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Background: Overexposure to sunlight and sunburn are the main preventable causes of skin cancer. Outdoor sports are associated with significant levels of sunlight exposure., Aims: We sought to quantify the sun radiation exposure received by outdoor rock climbers and assess their sun exposure habits, sun protection behaviors, attitudes, and knowledge regarding skin cancer., Methods: From April to June 2021, outdoor rock climbers contacted via email completed an online validated self-reported questionnaire on sun related habits, behaviors, attitudes and knowledge. As a pilot trial, ten participants wore a personal dosimeter during two outdoor climbing weekends in May and November 2021. Ambient ultraviolet radiation (UVR) was also recorded., Results: A total of 217 outdoor rock climbers (103 women), mean age 36.8 ± 8.8 years (range 20-70 years) and median climbing practice per week of 8 h (IQR 7.5) were studied. Two in three (65.9%) participants reported at least one sunburn event during the previous rock climbing season. Of the survey respondents, 49.3% reported using sunscreen with SPF ≥ 15, 47% wore sunglasses, and 14.3% indicated they reapplied sunscreen every two hours. The median personal UVR dose measured during the two outdoor climbing weekends analyzed was 5.2 (IQR 1.8) and 8.8 (IQR 1.1) standard erythemal doses, respectively., Conclusions: The high rates of sunburn, the elevated personal UVR measured and the clearly insufficient sun protection practices followed during rock climbing together with unsatisfactory attitudes towards tanning reveal the need to develop explicit sun protection campaigns and educational strategies to reduce the risk of skin cancer among the athletes studied., (© 2023. The Author(s).)

Background: Overexposure to sunlight is the main cause of skin cancer. Photoprotection practices and sunburn play a crucial role in skin cancer prevention., Objectives: This study aimed to quantify the risk of sun exposure and to evaluate photoprotection practices in Spanish sailors during Olympic competitions., Methods: Solar daily ultraviolet (UV) radiation cycle, personal UV dosimetry, photoprotection practices and sunburn checking were followed during three consecutive days of competition among sailors from the Spanish Olympic Sailing Team during a Tokyo Olympic Regatta Test Event., Results: A total of 13 sailors (7 women), with mean age of 27.6 ± 4.7 years and sports experience of 17.7 ± 5.4 years, were studied. The most common phototypes were type III (53.8%) and type II (38.5%). The rate of sunburn checked was high (46.2%). The mean daily personal UV exposure received was 761.0 ± 263.6 J/m 2 , 3.0 ± 1.1 minimal erythemal dose and 7.6 ± 2.6 standard erythemal dose, seven times greater than the maximum permissible UV light exposure values for an 8 h working day. The use of a T-shirt was the most common practice (94.2%), followed by the use of shade (50.2%), hat/cap (44.0%), sunglasses (26.1%) and sunscreen (11.8%)., Conclusions: Olympic sailor's studies presented high levels of UV radiation received, high rate of sunburn and insufficient adherence to sun-protective behaviours (especially, to use of sunscreen) to prevent sunburn, the main cause of skin cancer. Sport Federations should develop educational campaigns addressing sun-related exposure habits and photoprotection behaviours to reduce the risk of skin cancer among these athletes., (© 2022 The Authors. Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.)

