freeman LE, Smith BJ, Dawson DV, Coughlin JA. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol. 2008;18(8):614–27. doi:10.1016/j.annepidem.2008.04.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Diffey B. Sunbeds, beauty and melanoma. Br J Dermatol. 2007;157(2):215–6. doi:10.1111/j.1365-2133.2007.07960.x.

    Article  PubMed  Google Scholar 

  • Diffey BL, Cheeseman J. Sun protection with hats. Br J Dermatol. 1992;127(1):10–2.

    Article  CAS  PubMed  Google Scholar 

  • Eagle UL, Jones SJ, Hiom S, Kemp G, Naumann L, Cerny C. National skin cancer campaigns. 2010. Available via: http://www.nice.org.uk/nicemedia/live/13310/52652/52652.pdf. Accessed 30 Dec 2013.

  • El Ghissassi F, Baan R, Straif K, Grosse Y, Secretan B, Bouvard V, et al. A review of human carcinogens part D: radiation. Lancet Oncol. 2009;10:751–2.

    Article  PubMed  Google Scholar 

  • English DR, Milne E, Simpson JA. Ultraviolet radiation at places of residence and the development of melanocytic nevi in children (Australia). Cancer Cause Control. 2006;17(1):103–7. doi:10.1007/s10552-005-0425-0.

    Article  Google Scholar 

  • Faurschou A, Beyer DM, Schmedes A, Bogh MK, Philipsen PA, Wulf HC. The relation between sunscreen layer thickness and vitamin D production after ultraviolet B exposure: a randomized clinical trial. Br J Dermatol. 2012;167:391–5.

    Article  CAS  PubMed  Google Scholar 

  • Garcia AM, McLaren CE, Meyskens FL, Melanoma J. Is hair the root of the problem? Pigment Cell Melanoma Res. 2011;24(1):110–8. doi:10.1111/j.1755-148X.2010.00782.x.

    Article  PubMed  Google Scholar 

  • Gerber B, Mathys P, Moser M, Bressoud D, Braun-Fahrlander C. Ultraviolet emission spectra of sunbeds. Photochem Photobiol. 2002;76(6):664–8.

    Article  CAS  PubMed  Google Scholar 

  • Glanz K, Saraiya M, Wechsler H, Centers for Disease C. Prevention guidelines for school programs to prevent skin cancer. MMWR Recomm Rep. 2002;51(RR-4):1–18.

    Google Scholar 

  • Green AC. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Cancer. 2007;120:1116–22.

    CAS  Google Scholar 

  • Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011;29(3):257–63. doi:10.1200/JCO.2010.28.7078.

    Article  CAS  PubMed  Google Scholar 

  • Greinert R, Boniol M. Skin cancer – primary and secondary prevention (information campaigns and screening) – with a focus on children & sunbeds. Prog Biophys Mol Biol. 2011;107(3):473–6. doi:10.1016/j.pbiomolbio.2011.08.008.

    Article  PubMed  Google Scholar 

  • Grewal SK, et al. Compliance by California tanning facilities with the nation’s first statewide ban on use before the age of 18 years. J Am Acad Dermatol. 2013;69(6):883–9.

    Article  PubMed  Google Scholar 

  • Gonzalez H. Percutaneous absorption with emphasis on sunscreens. Photochem Photobiol Sci. 2010;9(4):482–8. doi:10.1039/b9pp00149b.

    Article  CAS  PubMed  Google Scholar 

  • Heckman CJ, Coups EJ. Correlates of sunscreen use among high school students: a cross-sectional survey. BMC Public Health. 2011;11:679. doi:10.1186/1471-2458-11-679.

    Article  PubMed  PubMed Central  Google Scholar 

  • Herzog C, Pappo A, Bondy M, Bleyer A, Kirkwood J. Malignant melanoma. In: Bleyer A, O’Leary M, Barr R, Ries LAG (editors). Cancer epidemiology in older adolescents and young adults 15–29 years of age, including SEER incidence and survival 1975–2000. National Cancer Institute, NIH publication No. 06–5767. Bethesda; 2006. p. 53–63.

