Joshua Arbesman, MD, on Balancing Photoprotection and Quality of Life in Melanoma Counseling

In a recent interview with Dermatology Times, Joshua Arbesman, MD, a dermatologist at Cleveland Clinic who specializes in patients with inherited cancer predisposition and melanoma, discusses key considerations for melanoma prevention counseling, including photoprotection, patient anxiety, and navigating misinformation.

In a recent webinar with the Melanoma Research Alliance, Arbesman emphasized the importance of helping patients understand their individual melanoma risk and the factors that may influence it, while avoiding overly restrictive recommendations about outdoor activities. He notes that much of the research linking ultraviolet (UV) exposure with melanoma risk has focused on sunburns occurring earlier in life, particularly before age 25. In his view, clinicians should distinguish melanoma-specific risk from other consequences of UV exposure, such as photoaging and keratinocyte carcinomas, when counseling patients about sun protection. An important component of these conversations is addressing the guilt that can accompany a melanoma diagnosis.

“There is a tremendous amount of guilt in the melanoma community and melanoma patients in particular about their previous sun exposure and that they gave themselves melanoma,” he noted. “And so I think that guilt can weigh on them and can be unhealthy in a different way.”

Arbesman suggests that clinicians provide context about the complex factors contributing to melanoma risk and reassure patients that an isolated episode of sun exposure does not mean they have immediately increased their likelihood of developing another melanoma. He always encourages patients to continue participating in outdoor activities while being “smart in the sun,” including avoiding sunburn, wearing protective clothing, and using sunscreen where appropriate.

Arbesman also highlighted the importance of explaining the long-term nature of melanoma risk. Patients may incorrectly assume that recent sun exposure will immediately result in melanoma or that avoiding sun exposure during a particular summer eliminates their risk of developing skin cancer later that year. Instead, the effects of UV exposure relevant to melanoma can manifest over much longer periods, potentially decades after exposure.

The discussion also addresses growing patient concerns about sunscreen, particularly those influenced by social media. Arbesman recommends that clinicians avoid presenting sunscreen and sun protection in overly simplistic or absolute terms. Instead, physicians should acknowledge that research has raised questions about certain sunscreen ingredients and systemic absorption while explaining what is known and what remains uncertain. He argues that acknowledging legitimate questions can help maintain trust rather than dismissing patients’ concerns. For patients who remain uncomfortable using sunscreen, Arbesman recommends emphasizing options such as sun-protective clothing.