Skin cancer is the most common malignant tumor worldwide. The World Health Organization estimates that, in 2022, approximately 1.2 million cases of nonmelanoma skin cancer and 330,000 cases of melanoma were diagnosed. In this context, the review “Photoprotection for Skin Cancer: What’s New,” recently published by Yolanda Gilaberte and colleagues, analyzes the most up-to-date scientific evidence on skin cancer prevention strategies. The authors review the role of broad-spectrum sunscreens, protection against UVA radiation and visible light, DNA-repairing enzymes, antioxidants, and oral photoprotection, as well as specific recommendations for vulnerable groups.

The authors argue that daily use of sunscreens reduces the incidence of actinic keratoses and squamous cell carcinoma in high-risk individuals. However, the evidence regarding their protective effect against basal cell carcinoma and melanoma is less consistent. Therefore, they consider broad-spectrum photoprotection — which shields against ultraviolet (UV) radiation (including UVA radiation) and visible light — to be important. Even so, the role of high-energy visible light still requires further study.

In addition to sunscreens, other preventive strategies are being investigated. As the authors note, certain DNA-repairing enzymes have been shown to reduce cellular damage and clinically improve actinic keratoses. Some antioxidants, such as Polypodium leucotomos extract, have also shown protective effects against sun damage. Nicotinamide, particularly when taken orally, has shown some preventive effect in people at higher risk for skin cancer.

Finally, the authors note that there are vulnerable groups — such as transplant recipients, people with xeroderma pigmentosum or albinism, and workers with high sun exposure — who require intensive and tailored photoprotection measures.

Sun Exposure and Organ Transplant Recipients

These patients are at high risk for skin cancer due to exposure to UV radiation and the need for chronic immunosuppression; however, they appear to have significant gaps in their knowledge of the skin cancer risks associated with UV radiation and preventive measures. This is confirmed by the study by Wiedenmayer and colleagues, which assessed knowledge and attitudes toward sun protection and skin cancer in 177 organ transplant recipients during routine follow-up at a specialized dermatology clinic in a German hospital, using the validated Skin Cancer and Sun Knowledge scale.

Although most patients understood the basic concepts of sun protection, deficits were observed in their understanding of the risks of tanning, the meaning of sun protection factor, and the signs and symptoms of skin cancer. Heart transplant recipients and those who had been receiving immunosuppressive therapy for more than 3 years had the lowest levels of knowledge. Male sex and ages less than 40 and more than 60 were also associated with lower levels of knowledge. The authors emphasized the need for educational strategies targeting this patient group, given their vulnerability to sun exposure.

Sun Protection in Patients With Xeroderma Pigmentosum

Another vulnerable group of patients consists of those with xeroderma pigmentosum. Poor adherence to sun protection measures in this group increases morbidity and shortens life expectancy due to the development of skin cancers. 

The XPAND (Xeroderma Pigmentosum: Adherence Intervention) clinical trial, led by researchers at King’s College London, London, England, showed that a personalized intervention based on behavior-change techniques improves adherence to sun protection and reduces exposure to UV radiation in adults with xeroderma pigmentosum.

Similarly, a pilot program conducted in Nepal showed that although educational interventions improve knowledge about sun protection, the practical application of these measures is insufficient. In this study, following educational interventions and home visits, an increase in the use of daily sun protection was observed, although barriers related to access to resources and adherence to comprehensive protection measures for the face and exposed extremities persisted.

According to another study, long-term experience in specialized centers has shown that intensive dermatologic follow-up using advanced technologies such as full-body mapping, digital dermoscopy, and confocal reflectance microscopy improves the early detection of melanoma in these patients and reduces the number of unnecessary surgical procedures. This approach increases the detection of lesions in early stages and reduces the morbidity associated with multiple excisions in a population with a high tumor burden.

These studies highlight that the management of xeroderma pigmentosum must combine strict photoprotection, personalized educational programs, and intensive dermatologic follow-up to reduce the burden of skin cancer.

Albinism and Skin Cancer Risk

In people with albinism, the reduction or absence of melanin increases susceptibility to UV radiation-induced damage and the risk for skin cancer. Evidence confirms that, although the prevalence of cancer may vary by region, these patients have a high burden of actinic damage and face difficulties with daily sun protection, particularly in settings where access to photoprotection measures is limited or adherence is suboptimal.

Furthermore, studies emphasize that photoprotection in this population requires individualized and multidisciplinary strategies, given that clinical manifestations are heterogeneous and dermatologic follow-up can be complex due to the presence of amelanotic lesions and difficulties in the early detection of skin tumors.

Similarly, pathophysiologic and clinical evidence highlights that photophobia and photosensitivity are common in these patients, which necessitates the use of specific optical protection measures, such as filters and customized adaptations, with the aim of improving quality of life and visual function in daily life.

Occupational Sun Exposure

A systematic review has shown that solar UV radiation is classified as a Group 1 carcinogen by the International Agency for Research on Cancer and that exposed workers face an increased risk for actinic keratosis, basal cell carcinoma, squamous cell carcinoma, and melanoma, associated with cumulative exposures that may exceed limits considered safe in the workplace.

Along these same lines, current evidence underscores that, despite the existence of preventive recommendations, adherence to sun protection measures remains inconsistent, which limits their effectiveness under real-world working conditions, particularly in sectors such as agriculture, construction, and fishing.

Organizations such as the National Institute for Occupational Safety and Health emphasized that working outdoors increases the risk for skin cancer and that preventive strategies are needed, including education, schedule adjustments, shaded areas, and the availability of adequate sun protection in the workplace.

Finally, a systematic review confirms that occupational exposure to UV radiation is a significant global risk and that the most common adverse effects include skin cancer, cataracts, and photoaging, reinforcing the need for structural preventive interventions in these populations.

Systemic Lupus Erythematosus

Although systemic lupus erythematosus is not a group specifically addressed in the review by Gilaberte and colleagues cited at the beginning, recent evidence reinforces the importance of strict sun protection in these patients due to the role of UV radiation as a trigger for disease activity. In these patients, sun exposure is associated not only with dermatologic manifestations but also with exacerbations of systemic inflammatory activity.

In this regard, the 2025 guidelines from the American College of Rheumatology for the treatment of systemic lupus erythematosus include photoprotection as a recommended measure within the comprehensive management of the disease, alongside hydroxychloroquine use, minimization of glucocorticoids, and early control of inflammatory activity. These recommendations reinforce the role of strict photoprotection — through broad-spectrum sunscreen, physical measures, and patient education — as a complementary strategy to reduce disease activity and prevent UV radiation-induced exacerbations.

This story was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.