UV imaging reveals facial areas that are prone to skin cancer are disproportionately missed during sunscreen application

Abstract

Application of sunscreen is a widely used mechanism for protecting skin from the harmful effects of UV light. However, protection can only be achieved through effective application, and areas that are routinely missed are likely at increased risk of UV damage. Here we sought to determine if specific areas of the face are missed during routine sunscreen application, and whether provision of public health information is sufficient to improve coverage. To investigate this, 57 participants were imaged with a UV sensitive camera before and after sunscreen application: first visit; minimal pre-instruction, second visit; provided with a public health information statement. Images were scored using a custom automated image analysis process designed to identify areas of high UV reflectance, i.e. missed during sunscreen application, and analysed for 5% significance. Analyses revealed eyelid and periorbital regions to be disproportionately missed during routine sunscreen application (median 14% missed in eyelid region vs 7% in rest of face, p<0.01). Provision of health information caused a significant improvement in coverage to eyelid areas in general however, the medial canthal area was still frequently missed. These data reveal that a public health announcement-type intervention could be effective at improving coverage of high risk areas of the face, however high risk areas are likely to remain unprotected therefore other mechanisms of sun protection should be widely promoted such as UV blocking sunglasses.

UV reflectance photography of skin: what are you imaging?

“…Film‐based UV reflectance photography of skin has been reported before, primarily aimed at pigmentation assessment given the strong absorption of UV by melanin . UV reflectance imaging has also been adopted for both artistic visualization of skin pigmentation and sun damage by photographers such as Cara Phillips and for visualization of sunscreen application onto skin to show consumers areas that they have missed when applying product .…”

Pharmacodynamic Modeling of Sunscreens: Efficacy Evaluation, Melanoma Incidences and Very Low to Very High Sun Protection Factor

“…Regardless of sunscreen strength or sunscreen brand, the most serious problem is probably the missing application, especially in the back of the trunk, on the legs, around the ears and on the eyelid area [18,19,25,[35][36][37]. It is very likely that sunburn would occur on these missed areas when exposed to intense burning sunlight [19,20,25,26,[35][36][37]; the sunburn is a known major risk factor for melanoma incidence. This is consistent with observations that melanoma occurred most often in the back of trunk in men where it is usually covered with clothes except during sunbathing [35].…”

The real protection of facial sunscreens

“…Both ultraviolet (UV)B and UVA radiation induce DNA damage, leading the formation of molecules, such as pyrimidine dimers and 6–4 photoproducts, which play a key role in the development of skin cancer . Despite the increasing awareness of the harmful effects of the sun and use of sun protection, 70–90% of basal cell carcinomas develop in the sun‐exposed head and neck region, and 5–10% of all skin cancers occur on the eyelids …”