    Google Scholar 

  • Hufford D, Rehfuess E. Sun protection and schools: how to make a difference. Geneva: World Health Organization; 2003.

    Google Scholar 

  • Huncharek M, Kupelnick B. Use of topical sunscreens and the risk of malignant melanoma: a meta-analysis of 9067 patients from 11 case–control studies. Am J Public Health. 2002;92(7):1173–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jansen R, et al. Photoprotection: part II. Sunscreen: development, efficacy, and controversies. J Am Acad Dermatol. 2013;69(6):867–e1.

    Article  PubMed  Google Scholar 

  • Kannan S, Lim HW. Photoprotection and vitamin D: a review. Photodermatol Photoimmunol Photomed. 2014;30:137–45. doi:10.1111/phpp.12096.

    Article  CAS  PubMed  Google Scholar 

  • Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst. 2002;94(3):224–6.

    Article  PubMed  Google Scholar 

  • Lange JR, Palis BE, Chang DC, Soong SJ, Balch CM. Melanoma in children and teenagers: an analysis of patients from the National Cancer Data Base. J Clin Oncol. 2007;25(11):1363–8. doi:10.1200/JCO.2006.08.8310.

    Article  PubMed  Google Scholar 

  • Manthe A. Successful school-based skin cancer prevention activities. ASHA successful school sun safety implementation. California Department of Public Health. 2008. Available via: http://www.cdph.ca.gov/programs/SkinCancer/Documents/SKIN-ASHASuccessfulSchoolSunSafetyImpl.pdf. Accessed10 Jan 2014.

  • Marks R. Role of childhood in the development of skin cancer. Aust Paediatr J. 1988;24(6):337–8.

    CAS  PubMed  Google Scholar 

  • Matsuoka LY, Ide L, Wortsman J, Maclaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab. 1987;64:1165–8.

    Article  CAS  PubMed  Google Scholar 

  • Matsuoka LY, Wortsman J, Hollis BW. Use of topical sunscreen for the evaluation of regional synthesis of vitamin D3. J Am Acad Dermatol. 1990;22:772–5.

    Article  CAS  PubMed  Google Scholar 

  • McBride P. Cutaneous squamous cell carcinoma and its determinants. Dissertation, University of Queensland; 2009.

    Google Scholar 

  • Miller SA, Hamilton SL, Wester UG, Cyr WH. An analysis of UVA emissions from sunlamps and the potential importance for melanoma. Photochem Photobiol. 1998;68(1):63–70.

    Article  CAS  PubMed  Google Scholar 

  • Nohynek GJ, Antignac E, Re T, Toutain H. Safety assessment of personal care products/cosmetics and their ingredients. Toxicol Appl Pharmacol. 2010;243(2):239–59. doi:10.1016/j.taap.2009.12.001.

    Article  CAS  PubMed  Google Scholar 

  • Oliveria SA, Satagopan JM, Geller AC, Dusza SW, Weinstock MA, Berwick M, Bishop M, Heneghan MK, Halpern AC. Study of Nevi in Children (SONIC): baseline findings and predictors of nevus count. Am J Epidemiol. 2009;169(1):41–53. doi:10.1093/aje/kwn289.

    Article  PubMed  Google Scholar 

  • Paller AS, Hawk JL, Honig P, Giam YC, Hoath S, Mack MC, Stamatas GN. New insights about infant and toddler skin: implications for sun protection. Pediatrics. 2011;128(1):92–102. doi:10.1542/peds.2010-1079.

    Article  PubMed  Google Scholar 

  • Pennello G, Devesa S, Gail M. Association of surface ultraviolet B radiation levels with melanoma and nonmelanoma skin cancer in United States blacks. Cancer Epidemiol Biomarkers Prev. 2000;9(3):291–7.

    CAS  PubMed  Google Scholar 

  • Quatrano NA, Dinulos JG. Current principles of sunscreen use in children. Curr Opin Pediatr. 2013;25(1):122–9. doi:10.1097/MOP.0b013e32835c2b57.

