Being out in the sun can be good for you - it provides both a good source of vitamin D and the opportunity to be physically active. However, prolonged exposure can significantly increase the risk of developing skin cancer. New NICE public health guidance published today encourages a balanced approach, helping to ensure that skin cancer prevention activities do not discourage outdoor physical activity, while encouraging people to use sensible skin protection.

The new guidance focuses on how the NHS and local authorities can help prevent skin cancer using public information, sun protection resources and by making changes to the natural and built environment.

There are two main types of skin cancer - non-melanoma and malignant melanoma. Non-melanoma is thought to account for around a third of all cancers detected in the UK, with an estimated 100,000[1] people affected. Malignant melanoma is the most serious and causes the majority of skin cancer deaths - around 2,500 per year¹. It is estimated that the NHS spends approximately £70 million on skin cancer each year[2]. The main cause of skin cancer is exposure to ultraviolet (UV) radiation from the sun and artificially from sunbeds and lamps.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: “There is nothing wrong with short periods of exposure to sunshine, and it may in fact be beneficial. But prolonged exposure and sunburn can have dangerous consequences - a third of all cancers detected in this country are from skin cancer, including non-malignant and malignant melanoma. The incidence of malignant melanoma in Great Britain has more than tripled since the 1970s and yet many people still underestimate the prevalence of skin cancer.

“Through this guidance we hope to raise awareness of the risks of UV exposure and help people to protect themselves and others. Simple actions can greatly reduce the risk of developing skin cancer - opting to stay in the shade, wearing protective clothing in the sun, avoiding too much sun during the middle of the day and using sunscreen can all have an effect.”

Recommendations include:

• Information provision: delivery:
  • Commissioners, organisers and planners of national, mass-media skin cancer prevention campaigns should continue to develop, deliver and sustain these campaigns to raise awareness of the risk of UV exposure and ways of protecting against it; try to integrate campaign messages within existing national health promotion programmes or services to keep costs as low as possible. For example, Sure Start.
• Protecting children, young people and outdoor workers:
  • Ensure policies aim to prevent children and young people from getting sunburnt by encouraging them to seek shade when possible. When it is not possible, they should be encouraged to wear hats and other clothing or sunscreen to protect themselves. Policies should also encourage parents to provide their children with sunscreen and guidelines should be provided on how to help children apply it (and how children can help each other to apply it).
  • Ensure policies encourage outdoor workers to wear clothing to avoid getting sunburnt (including a hat that shades the face and back of the neck, where possible). They should also be encouraged to stay in the shade when possible, especially during breaks and in the middle of the day (11am to 3pm). When it is not possible to stay in the shade or wear protective clothing, because of work requirements, they should be encouraged to wear a sunscreen with UVA and UVB (at least SPF 15) protection[3].
• Providing shade:
  • When designing and constructing new buildings, consider providing areas of shade created either artificially or naturally (for example, by trees).
  • When developing or redeveloping communal outdoor areas, check whether it is feasible to provide areas of shade. Shade could be created by constructing a specific structure or planting trees.
  • For all new developments, ensure there is adequate access to areas of shade for people with a disability.

Professor Catherine Law, Professor of Public Health and Epidemiology, UCL Institute of Child Health and Chair of NICE's Public Health Interventions Advisory Committee said: “This new public health guidance focuses on preventing skin cancer caused by overexposure to UV radiation. The guidance includes some simple and practical recommendations which can prevent over-exposure. These include creating shaded areas when constructing new or redeveloping existing buildings. It also recommends that schools should encourage children and young people to apply sun screen and seek shade during breaks outside; and employers should encourage staff working outside to wear clothing that protects them from the harmful effects of the sun, such as a broad-brimmed hat that covers the back of the neck.”

Sara Hiom, director of health information at Cancer Research UK, and guidance contributor said: “For most people, avoiding sunburn is one of the best ways to reduce their risk of developing skin cancer. Many of us like to make the most of the UK's rare sunny days and should be able to enjoy the sun safely. If we all make sure that our skin doesn't redden or burn in the sun, it could help to reduce the rocketing number of people who develop skin cancer every year. And that's the aim of Cancer Research UK's annual SunSmart campaign.”

The new guidance will be specifically aimed at local authority planners, public health practitioners, pharmacists, GPs, school nurses, practice nurses and skin cancer specialists. It may also be of interest those working in the wider public, private, voluntary and community sectors and to members of the public.

Ends

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Notes to Editors

About the guidance

1. The guidance is available on the NICE website (www.nice.org.uk/guidance/PH32) from 26 January, 2011.

Background information

2. Research by the British Association of Dermatologists revealed the vast majority of Britons believe that skin cancer accounted for less than 10% of all cancers in the UK, the actual figure is around 33%. The research also showed that nearly half the population cannot recognise the key signs of skin cancer, such as a mole which is getting larger or which has an irregular border or colour.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

Footnotes

[1] Cancer Research UK (2010a) Skin cancer statistics - key facts

[2] Morris S, Cox B, Bosanquet N (2005) Cost of skin cancer in England. London: Tanaka Business School

[3] Ultraviolet radiation is divided into UVA, UVB and UVC. "Broad spectrum" sun creams contain both UVA and UVB protection. UVC cannot get through the ozone layer so it isn't necessary for sun creams to protect against it.