Sunscreen application technique amongst patients with a history of skin cancer
Loyola University Chicago Stritch School of Medicine
Background: Data on how patients with a history of skin cancer apply sunscreen are lacking. Objective: We sought to characterize (i) gender differences in sunscreen application technique (quantity used, adequacy of anatomic site coverage and time allocated for product application to the head) and; (ii) differences in sunscreen application to unaffected skin versus previous skin cancer sites. Methods: Subjects with a past history of skin cancer were provided a broad-spectrum sunscreen with known fluorescence and were asked to apply it to the head as they normally would. Their application technique was observed, and the amount of sunscreen used and time required to apply it were recorded. Using Wood’s lamp lighting, adequacy of coverage of anatomic subunits was graded by a blinded investigator on an ordinal scale (1=0-25%, 2=26-50%, 3=51-75%, 4=76-100% coverage). Results: Forty-three females and twenty-seven males with a past history of skin cancer were enrolled. Males used 530mg more sunscreen (p < .001) and applied an average of 2mg/cm2 more sunscreen to the head than women. Average sunscreen coverage score among all subjects was 3.27. Males were 7.61 times more likely to apply adequate amounts to their ears (p= .001). No differences were noted in sunscreen application times. Coverage scores were similar for unaffected skin versus previous skin cancer sites. Limitations: Observations in a controlled indoor setting may not reflect usual sunscreen application practices. Conclusion: Overall, skin cancer survivors of both genders effectively applied sunscreen in line with recommended quantity guidelines, but men were significantly better at remembering to protect their ears.