Objective: Overexposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. Outdoor workers, exposed to the sun for many hours throughout their working lives, are at special risk. The aim of this study is to determine occupational photoexposure and photoprotection among outdoor workers employed by a municipality in southern Spain., Methods: Cross-sectional descriptive study focusing on outdoor workers employed by the municipality of Fuengirola (in areas such as construction, gardening, urban cleaning and beach maintenance). The participants were monitored by personal dosimetry, participated in a dermatological check-up and answered a validated questionnaire (CHACES) on their habits, attitudes and knowledge related to sun exposure., Results: The median effective erythema dose of exposure to solar UV radiation during the working day (n=20) was 379.4 J/m 2 , equivalent to 3.8 standard erythema doses, almost 3 times higher than the recommended limits for an 8-hour workday. Skin examination (n=128) revealed the presence of actinic lentigines (79.7%), actinic keratoses (8.6%) and skin cancer (3.9%). The CHACES questionnaire (n=128) revealed a sunburn rate of 50.0%. Photoprotection practices were markedly deficient: only 16.7% of the survey respondents sought protection in the shade, 20.3% avoided exposure during the peak exposure hours and 33.1% applied sunscreen., Conclusions: This is the first study to evaluate UV radiation exposure, occupational sun protection practices, sunburn and actinic injuries of different outdoor workers in one of the sunniest regions of Spain and underlines the need for effective interventions to protect outdoor workers' health., Competing Interests: Competing interests: The authors have no conflict of interest to declare., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Sunburn caused by overexposure to ultraviolet radiation is the main cause of preventable skin cancer. This study aimed to describe the sun protection habits and rate of sunburns associated with the practice of cycling and to identify predictive factors of sunburn among cyclists. A descriptive observational study based on online surveys was conducted. Recruitment of participants was conducted through the Andalusian Cycling Federation (Spain). A questionnaire on behaviour, attitudes, and knowledge related to sun exposure was used. A bivariate analysis was carried out with sunburn episodes during the previous year as outcome variable, and a multivariate logistic regression model was built. Of the 1018 surveys returned, 87.6% were answered by men, mean age was 41.8 years (SD: 11.0), and 37.6% of the participants had phototype I or II. Sunburns during the previous year were reported by 45.6% (95% CI: 42.5-48.7) of the respondents. Sunscreen use was reported by 39.2%, and 61.0% did not examine their skin regularly despite the fact that 34 subjects (3.4%) reported a personal history of skin cancer. The multivariate logistic regression analysis showed that there was a negative correlation between episodes of sunburn and age, phototypes I-II, more than 2 h of sun exposure, and inconsistent use of sunscreen. Cyclists have high rates of sunburns and thus constitute a high-risk group for developing skin cancer. Educational interventions specifically aimed at this group of athletes would improve sun protection knowledge and practices, particularly the use of sunscreen., (© 2020. American Association for Cancer Education.)

Non-melanoma skin cancer (NMSC), despite its low mortality, can impose a significant psychological burden on patients. The aim of the present study is to examine the evolution of the quality of life (QOL) in patients with cervicofacial NMSC during treatment. This prospective cohort study was conducted to a group of patients with cervicofacial NMSC, confirmed by skin biopsy. These patients completed the Skin Cancer Index questionnaire at the time of diagnosis and at 1 week, 1 month and 6 months after treatment began. Data for these patients' demographic characteristics and variables related to the type of tumour, the treatment received and the evolution of the condition were recorded. The study group was composed of 220 patients. At the time of diagnosis, the overall mean score for QOL was 54.1 (SD 21.9); for the social appearance component, it was 76.7 (SD 26.2), and for the emotional component, it was 23 (SD 25.1). Six months after treatment began, the overall mean score was 61 (SD19.1), that for social appearance, 85 (SD 20.6), and that for the emotional component, 27.4 (SD 26.6). All the differences were statistically significant (p < 0.05). The results obtained show that during the treatment period, it is at the time of diagnosis when patients with cervicofacial NMSC undergo the greatest deterioration in their QOL. In comparison with the findings obtained in previous studies, our population obtained lower overall scores in the questionnaires and less improvement during follow-up., (© 2020. American Association for Cancer Education.)

Non-melanoma skin cancer (NMSC) is the most common neoplasm. The characteristics of this disease (location in aesthetically sensitive areas, the appearance of successive tumors during follow-up, and high rates of survival) are such that the concept of health-related quality of life (HRQoL) is of particular importance. The aim of the present study was to describe and analyses patient quality of life following diagnosis with cervicofacial NMSC. A descriptive cross-sectional study was conducted on patients with cervicofacial NMSC, confirmed by skin biopsy. In each case, when the definitive diagnosis of NMSC was established, the patient completed the Skin Cancer Index questionnaire and demographic data, health status, and sun exposure habits were recorded. The study population was composed of 220 patients with histologically confirmed cervicofacial NMSC. The mean score obtained for the Skin Cancer Index questionnaire was 54.1 (SD 21.9), in which the social-aesthetic component had a mean score of 76.7 (SD 26.2), while the emotional component had a mean score of 23 (SD 25.1). Male patients, those with secondary or higher education, and those who had no history of anxiety or depression had significantly higher mean scores for HRQoL. This study demonstrated that the diagnosis of cervicofacial NMSC significantly impacts HRQoL and that certain population groups (women, persons with only primary or no education qualifications, and those a history of anxiety or depression) are more susceptible. The questionnaire scores obtained were lower than those reported in previous studies on this topic and reflect a particularly strong impact on emotional aspects of patient quality of life.

