Nathalie Nguyen and Darrell S. Rigel
Department of Dermatology, New York University School of Medicine, New York, New York, U. S.A.
Exposure to ultraviolet (UV) energy leads to two significant types of skin problems— increased risk for the development of skin cancer and accelerated photoaging changes. At current rates, one in five Americans will develop a skin cancer of some sort during their lifetime, with over 1,000,000 new cases appearing this year alone in the U. S. The incidence of malignant melanoma is increasing faster than any other cancer in the United States. In 1935, the lifetime risk for an American developing invasive melanoma was one in 1500. In 2005, this risk was one in 62 for invasive melanomas and one in 34 if in situ melanomas are included. In addition, according to the World Health Organization, melanoma is increasing faster than any other malignancy worldwide. The economic magnitude of this public health problem is illustrated by the fact that costs associated with the treatment of skin cancers are over 500 million dollars annually in the U. S. alone (1). Therefore, the development and implementation of effective mechanisms that protect the skin from cancer-causing UV rays is critical.
Photoprotection is therefore focused on protecting the skin from the damage that occurs as a result of UV exposure. The approach to photoprotection focuses on a reduction in the overall exposure to sunlight, not to just a single component of it. To put the importance of photoprotection and skin cancer into perspective and to better understand the key associated issues, one needs to appreciate:
• The relationship of skin cancer and UV exposure
• Why recent changes have made this issue even more important,
• Current available agents and approaches,
• How effective these approaches are and can be,
• What can be done in the future to improve photoprotection effectiveness, and,
• What clinical recommendations can be made to patients to lower their future risks for photoaging and skin cancer.
Increasing awareness of the damaging effects of sunlight has led to an increased need for adequate photoprotection. Primary prevention to reduce the incidence of skin
cancer therefore includes a regimen consisting of effective sunscreen, protective clothing, and behavior modification.