    Article  CAS  PubMed  Google Scholar 

  • Sadrieh N, Wokovich AM, Gopee NV, Zheng J, Haines D, Parmiter D, Siitonen PH, Cozart CR, Patri AK, McNeil SE, Howard PC, Doub WH, Buhse LF. Lack of significant dermal penetration of titanium dioxide from sunscreen formulations containing nano- and submicron-size TiO2 particles. Toxicol Sci. 2010;115(1):156–66. doi:10.1093/toxsci/kfq041.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Saraiya M, Glanz K, Briss PA, Nichols P, White C, Das D, Smith SJ, Tannor B, Hutchinson AB, Wilson KM, Gandhi N, Lee NC, Rimer B, Coates RC, Kerner JF, Hiatt RA, Buffler P, Rochester P. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med. 2004;27(5):422–66. doi:10.1016/j.amepre.2004.08.009.

    PubMed  Google Scholar 

  • Schulman JM, Fisher DE. Indoor ultraviolet tanning and skin cancer: health risks and opportunities. Curr Opin Oncol. 2009;21(2):144–9. doi:10.1097/CCO.0b013e3283252fc5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Seidel N, Stoelzel F, Garzarolli M, Herrmann S, Breitbart EW, Berth H, Baumann M, Ehninger G. Sun protection training based on a theater play for preschoolers: an effective method for imparting knowledge on sun protection? J Cancer Educ. 2013;28(3):435–8. doi:10.1007/s13187-013-0483-z.

    Article  PubMed  Google Scholar 

  • Skin Cancer Facts American Cancer Society. http://www.cancer.org/Cancer/CancerCauses/SunandUVExposure/skin-cancer-facts?sitearear_PED2008. Accessed 28 Dec 2013.

  • Stern RS, Weinstein MC, Baker SG. Risk reduction for nonmelanoma skin cancer with childhood sunscreen use. Arch Dermatol. 1986;122(5):537–45.

    Article  CAS  PubMed  Google Scholar 

  • Sunscreen FAQs. American Academy of Dermatology. http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens. Accessed 30 Dec 2013.

  • Townsend JS, Pinkerton B, McKenna SA, Higgins SM, Tai E, Steele CB, Derrick SR, Brown C. Targeting children through school-based education and policy strategies: comprehensive cancer control activities in melanoma prevention. J Am Acad Dermatol. 2011;65(5 Suppl 1):S104–13. doi:10.1016/j.jaad.2011.05.036.

    PubMed  Google Scholar 

  • Zeller S, Lazovich D, Forster J, Widome R. Do adolescent indoor tanners exhibit dependency? J Am Acad Dermatol. 2006;54(4):589–96. doi:10.1016/j.jaad.2005.12.038.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA

    Yi Chun Lai MD, MPH

  2. Rutgers University School of Public Affairs and Administration, 185 South Orange Avenue, Newark, NJ, 07103, USA

    Edmund J. Janniger

  3. Departments of Dermatology, Pediatrics, and Pathology, Rutgers New Jersey Medical School and Rutgers University School of Public Affairs and Administration, 185 South Orange Avenue, Newark, NJ, 07103, USA

    Robert A. Schwartz MD, MPH, DSc (Hon), FRCP Edin

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  1. Yi Chun Lai MD, MPH
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  2. Edmund J. Janniger
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  3. Robert A. Schwartz MD, MPH, DSc (Hon), FRCP Edin
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Correspondence to Robert A. Schwartz MD, MPH, DSc (Hon), FRCP Edin .

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Editors and Affiliations

  1. Rotterdam, The Netherlands

    Arnold P. Oranje

  2. Farwaniya, Kuwait

    Nawaf Al-Mutairi

  3. Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA

    Tor Shwayder

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Lai, Y.C., Janniger, E.J., Schwartz, R.A. (2016). Solar Protection Policy in School Children: Proposals for Progress. In: Oranje, A., Al-Mutairi, N., Shwayder, T. (eds) Practical Pediatric Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-32159-2_17

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  • DOI: https://doi.org/10.1007/978-3-319-32159-2_17

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  • Online ISBN: 978-3-319-32159-2

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