Nearly half of skin cancer patients who underwent surgery still do not use sunscreen, a third do not use protective gear, like hats, and one in six do not avoid the midday sun, a new study has shown.

The study, published in the Malta Medical Journal, revealed a worrying lack of awareness – and medical guidance – among patients who experienced skin cancer.

One in three said they were not advised to use sun protection measures by healthcare professionals.

The main cause of skin cancer is ultraviolet (UV) radiation from the sun or tanning beds.  Prolonged and repeated exposure to UV radiation can damage the DNA in skin cells, leading to the development of cancer. Sunbathing, working outdoors or spending long hours exposed to the sun can greatly increase the chances of getting skin cancer.

This is why it is important to decrease exposure to the sun, especially during peak sunlight hours (11am to 3pm) when UV rays are the strongest, use sunscreen and wear protective clothing.

The study, conducted by Juanita Parnis, Esther Muscat and Petra Magri Gatt, analysed the practices of patients who underwent surgical procedures at Mater Dei Hospital’s Plastic Surgery and Burns Unit between January and March 2020.

Based on questionnaire responses from 62 patients, the study found that 45% of respondents do not use sunscreen at all, even after having done a surgical procedure.

“According to World Health Rankings, skin disease in Malta ranks as the 32nd cause of death, with a death rate of 1.86 per 100,000. It also places 73rd worldwide, with regards to deaths due to skin disease,” the study states.

Among those who use sunscreen, a third of patients (33%) said they did so before and after the procedure. However, two of these patients specified that they only use it when they go swimming.

A further 22% said they only started using sunscreen after the procedure. Another two respondents admitted they rarely use sunscreen.

Of those who do apply sunscreen, the large majority (76%) said they use it at a strength of SPF 50+. Most (71%) said they apply sunscreen a few minutes before they are exposed to the sun.

The study also found that, as a prevention measure, it was more common for people to avoid the sun or cover their skin from sun exposure, rather than put sunscreen on their skin.

Over half of the patients (51%) said they avoid the sun and an additional 24% started to stay out of the sun after their diagnosis. Nearly half of the respondents (48%) use other types of protection such as hats, sunglasses, long sleeves or an umbrella and 16% started to protect themselves after the diagnosis.

The study established that 15% of patients do not avoid sun exposure and 32% do not use any other form of protection from the sun’s rays.

This notwithstanding that the majority of respondents (60%) acknowledged that UV rays are harmful, 6% of whom said they can lead to skin cancer.

However, 13% said they were unaware of the harm UV rays can cause and 11% did not reply.

Having said that, fewer people were aware of the increased risk of having another lesion in the future following the procedure, with only 37% claiming to be aware of this. Just under a third, 31%, said they were unsure and 32% said they were unaware.

Overall, the majority of patients (67%) said they were advised by healthcare professionals to use sun protection measures. However, almost a third (30%) said they were never offered such advice.

Patients who underwent the surgical procedure spoke about the importance of increasing awareness through different forms of media.

Other patients suggested the distribution of cheaper or free sunscreen products, especially for vulnerable people. Some patients also said there should be more accessible shaded areas for people to avoid the sunlight.

While the study acknowledged that there have been several measures to prevent skin cancer, it noted there seems to be a lack of awareness about “sun protection practices after skin cancer procedures”.

“This suggests that further work needs to be done on educating patients with regards to sun protection behaviour,” the study said.

The call for more awareness was also made by Paul Spiteri Lucas, who shared the story of his wife passing away from melanoma skin cancer, to ensure “others don’t go through what we went through”.

How can I prevent skin cancer?

Other than regular skin checks, you can prevent skin cancer in other ways such as: seek shade, especially during peak sunlight hours (11am to 3pm) when UV rays are the strongest; wear protective clothing; use sunscreen and avoid tanning beds.

You should apply a broad-spectrum sunscreen with a minimum SPF of 30 on all exposed skin areas (including often forgotten areas such as the ears and neck), and re-apply every two hours, especially after swimming or sweating. UV rays can penetrate clouds, so SPF is recommended every day, even in the winter or when it is not particularly sunny.