Abstract

About 5% of sunlight is ultraviolet (UV). UV causes gene mutations in skin cells, and is the main cause of all forms of skin cancer. Sun protection is crucial for people at high risk of malignant melanoma: those with fair skin, and are moley or have a family history of melanoma. It is required in patients at risk of squamous and basal cell skin cancers, and is vital in patients with photosensitivity. There is no agreement about how much sun protection is advisable for healthy adults at low risk of skin cancer. Protecting against UV in sunlight involves a set of behaviours: avoiding the hottest part of the day, wearing a hat and long sleeves, and wearing sunscreen. Sunscreens contain chemicals that absorb UV. The ‘sun protection factor’ (SPF) measures a sunscreen's effectiveness at protecting against sunburn. Protection in real life is less than the SPF predicts because people apply sunscreens thinly. Patients are resistant to changing behaviour to photoprotect better, even when advised to having had a malignant melanoma. This is an example of the ‘non-adherence’ to following medical advice that is a major barrier to good health outcomes in all branches of medicine.

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