An international team of authors representing five continents has developed a message for the prevention of skin cancer and UV protection. The central message is: avoid sunbathing and tanning. This message is radical and most dermatologists do not include it in their patient education programs.

From my own experience, I can confirm that we dermatologists do tend to compromise on this issue. The patient asks: “Can I still go out in the sun for a while?” The doctor replies: “Yes, you can, with the necessary precautions.” The patient asks: “Is a sunscreen with a protection factor of 50 a suitable protective measure?” The doc- tor replies: “Yes, that is good sun protection. However, you should also use clothing to protect yourself from the sun and seek shade.” What does the patient take away from this? The patient interprets this to mean that they can lie in the sun with sunscreen on. And in fact, the vast majority of the population think that they can sunbathe without danger if they use sunscreen. As a result, the incidence of melanoma and skin cancer continues to rise steadily.

The vast majority of the European population goes on sun vacations, often several times a year, and prefers a “healthy” tan. These needs and behaviors are deeply rooted and will be difficult to change. Sustainable change will take decades. We therefore need to start with clear and unambiguous messages. A lot would be gained if at least the dermatologists spoke the same language here.

We have a role model: the campaigns against smoking. Here there are clear messages, cumulated in the statement: smoking is deadly. It is written like this and in variations on all cigarette packets today. Smoking was banned on trains, in airplanes, in many public buildings and in restaurants. The number of smokers fell significantly and lung cancer also decreased. Unfortunately, it will not be possible to stop sunbathing with bans. It will be up to dermatologists and then the medical profession as a whole to spread the message: “Avoid sunbathing and tanning”.

I have included the following comparison in my patient education: “Sunbathing is more dangerous than smoking. UV radiation causes more mutations in the skin than smoking does in the lungs. UV radiation causes many more cancers than smoking. Sunscreen does not offer suffi- cient protection against mutations when sunbathing, so the only sensible solution is: “Avoid sunbathing and tanning”.

I hope that thousands of dermatologists will spread this message in Europe and that we can involve colleagues from other disciplines (especially with cancer screening).

Prof. Dr. med. Claus Garbe
Center for Dermatooncology, University Dermatology Clinic Tübingen, Germany
President of the European Association of Dermatooncology (EADO)