Even though people may be more careful in the sun after skin cancer, having had a malignancy still doesn't convince everybody to take basic precautions like wearing hats or sunscreen, a recent U.S. study suggests.
Researchers analyzed survey data from about 760 adults with a history of skin cancer and more than 34,000 people without prior malignancies.
With a skin cancer history, people were more than twice as likely to wear sunscreen and more than 50 percent more likely to wear hats and long sleeves than individuals who didn't have a history of these tumors, the study found.
But history of skin cancer wasn't tied to lower odds of sunburns, even after accounting for the fact that some people are more susceptible to sunburn than others, said lead study author Alexander Fischer of Johns Hopkins University School of Medicine in Baltimore.
"We were surprised to see that," Fischer said by email. "This population is already at high risk for developing a subsequent skin cancer."
One in five Americans will develop skin cancer in their lifetime, and one person in the U.S. dies from melanoma every hour, according to the American Academy of Dermatology.
To assess how a history of skin cancer influences behavior in the sun, Fischer and colleagues focused on what's known as non-melanoma skin cancers, the most common type. Most of these malignancies are basal cell carcinoma, which can damage deeper tissues like muscle and bone but generally doesn't spread to other parts of the body.
With a history of these tumors, 44 percent of people said they frequently sought out shade outdoors, compared with 27 percent of individuals who had no such history, researchers report in the Journal of the American Academy of Dermatology.
About 26 percent of people with a history of skin cancer wore wide-brimmed hats and roughly 21 percent donned long sleeves, compared with 11 percent and 8 percent, respectively, for people without any history of these tumors.
Even with history of skin cancer, though, only 54 percent of people used sunscreen. That's better than just 33 percent among people without a history of skin cancer, but still leaves a lot of people unprotected from sun damage.
"It's a wake up call," said Dr. Elizabeth Tanzi, director of Capital Laser and Skin Care and a researcher at George Washington University School of Medicine in Washington, D.C.
"For some people, there is a perception that the sun is healthy and that maybe the risk of skin cancer has been overblown," Tanzi, who wasn't involved in the study, said by email.
"But once it happens to a patient and they go through treatment for skin cancer, they are more likely to take precautions," Tanzi added.
Part of the problem may be that most sunburns aren't the result of people deliberately sitting out in the sun all day to get a tan, said Dr. David Leffell, chief of skin cancer and dermatologic surgery at Yale School of Medicine in New Haven, Connecticut.
"Most sunburns in patients who have had skin cancer are not the result of intentional sunning - as on the beach, etc. - but from moments of inattention, or unexpected such as on the playing field, walking outdoors, etc.," Leffell, who wasn't involved in the study, said by email.
When people do have bad habits, it can be really hard to break them even in the face of a cancer diagnosis, said Dr. Elizabeth Martin of Pure Dermatology and Aesthetics and the University of Alabama at Birmingham School of Medicine.
"It is critical for physicians to counsel skin cancer patients on the importance of proper sun protection," Martin, who wasn't involved in the study, said by email.
"Patients need to be reminded that this is one risk factor that absolutely can be controlled," Martin added.