Skin cancer: prevention is better than cure

Abstract

I agree with Dr Rees1 that skin cancer is an important health issue due to its raising incidence. Although the article focuses on the management of skin cancer by surgery, there are preventive programmes and treatments to reduce the risk of developing skin cancer. These include well publicized annual sun exposure reduction programs, such as the Sun Smart campaign by Cancer Research UK and Sun Awareness by the British Association of Dermatologists. NICE has published public health guidance on skin cancer prevention.2 There is also the Sunbeds (Regulation) Act that came into force in 2011 in England and Wales that stops under-18s from using sunbeds and now recently forcible in Northern Ireland. It is well recognized that the rising burden on managing skin cancer is related to an ageing population but there are iatrogenic causes: patients who require immunosuppressants, such as organ transplant recipients, and those with severe inflammatory dermatosis, for example psoriasis. The use of a type of phototherapy, PUVA, was cautioned in recently published NICE psoriasis guidelines in those with fairer skin types due to the long-term risk of skin cancer, worsened when systemic treatments are subsequently used.3 These patients should more vigilant to undertake sun protection measures. Furthermore, attempts to reverse skin field cancerization have also been employed, which includes the use of creams (e.g. 5-fluorouracil, imiquimod) and photodynamic therapy. Chemoprophylaxis with acitretin, a systemic retinoid, has also shown to be effective in reducing the skin cancer burden.4 As they say, ‘prevention is better than cure’, which is also an aim supported by the Institute for Innovation and Improvement.