Understanding the Perceived Relationship between Sun Exposure and Melanoma in Atlantic Canada: A Consensual Qualitative Study Highlighting a “Sunscreen Paradox”

Abstract

Globally, cutaneous melanoma (CM) incidence is increasing, with sun exposure identified as a key modifiable risk factor. The Atlantic provinces of Canada display varied CM incidence rates: New Brunswick aligns with the national average, while Nova Scotia and Prince Edward Island exceed it, and Newfoundland and Labrador fall below this benchmark. We investigated the relationship between sun exposure and CM in these provinces. Twenty-two focus groups encompassing 95 Atlantic Canada residents were conducted and transcribed. A thematic analysis was conducted in MAXQDA using the social–ecological model as a framework. Residents of high-CM incidence provinces demonstrated greater sun exposure awareness, consulting UV indices, and using sunscreen and sun-protective clothing. However, they received greater UV exposure due to warmer climates and outdoor work and cultural activities. Conversely, those in low-incidence provinces used sunscreen and sun-protective clothing less often, engaged in occupations and hobbies affording less sun exposure, and lived in cooler climates. Our data supports a possible “sunscreen paradox”, whereby increased sunscreen use is correlated with augmented sun exposure, leading to a deceptive sense of security. Public health initiatives in Atlantic Canada promoting sun safety must address this paradox while integrating community-specific behaviors and norms in order to develop tailored campaigns.

Beyond the Tropics: Unraveling the Complex Relationship between Sun Exposure, Dietary Intake, and Vitamin D Deficiency in Coastal Malaysians

“…This has already been proven by multiple studies that found that individuals with a lower perceived UV sensitivity, as characterised by the Fitzpatrick skin types, were more likely to incorporate sunscreen usage when exposed to the sun [ 24 , 25 ]. This could be due to a false sense of security or a “sunscreen paradox” rooted in misconception about the amount of melanin in one’s skin and the subsequent protection it offers against UVA and UVB rays [ 26 , 27 , 28 , 29 ]. Furthermore, the Fitzpatrick classification for skin types has a poor correlation with UV sensitivity.…”

“…Apart from those with skin type 1, those with darker skin types were less likely to adopt safer behaviours in the sun. This could be due to a false sense of security that darker skin helps to protect against UVA and UVB rays and, thus, could hamper individuals from changing their behaviour [ 26 , 27 , 28 , 29 ]. However, this trend was reversed when looking at protective headwear use, with the tendency to adopt this behaviour decreasing with darker skin types.…”

“…Vitamin D levels were characterised into three major groups-insufficient (<20 ng/mL), deficient (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and normal (>30). Two bar graphs were constructed to display the number of respondents in these categories according to gender and skin tone.…”

Possible Explanations for Rising Melanoma Rates Despite Increased Sunscreen Use over the Past Several Decades

“…Thus, the duration of sun exposure, especially unprotected sun exposure, may be a confounding variable in these studies that have found sunscreen use to be associated with higher melanoma rates. Further, many of these studies included sunscreens with a sun protection factor (SPF) lower than 30; however, 30 is the minimum SPF recommended by the American Academy of Dermatology for daily use [42], so this SPF or higher should be used in studies. Even when sunscreen with an adequate SPF is used, it is also well established that sunscreen users typically apply just a fifth to a third of the amount of sunscreen required to achieve the maximum SPF potential [35].…”