Individualizing Sun-Safety Counseling: Matching Patient Goals With Cancer Risk

Sun-safety counseling should be individualized according to a patient’s age, skin tone, cancer history, and goals rather than delivered as a universal recommendation, according to Joshua Arbesman, MD. In the second part of our interview, Arbesman emphasized that dermatologists should first consider the purpose of sun protection. Counseling aimed at preventing photoaging may differ substantially from counseling focused on skin cancer prevention, and clinicians should determine whether a particular outcome is meaningful to the patient.

For skin cancer prevention, Arbesman advocates tailoring recommendations to an individual’s level of risk. In older patients, for example, emphasizing every instance of sun exposure may have limited clinical value when future cancer risk from that exposure is negligible.

“If someone is 90 years old and coming into your office, to lecture them if they happen to be a little bit tan…I think also is not necessarily a wise approach,” Arbesman said.

In pediatric patients, counseling is directed primarily toward parents and should acknowledge the realities of parenting while emphasizing avoidance or reduction of sunburn, which is associated with increased melanoma risk later in life.

Patients with a personal history of melanoma or varying skin tones also require a nuanced approach. Arbesman recommends emphasizing avoidance of sunburn and being “smart in the sun,” while avoiding counseling that could reinforce guilt or create the misconception that eliminating all sun exposure will prevent another melanoma. He notes that counseling may appropriately differ for patients with rare genetic disorders involving DNA repair, such as xeroderma pigmentosum, in whom UV exposure has a substantially different clinical significance.

For time-limited skin checks, Arbesman views patient education as a longitudinal process rather than something that must be repeated in full at every visit.

“We do know that patients only retain, say, a quarter of the information that’s going to come at them. So throwing a lot of things at them…not necessarily valuable from an educational perspective. That being said, I'm speaking from an experience where my visits with my patients are longer than the average dermatologist,” he shared.

The essential message is concise: patients should continue activities they enjoy, avoid sunburn, and practice practical sun-safety measures without developing excessive fear of sunlight. He also encourages dermatologists to consider the broader health consequences of overly restrictive counseling. If fear of sun exposure leads patients to abandon outdoor exercise or activities that support mental well-being, clinicians should help patients find a reasonable balance between skin cancer prevention and overall health.

For more from the Melanoma Research Alliance, click here.