Purpose: Non-melanoma skin cancer (NMSC) is the most frequent neoplasm today, worldwide. This type of tumour presents low mortality but causes a major psychosocial impact on the patient. Studies have shown that the patient's quality of life (as detected by questionnaire scores in this respect) improves as the care process advances. The main aim of the present study is to identify the factors that are related to this favourable evolution., Methods: This descriptive cross-sectional study included patients with cervicofacial NMSC, confirmed by skin biopsy. The patients were asked to complete the Skin Cancer Index questionnaire at the time of diagnosis and subsequently at 1 week, 1 month and 6 months after treatment. Relevant demographic variables were recorded, together with information on health status and the treatment received., Results: A total of 229 patients with biopsy-confirmed cervicofacial NMSC were included in the study population, and 220 completed the quality of life questionnaires at the necessary time points during the care process. Some variables-sex, education, marital status, history of anxiety or depression, tumour type, the treatment received and the VAS score in this respect-were found to have a statistically significant influence on the degree of improvement recorded in the quality of life questionnaire scores during follow-up., Conclusions: The quality of life questionnaire scores of patients with cervicofacial NMSC improve following treatment, but this progression is not homogeneous among patients. We identify the variables that are related to a greater degree of improvement on the questionnaire scales (overall, emotional and social-aesthetic)., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Excessive sun exposure and insufficient protection are the main risk factors for the onset of melanoma and non-melanoma skin cancer (the most common types of cancer suffered by fair-skinned populations) and other adverse effects on the skin and eyes. Epidemiological data highlight the scant awareness of this risk among young people and the high rates of sunburn often recorded among this population. The main aim of the present study is to examine sun exposure and protection behavior by university students. A cross-sectional questionnaire-based study was undertaken to investigate sun exposure and protection practices among students of education sciences at a university in southern Spain. The data obtained were used to perform a descriptive, comparative analysis, by groups and by gender, of photoprotection and skin self-examination practices. The reliability and validity of the questionnaire were both tested. Of the 315 students who completed the questionnaire, 74.6% had suffered at least one sunburn during the previous year. Few made frequent use of sunscreen or protective clothing and 89.5% did not self-examine their skin. The metric properties of the questionnaire revealed its excellent reliability and validity. Among the Spanish university students considered, there was little awareness of the risk of excessive sun exposure, self-protection was insufficient, the potential exposure to dangerous levels of ultraviolet radiation was high, and most had suffered one or more sunburns in the last year. Intervention strategies should be implemented to highlight the risks involved and the need for more appropriate sun protection practices. Information campaigns should be conducted in this respect so that, when these students become teachers, they will have adequate knowledge of the risks involved and of the benefits of addressing this problem effectively, and will ultimately transfer these health education competences to their own students.

The principal cause of skin cancer is sun exposure. In areas with high sun exposure levels, early diagnosis and sun protection education strategies must be developed. Aim of the study was to evaluate the impact of an early skin cancer diagnosis intervention implementing teledermatology. Transversal descriptive study on a population in the Western Costa del Sol. Primary care physicians were instructed on skin cancer diagnosis. They recruited consecutive at-risk patients and held four workshops for early skin cancer diagnosis and education on sun protection. The resulting variables on participants' satisfaction and intention to change were collected. 393 patients were recruited. The mean age was 52.9 years, and 65.4% were women. Suspicious lesions were detected in 24.1% of participants, and 11.7% were attended to via teledermatology. Of these, 65.2% were evaluated in person at the Dermatology Department. Fourteen basal cell carcinomas, 5 squamous cell carcinomas, and 2 melanomas were diagnosed. Regarding patient satisfaction, 67.7% found all aspects of the workshops of interest, 41.7% found the skin check-up of interest, and 26.4% found sun and skin cancer prevention information of interest. Of the patients attended to via teledermatology, 100% stated it was good or very good and 100% would consult again via this method. The intervention was successful in terms of participation, skin cancer diagnosis, and satisfaction, especially compared with other international campaigns. Therefore, although the data cannot be extrapolated to all environments, this initiative may be used as the basis for the development of future interventions.

Beach users and outdoor workers in resort areas are major risk groups for skin cancer, and therefore seaside hotels constitute a strategic area in which to conduct awareness-raising campaigns and interventions. The main aim of the present study is to describe habits, attitudes and knowledge related to sun exposure, the sunburn events experienced and potentially malignant skin lesions observed among hotel staff and guests recruited during a skin cancer prevention campaign at seaside hotels in the western Costa del Sol (southern Spain). This descriptive cross-sectional study was conducted at four seaside hotels in the western Costa del Sol. An 8-day awareness-raising campaign on skin cancer was conducted for hotel guests and staff, who were invited to complete a questionnaire about their habits, attitudes and knowledge regarding photoprotection, and to receive a comprehensive skin examination. The questionnaire on habits, attitudes and knowledge related to sun exposure was completed by 542 participants. The most common photoprotection practice was the use of sunglasses (79.3%). Potentially dangerous lesions were identified in 39 persons (14%). In addition, 94.0% reported having gained new knowledge, 89.6% had changed their attitudes towards sun tanning and 94.7% intended to improve their photoprotection practices in the future. Seaside hotels are an optimal scenario for conducting studies aimed at skin cancer prevention and reduction. Further studies should be carried out in other geographical areas to confirm our results, to evaluate the costs and benefits of such interventions and determine their long-term impact on health.

