A 16-year-old girl is brought to the physician for a routine well-child examination. She recently moved to a new high school in southern California and engages in outdoor sports throughout the year. The girl is on the varsity soccer team and participates in local surfing competitions. Her grandfather died of melanoma recently. The physical examination shows light blonde hair and a fair complexion. She has several freckles on the nose and malar area of the face but no concerning nevi on her body. The girl says that several of her friends use tanning beds prior to spending the weekend at the beach. Her parents request guidance in preventing malignant melanoma. Which of the following is the most appropriate response to the parents' concerns?

Question

A 16-year-old girl is brought to the physician for a routine well-child examination.  She recently moved to a new high school in southern California and engages in outdoor sports throughout the year.  The girl is on the varsity soccer team and participates in local surfing competitions.  Her grandfather died of melanoma recently.  The physical examination shows light blonde hair and a fair complexion.  She has several freckles on the nose and malar area of the face but no concerning nevi on her body.  The girl says that several of her friends use tanning beds prior to spending the weekend at the beach.  Her parents request guidance in preventing malignant melanoma.  Which of the following is the most appropriate response to the parents' concerns?

Quizplus · Accepted Answer

Explanation: 11ec2b69_be7b_6150_8f63_6baf1ec414c4_MD0005_00 Sunlight exposure is beneficial for mood, vitamin D synthesis, and modulating the circadian rhythm. However, excessive exposure to ultraviolet (UV) rays, especially during childhood and adolescence, is a significant risk factor for sunburn, skin cancer, and photoaging. All individuals benefit from photoprotection, especially those with fair complexion. Patients should be counseled to apply sunscreen liberally 15-30 minutes prior to sun exposure; sunscreen should be reapplied every 2 hours or after water exposure. Sun protection factor (SPF) 15 (Choice D) is recommended for regular daily use and is often contained in facial lotions and cosmetics. SPF >30 is recommended for outdoor work or recreation, as those participating in outdoor activities tend to have less consistent sunscreen application. (Choice A) Patients should be advised to avoid sun exposure between 10 AM-4 PM whenever possible. In addition, tightly-woven, dark-colored fabrics confer the greatest protection from UV rays. However, these measures are often impractical for individuals who participate in outdoor sports. (Choice B) Sunless tanning products (ie, self-tanners) contain dihydroxyacetone which temporarily darkens or "bronzes" the skin. These are generally safe but the color does not protect from UV rays. Patients should also be discouraged from tanning bed and suntan lotion/oil use as these products increase exposure to UV light. (Choice C) Sunscreen use reduces the incidence of all 3 types of cutaneous carcinomas (basal and squamous cell, and malignant melanoma). Educational objective: Excessive sun exposure is a significant risk factor for basal and squamous cell carcinoma and malignant melanoma. Daily liberal application of sunscreen is essential for protection, and a sun protection factor >30 should be used when engaging in outdoor work or recreation. Tightly-knit clothing and sun avoidance are also important preventive strategies, but these may be impractical when participating in outdoor sports. References: Reduced melanoma after regular sunscreen use: randomized trial follow-up. (http://www.ncbi.nlm.nih.gov/pubmed/21135266) The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/17131335) Ultraviolet radiation: a hazard to children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/21357345) Photoprotection. (http://www.ncbi.nlm.nih.gov/pubmed/17693182) Use of sunless tanning products among US adolescents aged 11 to 18 years. (http://www.ncbi.nlm.nih.gov/pubmed/20855697)

A 16-Year-Old Girl Is Brought to the Physician for a Routine