Introduction

Skin cancer is the most common form of cancer in the United States [1]. One in five Americans are projected to develop skin cancer in their lifetime [2]. Although skin cancers are known to be the most successfully treated human cancers, [3] it is estimated to cost approximately $8.1 billion annually to treat skin cancers [4] with more than one million new diagnoses of skin cancers each year in the United States [5]. A major risk factor for skin cancer is ultraviolet (UV) radiation from sun [6]. A common strategy is to avoid sun exposure during peak UV exposure hours between 10 a.m. to 4 p.m., but it is often impractical for many outdoor enthusiasts. Prolonged UV exposure causes skin damage and results in greater skin cancer risk [7]. Despite this risk, studies revealed that the majority of outdoor collegiate athletes who responded to their surveys admitted to rarely using sunscreen [8,9].

Cloudiness may not securely protect your skin from sun damage. UV radiation may still be high and sky conditions can change rapidly [10]. Therefore, sun safety measures should still be practiced. Attempting to follow shade during exercise does not reliably protect you from UV exposure either. A study that compared shade and sunscreen found that high-SPF sunscreen provided better protection against sunburn than a beach umbrella, although the sunscreen did not completely prevent sunburn [11].

People of color also need to protect themselves from UV light. They are less likely to wear sunscreen due to the false notion that they are not at risk of skin cancer [12]. Although skin cancer is less common than in Caucasians, people of color have a higher rate of advanced and thicker skin cancer along with a higher death rate from skin cancer due to delayed diagnosis [13,14]. Programs that promoted sun safety habits to professional and recreational athletes have been successful. National Cancer Institute implemented an intervention at ski resorts in North America through an education program called “Go Sun Smart.” The program logo “Use sunscreen, sunglasses, and a hat” was advertised via posters, window decals, table tents, brochures, newsletter articles, a website, and a training module with presentation. The ski lift operators received sunscreen and wide-brimmed hats. This resulted in reduced sunburn and excessive UVR exposure in skiers and snowboarders [15]. Providing select NCAA female golfers an easy access to sunscreen by placing sunscreen in their locker rooms and bags increased their sunscreen application [16]. More of these systematic approaches for sun safety education are desired.

Summary

• Wear sun protective gear such as wide-brimmed hats, sunglasses, and long pants and long-sleeve shirts

• Limit the hour’s practices between 10 a.m. and 4 p.m.

• Keep a sunscreen and sun protective gear in locker rooms or sports field for an easy access

• Apply sunscreen with a sun protection factor of 30 or above [17]

• Wear sunscreen even on a cloudy day

• Colored skin also need sun protection

• Reapply sunscreen every two hours to reduce the risk of skin cancer [1]

1. Cancer Facts & Figures 2017. American Cancer Society. 2017. https://goo.gl/1HPdio
2. Robinson JK. Sun exposure, sun protection, and vitamin D. JAMA. 2005; 294: 1541-1543. https://goo.gl/K4jwk7
3. Amir Z, Wright A, Kernohan EE, Hart G. Attitudes, beliefs and behaviour regarding the use of sunbeds amongst healthcare workers in Bradford. Eur J Cancer Care (Engl). 2000; 9: 76-79. https://goo.gl/GLN4sp
4. Guy GP Jr, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. Am J Prev Med. 2015; 48: 183-187. https://goo.gl/X52qSz  
5. Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, et al., Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010; 146: 283-287. https://goo.gl/BcGYYN
6. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer. Current status. Arch Dermatol. 1996; 132: 436-443. https://goo.gl/B9fNFB
7. Liffrig JR. Phototrauma prevention. Wilderness Environ Med. 2001; 12: 195-200. https://goo.gl/HPU3zs
8. Hamant ES, Adams BB. Sunscreen use among collegiate athletes. J Am Acad Dermatol. 2005. 53: 237-241. https://goo.gl/XsDkaA
9. Ellis RM, Mohr MR, Indika SH, Salkey KS. Sunscreen use in student athletes: a survey study. J Am Acad Dermatol. 2012; 67: 159-160. https://goo.gl/3TQvW4
10. Andersen PA, Buller DB, Walkosz BJ, Scott MD, Maloy JA, Cutter GR, et al. Environmental cues to UV radiation and personal sun protection in outdoor winter recreation. Arch Dermatol. 2010; 146: 1241-1247. https://goo.gl/uuiuKY
11. Ou-Yang H, Jiang LI, Meyer K, Wang SQ, Farberg AS, Rigel DS. Sun Protection by Beach Umbrella vs Sunscreen with a High Sun Protection Factor: A Randomized Clinical Trial. JAMA Dermatol. 2017; 153: 304-308. https://goo.gl/BH8EAQ
12. Battie C, Gohara M, Verschoore M, Roberts W. Skin cancer in skin of color: an update on current facts, trends, and misconceptions. J Drugs Dermatol. 2013; 12: 194-198. https://goo.gl/fKNd8r
13. Byrd-Miles K, Toombs EL, Peck GL. Skin cancer in individuals of African, Asian, Latin-American, and American-Indian descent: differences in incidence, clinical presentation, and survival compared to Caucasians. J Drugs Dermatol. 2007; 6: 10-16. https://goo.gl/D6SVz1
14. Cormier JN, Xing Y, Ding M, Lee JE, Mansfield PF, Gershenwald JE, et al. Ethnic differences among patients with cutaneous melanoma. Arch Intern Med. 2006; 166: 1907-1914. https://goo.gl/PXVs49
15. Scott MD, Buller DB, Walkosz BJ, Andersen PA, Cutter GR, Dignan MB. Go Sun Smart. Commun Educ. 2008; 57: 423. https://goo.gl/aiGzsy
16. Dubas LE, Adams BB. Sunscreen use and availability among female collegiate athletes. J Am Acad Dermatol. 2012; 67: 1-6. https://goo.gl/3vqrLM
17. Jinna S, Adams BB. Ultraviolet radiation and the athlete: risk, sun safety, and barriers to implementation of protective strategies. Sports Med. 2013; 43: 531-537. https://goo.gl/38czGQ