Background: Multiple BRCA1-associated protein 1 (BAP1)-inactivated melanocytic tumors (BIMTs) have been associated with a familial cancer syndrome involving germline mutations in BAP1., Objectives: We sought to describe the clinical and dermoscopic features of BIMTs., Methods: This was a retrospective, multicenter, case-control study. Participating centers contributed clinical data, dermoscopic images, and histopathologic data of biopsy-proven BIMTs. We compared the dermoscopic features between BIMTs and control patients., Results: The dataset consisted of 48 BIMTs from 31 patients (22 women; median age 37 years) and 80 control patients. Eleven patients had a BAP1 germline mutation. Clinically, most BIMTs presented as pink, dome-shaped papules (n = 24). Dermoscopically, we identified 5 patterns: structureless pink-to-tan with irregular eccentric dots/globules (n = 14, 29.8%); structureless pink-to-tan with peripheral vessels (n = 10, 21.3%); structureless pink-to-tan (n = 7, 14.9%); a network with raised, structureless, pink-to-tan areas (n = 7, 14.9%); and globular pattern (n = 4, 8.5%). The structureless with eccentric dots/globules pattern and network with raised structureless areas pattern were only identified in BIMT and were more common in patients with BAP1 germline mutations (P < .0001 and P = .001, respectively)., Limitations: Limitations included our small sample size, retrospective design, the absence of germline genetic testing in all patients, and inclusion bias toward more atypical-looking BIMTs., Conclusions: Dome-shaped papules with pink-to-tan structureless areas and peripheral irregular dots/globules or network should raise the clinical suspicion for BIMT., (Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: Photodynamic therapy (PDT) is an effective treatment against skin field cancerization. Its main side effect is local inflammation in the treated area. The phenolic compound oleocanthal (decarboxy methyl ligstroside aglycone), which is present in extra virgin olive oil (EVOO), has anti-inflammatory properties. The purpose of this study was to evaluate the topical efficacy of an oily fluid enriched with oleocanthal (OC) extract, in comparison with a conventional oily fluid, in reducing the degree of inflammatory reaction after conventional PDT., Methods: Quasi-experimental pilot study, before-after with a control group, performed with a cohort of consecutive patients diagnosed with actinic keratosis/field cancerization (AK/FC) in the forehead and/or scalp, treated by PDT. The study was carried out from April 2016 to November 2017 at a speciality hospital in southern Spain. A group of 24 consecutive patients received the topical application, three times daily for one week, of an emollient oily fluid in the area treated with PDT. Subsequently, another group, of 23 consecutive patients, received the same treatment pattern with an oily fluid enriched with OC extract. The post-PDT inflammatory reaction was measured by an independent member of the hospital's dermatology department, using the following visual scale of erythema (from 0 to 4).The assessment was conducted at 30 min and at 48 h post-PDT., Results: In the assessment at 48 h after treatment, the inflammation had improved more among the patients treated with OC (median: 25%, 95%CI: -5.3 to 28.5) than in the non-OC group (median: 0%; 95%CI: -45.2 to -6.2). The difference was statistically significant (p<0.01), and the Cohen's d value was 0.89 (large effect). At three months after PDT, a complete response had been obtained by 60.9% of the patients treated with OC compared to 29.2% of the non-OC group, and the difference was close to statistical significance (p=0.059)., Conclusions: The topical application of an oily fluid enriched with OC extract achieved a greater reduction in post-PDT cutaneous inflammation and a better treatment response, in comparison with the application of a conventional oily fluid., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Sun exposure in childhood is the main risk determinant for skin cancer in adulthood. Several questionnaires have been used to examine behaviour patterns in terms of sun exposure in childhood, but none have been subjected to a rigorous analysis of their measurement properties. To evaluate the psychometric properties of a questionnaire adapted to investigate children's sun exposure behaviour, a two-stage validation study was carried out. First, in a transverse study, the questionnaire was administered to a sample of 333 children recruited from schools, and the validity and internal consistency were analysed. Second, 32 children recruited in a hospital setting were interviewed for the test-retest analysis. All the items in the 'Photoprotection habits' category were significantly correlated. Principal components analysis showed that two components accounted for over 53% of the variance. The Cronbach's α-coefficient was 0.63 for the first component and 0.43 for the second. In the stability analysis, the percentage of absolute agreement exceeded 70% for all the questions. The Questionnaire on Habits RElated to Sun exposure during Infancy (CHRESI) questionnaire examines sun protection habits by children. Its proven reliability, validity and stability make it a useful tool both in epidemiologic research and in the development and evaluation of campaigns to reduce the risk of skin cancer.

