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A 63-year-old fair-skinned woman with a history of basal cell carcinoma presents for a screening skin exam. She has extensive sun damage to her skin from years of working outdoors without sun protection (Figure 172-1). She would like to know what she can do to prevent development of new skin cancers.

FIGURE 172-1

Extensive sun damage on the face of a 63-year-old woman from years of working outdoors without sun protection. (Reproduced with permission from Richard P. Usatine, MD.)


Prolonged sun exposure has destructive effects on the skin and increases risk of skin cancer. It is the most common cancer in the United States: skin cancer affects an estimated 3.3 million Americans annually, and 1 in 5 Americans in their lifetime.1,2 Prevention for many of these skin cancers is simple—sun protection. Educating our patients about sun protection has the potential to reduce morbidity and mortality from skin cancer.


Sun-damaged skin is also known as actinic elastosis, solar elastosis, chronic actinic damage of the skin, dermatoheliosis, and photoaging.

Nonmelanoma skin cancers are also known as keratinocyte carcinomas.


In the United States, the incidence of nonmelanoma skin cancer is highest among the elderly, non-Hispanic white population. According to a 2010 study, 20% of non-Hispanic white 70-year-olds have had at least one nonmelanoma skin cancer, and most of that 20% have had several.2

The incidence of melanoma in the United States is also highest in non-Hispanic whites, with an incidence rate of 30.8 of 100,000 white men and 19.3 of 100,000 white women reported by the Centers for Disease Control and Prevention (CDC) in 2014.3 For comparison, the next highest incidence rates are in American Indian/Alaskan native men and Hispanic women, occurring in 6.2 of 100,000, and 4.4 of 100,000, respectively.3

In people of color the incidence of both melanoma and non-melanoma skin cancer is much lower than in non-Hispanic whites, occurring in about 5% of Hispanics, 4% of Asians, and 2% in people of African descent. Although the incidence of skin cancer is lower in people of color, it is more likely to present at a more advanced stage and have a poorer prognosis.4,5

Although the link between skin cancer and sun exposure is widely known and publicized, sunburn is still a common occurrence. National surveys from 2004 and 2005 show 1 in 3 adults in the United States reported sunburn in the past 12 months.6 The incidence of sunburn for U.S. children is also high, with an estimate of 29% to 83% over the summer season.7 The potential impact of sun protection in ...

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