Skin Cancer Knowledge, Sun Exposure, Photoprotection Behavior, and Perceived Barriers Associated with Skin Cancer Types in a Greek Cohort: A Cross-Sectional Study on the Island of Crete

doi:10.3390/cancers16244226

. 2024 Dec 18;16(24):4226.

doi: 10.3390/cancers16244226.

Skin Cancer Knowledge, Sun Exposure, Photoprotection Behavior, and Perceived Barriers Associated with Skin Cancer Types in a Greek Cohort: A Cross-Sectional Study on the Island of Crete

Dimitra Koumaki¹, Georgios Evangelou¹, Stamatios Gregoriou², Stamatoula Kouloumvakou³, Andreas Manios⁴, Alexander Katoulis⁵, Georgios Vasileiou Zacharopoulos⁴, Pavel Viktorovich Chernyshov⁶, Marios Papadakis⁷, Dimitrios Kassotakis⁴, Georgios A Manios⁸, Evangelia Rovithi¹, Kyriaki Zografaki¹, Aikaterini Doxastaki¹, Ioanna Gkiaouraki¹, Danae Petrou¹, Faidra Marazaki¹, Dimitrios Mylonakis¹, Eelco de Bree⁹, Konstantinos Krasagakis¹

Affiliations

¹ Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece.
² 1st Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Medical School of Athens, I. Dragoumi 5, 16121 Athens, Greece.
³ 2nd Department of Internal Medicine, Sismanoglio General Hospital, Sismanogliou 37, 15126 Marousi, Greece.
⁴ Plastic Surgery Unit, Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece.
⁵ 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Rimini 1, 12462 Haidari, Greece.
⁶ Department of Dermatology and Venereology, National Medical University, 01601 Kyiv, Ukraine.
⁷ Department of Surgery, Helios Clinic, University Hospital Witten-Herdecke, Heusnerstr 40, 42283 Wuppertal, Germany.
⁸ Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece.
⁹ Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece.

PMID: 39766125
PMCID: PMC11726760
DOI: 10.3390/cancers16244226

Skin Cancer Knowledge, Sun Exposure, Photoprotection Behavior, and Perceived Barriers Associated with Skin Cancer Types in a Greek Cohort: A Cross-Sectional Study on the Island of Crete

Dimitra Koumaki et al. Cancers (Basel). 2024.

. 2024 Dec 18;16(24):4226.

doi: 10.3390/cancers16244226.

Authors

Affiliations

¹ Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece.
² 1st Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Medical School of Athens, I. Dragoumi 5, 16121 Athens, Greece.
³ 2nd Department of Internal Medicine, Sismanoglio General Hospital, Sismanogliou 37, 15126 Marousi, Greece.
⁴ Plastic Surgery Unit, Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece.
⁵ 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Rimini 1, 12462 Haidari, Greece.
⁶ Department of Dermatology and Venereology, National Medical University, 01601 Kyiv, Ukraine.
⁷ Department of Surgery, Helios Clinic, University Hospital Witten-Herdecke, Heusnerstr 40, 42283 Wuppertal, Germany.
⁸ Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece.
⁹ Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece.

PMID: 39766125
PMCID: PMC11726760
DOI: 10.3390/cancers16244226

Abstract

Background: This study aimed to explore the relationship between different types of skin cancer and factors such as sun exposure and photoprotection measures in a Greek cohort on the island of Crete.

Methods: This cross-sectional observational study was conducted in the Dermatology Department of the University Hospital in Heraklion, Crete, between January 2019 and January 2024. The study population included consecutive patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM), as well as healthy controls. The participants completed a self-reported questionnaire covering demographic and clinical data as well as questions about sun exposure and photoprotection habits.