Adolescents are considered a risk group for the development of skin cancer in later life due to their high rates of sunburn. The aim of this study is to evaluate the association between attitudes to sun exposure and the sociodemographic characteristics of adolescents, their habits, practices and knowledge. As a secondary goal, we describe the magnitude and sign of the correlations between these attitudes. Cross-sectional study of adolescent students from 12 secondary schools in southern Spain, the subjects were asked to complete the 'Beach Questionnaire'. This instrument examines four dimensions of attitudes, with standardised scores of 0-100, related to the sun, sun tanning, sun protection and sun cream. The higher the score, the more positive the attitude. The study population was composed of 270 adolescents. The highest scores were obtained for attitudes towards sun protection practices (mean 66.2; SD 18.6) and towards sun tanning (mean 64.2; SD 21.1). The lowest scores were obtained for attitudes towards using sun cream (mean 50.1; SD 24.6). Significant differences were found for all four attitudes, with a positive sign for the relationship between the number of days of sun exposure and a higher score for attitudes towards sunbathing (27.3 points difference between response extremes) and for attitudes towards suntanning (20 points difference). Favourable attitudes towards sunbathing and sun tanning have most influence on inadequate habits of sun exposure and deficient measures of sun protection. Adolescents should be considered a priority group for targeted interventions to improve sun protection behaviour.

Health professionals are key agents in healthcare promotion. In the field of skin cancer, they play a crucial role in the development of prevention strategies in the community. This paper aims to describe the sun exposure attitudes and habits of public healthcare professionals in the western Costa del Sol (Spain). A cross-sectional descriptive study was conducted in the Costa del Sol healthcare district to analyse sun exposure and protection practices and habits, and attitudes to tanning and sun protection. The respondents, all healthcare personnel in various professional categories and workplace situations, were asked to complete a self-administered questionnaire. Six hundred forty-three workers in the Costa del Sol healthcare district took part in the study. Of these participants, 450 were healthcare professionals. Of the 450 health professionals, 226 (50.2 %) were nurses or auxiliary nursing staff, and the remaining 224 were doctors. These two groups presented differences regarding habits of sun exposure: 15.3 % of the doctors went to the beach at least 30 days a year, compared to 30.9 % of the nurses (p < 0.001). With respect to workplace situation, there were differences (p < 0.001) between the sunburn events reported by healthcare staff who worked in hospitals (52.4 %) compared to those working in primary healthcare (30.4 %); comparable differences were found with respect to attitudes toward the use of sunscreen creams (p = 0.014). This study identifies two distinct subgroups within healthcare personnel: on one hand, primary healthcare professionals, who are key agents for future policy strategies, and on the other, specialist healthcare professionals, who are more likely to suffer sunburn events and therefore toward whom strategies should be addressed to encourage them to change their sun exposure attitudes and habits and sun protection practices.

Background: Sunbathing on the beach is one of the main risks for skin cancer., Objective: In the summer of 2010, a skin cancer prevention campaign aimed at beachgoers was undertaken on the western Costa del Sol (southern Spain)., Methods: The campaign took place on beaches during July and August. A multicomponent intervention was conducted by a dermatologist and other healthcare professionals, including: (1) interviews about risk factors and sun protection habits; (2) full skin examination using dermoscopy; (3) health advice plus educational brochure; (4) sunscreen workshop plus free samples; and (5) survey about satisfaction and behavioral intentions. A journalism and health prize was offered to encourage mass media coverage., Results: Four hundred and seven beachgoers (56% tourists) were recruited during the campaign, mean age 45 years. Most of the participants reported high-risk sun exposure and revealed high rates of clinically suspicious lesions of skin cancer (8.1%), melanoma (2.9%), actinic keratosis (10.2%), and atypical nevus (7.6%). The campaign was highly appreciated by the participants and followed not only by local but also regional and national media., Conclusion: Beachgoers are a strategic target to prevent skin cancer. Beaches are also suitable places to develop a skin cancer prevention campaign, allowing direct access to the high-risk population for surveying, health behavior education, and screening. Several keys may be useful to optimize results as the design of a personalized intervention of proven efficacy, provision of a trained healthcare team, and development of an attractive strategy for the mass media., (© 2014 The International Society of Dermatology.)