A Survey-Based Comparison of Sun Safety Practices in a Representative Cohort of the General Public Versus Attendees of a Skin Cancer Screening

July 2019 | Volume 18 | Issue 7 | Original Article | 649 | Copyright © July 2019

Emily C. Murphy BS,a,b Stephanie Kao BA,a Huan Wang MS,c Dechang Chen PhD,d Hong Nguyen MD MPH,e,f Adam J. Friedman MDa 

aDepartment of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, DC BGeorgetown University, School of Medicine, Washington, DC cDepartment of Biostatistics, The George Washington University, Washington, DCDDepartment of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences,Washington, DCEThe George Washington University Hospital Cancer Registry, Washington, DCfAlexandria Campus, Northern Virginia Community College, Alexandria, VA


A large proportion of data on photoprotective practices is yielded from free skin cancer screenings. However, the sun safety practices of populations who seek these skin cancer screenings may differ from the general public. To examine differences in skin cancer prevention practices and risk factors, we surveyed pedestrians at six locations in Washington, DC (public group, n=285) and attendees of a free skin cancer screening (screening group, n=144) using an IRB-approved survey. The screening group was older and included more individuals with fair skin than the public group. Respondents from the screening group were significantly more likely to always wear sunscreen, always seeks shade, and always or sometimes wear sun-protective clothing than the public group (P<0.05). To examine whether younger and non-white participants, who were less likely to attend our free screening, have different practices and risk factors than older and white participants, respectively, we compared survey answers for all participants by age and race. White participants were more likely to always or sometimes wear sunscreen and sun-protective clothing than non-white participants (P<0.05). Patients over 61 years were more likely to always seek shade and wear sun-protective clothing than those younger than 31 years (P<0.05). Therefore, free skin cancer screenings need to be better popularized among non-white and younger populations or more effective educational vehicles are needed. 

J Drugs Dermatol. 2019;18(7):649-653. 


Proper photoprotective practices are critical for the prevention of melanoma and non-melanoma skin cancers. A significant proportion of data on these practices is yielded from intake forms for free skin cancer screenings, such as through the American Academy of Dermatology’s SPOTme program. This program was started in 1985 and is one of the largest cancer screening programs.1 The risk profile, care access, and examination results of SPOTme’s screening population from 1986 to 2014 was recently examined by Okhovat et al.1 Nearly two million screenings were reviewed, which showed that the SPOTme program detected thousands of skin cancers that may have gone undetected given 52% of those screened would not have seen a doctor otherwise.1 Compared to the general United States (US) population, the screening sample was older (only 8.9% of participants were 15 to 29 years old) and included more white individuals (90.3% of the sample was Caucasian). The screening population also included only 37.7% men, and the percentage of men attending screenings decreased over time. Given melanoma deaths are higher among men than women,2 the authors stated that men, especially white men, are a critical group to screen for skin cancer.1

However, it is possible that the knowledge and perceptions of populations who seek skin cancer screenings may differ from the general public, leading to different photoprotective practices among these populations. This is especially relevant in the US where the demographics of our largest skin cancer screening program was not representative of the general population.1 The SPOTme program is clearly valuable as it has identified over 20,000 melanomas, 32,000 squamous cell carcinomas, and 129,000 basal cell carcinomas,1 but the data gathered from this program includes only patients who self-select to attend free screenings.