After I started working in a dermatology clinic, I recognized that I had made errors diagnosing and treating dermatological problems while practicing in primary care. Once in the specialty of dermatology, I decided to write Dermatology for the Advanced Practice Nurse for Nurse Practitioners in primary care to have a fast concise way to diagnose dermatological problems and identify treatment options. When a patient presents with dermatitis, the provider can use our book to diagnose the rash with the decision trees, have access to treatment options, and be able to educate the patient. The book is also a resource for providers to identify skin cancers and abnormal nevi.
The Surgeon General’s Call to Action to Prevent Skin Cancer (2014) calls for healthcare providers, businesses, educators, religious organizations, and families in the United States to follow five strategic goals to increase awareness of skin cancer and actions to prevent the risk. These five goals are:
- Increase opportunities for sun protection in outdoor settings
- Provide individuals with the information they need to make informed decisions about ultraviolet radiation exposure
- Encourage policies that advance the national goal of preventing skin cancer
- Reduce harms from indoor tanning
- Support research, surveillance, monitoring, and evaluation related to skin cancer prevention
Currently, 44 states have imposed age restrictions on the use of indoor tanning facilities. Many states have passed laws to promote sun safety educational programs and skin cancer prevention as part of the curriculum in public schools. Also employers are onboard with prevention by mandating sun-safety programs for employees that spend more than 5 hours working outdoors.
The FDA governs sunscreens sold in the U.S as over-the-counter drugs. Current regulations state acceptable ingredients and dosage strengths, provide language and format for product labels, and standardized testing to determine a products sun protection factor (SPF).
The FDA also regulates indoor UV tanning devices under separate authorities, both as medical devices and as radiation-emitting electronic products. On May 29, 2014, the FDA reclassified indoor tanning devices to Class II medical devices (moderate to high risk). Now manufactures will have to include a warning that people younger than 18 years should not use these devices, receive premarket notification clearance from the FDA, and meet other requirements. Many other countries are following suite in the prevention of skin cancer.
As Nurse Practitioners, we have been educating patients about skin cancer prevention long before the recent Surgeon Generals Call to Action program. This action program expands our resources and ability to take further proactive steps in education and prevention of skin cancer. These new mandates will have a huge impact on skin cancer prevalence in America.
Skin cancer is the most commonly diagnosed cancer in the United States. Each year 5 million people are treated, costing Americans $8.1 billion for treatment.
Melanoma is the most deadly of all skin cancers, with an estimated 9,000 deaths per year. Alarmingly, Melanoma is the most common type of cancer among U.S. adolescents and young adults. This is attributed to the increased UV exposure outdoors without proper sun protection, or by the use of indoor tanning facilities.
As providers, we should educate parents of children, adolescents, and young of skin cancer prevention. We must educate patients “tanned skin is damaged skin” and provide brochures on prevention along with samples of sunscreen. If asked, many manufacturers will provide samples of sunscreen for our patients. Additionally, providers should find opportunities to volunteer to speak to Boy Scout and Girl Scout troops, sports teams in the schools, daycares, and churches about sun protection and skin cancer prevention.
What other recommendations would you give to providers in preventing skin cancer?