"The benefits of sun protection clearly outweigh the risks," said Dr. Sheila Fallon Friedlander, but the debate continues over how to balance the benefits of outdoor activities for children with protection against skin cancer.
Some studies suggest outdoor activity is protective against melanoma, Dr. Friedlander said She cited a case-control study of 583 cases of cutaneous malignant melanoma and 608 controls (Int. J. Epidemiol. 1999;28:418-27). Intermittent sun exposure, such as beach vacations during adolescence and the use of tanning beds and sunlamps, was associated with a significantly greater risk for melanoma, whereas chronic exposure, indicated by days of outdoor activity during adolescence and by outdoor jobs in adulthood, was associated with a significantly reduced risk for melanoma.
But sun protection and patient education does appear to play a role in reducing the number of nevi in children. Dr. Friedlander, clinical professor of pediatrics and medicine at the University of California, San Diego, cited another study in which 458 children in first to fourth grade in Canada were randomized to receive sunscreen and counseling about sun protection. Three years later, the sunscreen group had significantly fewer new nevi compared with the control group (JAMA 2000;283:2955-60).
What's a dermatologist to do? "Common sense prevails," Dr. Friedlander said. She advised dermatologists to counsel children and their parents to protect against sunburns by using sunscreens and sun-protective clothing. Also, "identify high-risk patients and follow them" so that any problems can be spotted early, she said.
But once parents and children are on board with sun protection, what should they use? The Environmental Working Group (EWG), a nonprofit organization that reviews and disseminates information about contaminants in consumer products and the environment, has come down in favor of physical sunscreens, based on a review of 400 studies and 2,000 sunscreens, Dr. Friedlander said.
Some parents and children prefer organic sunscreens, which contain oxybenzones, but the EWG rates these products as more dangerous than physical sunscreens. Some research suggests that oxybenzones can be absorbed into the skin in a way that the nano-particles of zinc oxide and titanium dioxide in physical sunscreens cannot, Dr. Friedlander said.
Be aware of what sunscreen characteristics raise concerns in your patients and their parents, Dr. Friedlander said. Share information with them, refer them to the EWG Web (www.ewg.org) and come up with a reasonable plan for sun protection.
Dr. Friedlander has served as a clinical investigator for Johnson & Johnson, which manufactures sunscreen products. SDEF and this news organization are owned by Elsevier.