Sunscreen use and melanoma: a case of evidence-based prevention?
BACKGROUND
A preventive effect of sunscreens on melanoma development is still subject of intense discussion. The practical consequences for changes in public health campaigns are neglected in this debate.


METHODS
An extensive literature search for studies on the association between sunscreen use and melanoma occurrence was performed. The principles of evidence-based medicine (EBM) are applied to the issue to derive at recommendations for an evidence-based prevention of melanoma.


RESULTS
We identified 17 case-control studies providing risk estimates for the relationship under study. These risk estimates are too heterogeneous to allow a reasonable conclusion by summarizing the evidence. The application of the EBM approach yields therefore an inconclusive result: the melanoma protective potential of sunscreens cannot be proven using the existing evidence. The information necessary to fully assess the effect of sunscreen use on melanoma development is not currently available.


CONCLUSIONS
Based on the current evidence the focus of recommendations for melanoma prevention in public awareness campaigns has to be changed. It should be much more emphasized to minimize exposure to ultraviolet (UV) radiation during peak hours, wear protective clothing, hats and UV-opaque sunglasses, seek shade and protect infants and children against too much UV radiation exposure at all than to use sunscreens.
Gefeller
Olaf
O
Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Waldstrasse 6, D-91054 Erlangen, Germany. gefeller@rzmail.uni-erlangen.de
Pfahlberg
A
A
D019317:Evidence-Based Medicine; D006801:Humans; D008545:Melanoma / Q000517:prevention & control*; D009381:Neoplasms, Radiation-Induced / Q000517:prevention & control*; D011481:Protective Clothing; D012307:Risk Factors; D012878:Skin Neoplasms / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000627:therapeutic use*; D014466:Ultraviolet Rays / Q000009:adverse effects*
D013473:Sunscreening Agents