The ABCs of Sun Protection for Children

Maryellen Maguire-Eisen, MSN, RN, OCN; Karen Rothman, MD; Marie France Demierre, MD, FRCPC


Dermatology Nursing. 2005;17(6):419-433. 

In This Article


Skin cancers are malignancies that develop in the epidermis, dermis, or the adnexal structures of the skin most often due to overexposure to both natural and artificial sources of ultraviolet light. There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Anyone can get skin cancer but inherent risk factors are very important (Maguire-Eisen, 2003). Skin color, eye color, freckling tendency, nevi count, and family history increase one's risk of developing skin cancer. However, the individual's childhood sun-exposure history appears to significantly influence the risk of skin cancer (Kennedy, Bajdik, Willemze, & Gruijl, 2003; Rhodes, 1995; Silverberg, 2001; Tsao, Atkins, & Sober, 2004). Skin cancers are associated with both intense, sporadic sun exposure (sunburn) and with chronic sun exposure (tanning) (Koh, Geller, Miller, Grossbart, & Lew, 1996).

Overexposure to ultraviolet radiation is a growing health concern for children in our society due to environmental changes and cultural trends. The ozone layer acts as a planetary "sunscreen" reflecting and absorbing ultraviolet radiation. Ozone depletion has resulted in increasing levels of ultraviolet (UV) radiation reaching the Earth's surface. Between 1983 and 1993, there was a 6% drop in total ozone. It is estimated that for every 1% drop in ozone there is a 1% to 5% increase in skin cancer (Grant-Kels, 1993).

Sunburn incidence among American children is extremely high, ranging from 29% to 83% for the previous summer season and between 7% and 13% for the previous summer weekend (Geller et al., 2002; Robinson, Rigel, & Amonette, 2000). Repeated and severe sunburns affect 12% of adolescents with reports of five or more sunburns during one summer season (Davis, Cokkinides, Weinstock, O'Connell, & Wingo, 2002). Sun burn incidence is associated with increasing age, fair skin, time spent outdoors, sporadic sunscreen use, and inadequate protective clothing (Geller et al., 2002). These factors are important because one sunburn may double a child's risk for developing melanoma. Parental attitudes that a child looks "healthier with a tan" may be a contributing factor influencing sun damage and skin cancer risk (Robinson, Rigel, & Amonette, 1997).

Overexposure to ultraviolet radiation via indoor tanning is another growing concern. Artificial tanning is a billion dollar industry frequented by an increasing number of teenage girls (Lazovich & Forster, 2005). Tanning rates for teenage girls double between ages 14 to 15 and 15 to 16 (Geller et al., 2002). Indoor tanning is driven by social pressures, appearance motivation, physiologic effects on mood, and having a parent who tans (Feldman et al., 2004; Lazovich, et al., 2004; Stryker et al., 2004). Health risks associated with indoor tanning include severe skin or corneal burns, cataract formation, skin infections, photoaging, exacerbation of photosensitive disorders, and skin cancer. Basal cell carcinomas, squamous cell carcinomas, and cutaneous melanomas are the most serious health risks.