Results: A total of 265 skin cancer patients and 106 healthy controls participated in the study: 50.6% of the patients had basal cell carcinoma, 35.1% had squamous cell carcinoma, and 14.3% had malignant melanoma. The cohort comprised 41.5% females and 58.5% males, with a mean age of 73.2 years. As expected, the patients with skin cancer had a lighter skin phototype compared to the healthy controls (p < 0.01). They also reported greater occupational (p < 0.01) and leisure sun exposure (p < 0.01) and a higher median number of vacation weeks spent outdoors before the age of 18 (p = 0.030). Furthermore, the healthy controls were more likely to use sunscreen (p = 0.035) and preferred higher SPF (>50) when they did so (p < 0.01). The healthy controls also reported more frequent use of sunglasses (p < 0.01), brimmed hats (p < 0.01), and long-sleeved clothing (p < 0.01) compared to the skin cancer patients.

Conclusion: This is the first study to analyze sun exposure and photoprotection behaviors in patients with nonmelanoma skin cancer (NMSC) and malignant melanoma (MM) in Crete, revealing the key associations and underscoring the need for targeted prevention strategies.

Keywords: basal cell carcinoma; malignant melanoma; photoprotection; skin cancer; squamous cell carcinoma; sunscreen.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

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1. Olsen C.M., Pandeya N., Ragaini B.S., Neale R.E., Whiteman D.C. International patterns and trends in the incidence of melanoma and cutaneous squamous cell carcinoma, 1989–2020. Br. J. Dermatol. 2024;190:492–500. doi: 10.1093/bjd/ljad425. - DOI - PubMed
1. Leiter U., Keim U., Garbe C. Epidemiology of Skin Cancer: Update 2019. Adv. Exp. Med. Biol. 2020;1268:123–139. doi: 10.1007/978-3-030-46227-7_6. - DOI - PubMed
1. Rogers H.W., Weinstock M.A., Harris A.R., Hinckley M.R., Feldman S.R., Fleischer A.B., Coldiron B.M. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch. Dermatol. 2010;146:283–287. doi: 10.1001/archdermatol.2010.19. - DOI - PubMed
1. Goldenberg G., Karagiannis T., Palmer J.B., Lotya J., O’Neill C., Kisa R., Herrera V., Siegel D.M. Incidence and prevalence of basal cell carcinoma (BCC) and locally advanced BCC (LABCC) in a large commercially insured population in the United States: A retrospective cohort study. J. Am. Acad. Dermatol. 2016;75:957–966.e2. doi: 10.1016/j.jaad.2016.06.020. - DOI - PubMed

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[1] Aggarwal P., Knabel P., Fleischer A.B., Jr. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J. Am. Acad. Dermatol. 2021;85:388–395. doi: 10.1016/j.jaad.2021.03.109. - DOI - PubMed

[2] Aggarwal P., Knabel P., Fleischer A.B., Jr. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J. Am. Acad. Dermatol. 2021;85:388–395. doi: 10.1016/j.jaad.2021.03.109. - DOI - PubMed

[3] Olsen C.M., Pandeya N., Ragaini B.S., Neale R.E., Whiteman D.C. International patterns and trends in the incidence of melanoma and cutaneous squamous cell carcinoma, 1989–2020. Br. J. Dermatol. 2024;190:492–500. doi: 10.1093/bjd/ljad425. - DOI - PubMed

[4] Olsen C.M., Pandeya N., Ragaini B.S., Neale R.E., Whiteman D.C. International patterns and trends in the incidence of melanoma and cutaneous squamous cell carcinoma, 1989–2020. Br. J. Dermatol. 2024;190:492–500. doi: 10.1093/bjd/ljad425. - DOI - PubMed

[5] Leiter U., Keim U., Garbe C. Epidemiology of Skin Cancer: Update 2019. Adv. Exp. Med. Biol. 2020;1268:123–139. doi: 10.1007/978-3-030-46227-7_6. - DOI - PubMed

[6] Leiter U., Keim U., Garbe C. Epidemiology of Skin Cancer: Update 2019. Adv. Exp. Med. Biol. 2020;1268:123–139. doi: 10.1007/978-3-030-46227-7_6. - DOI - PubMed

[7] Rogers H.W., Weinstock M.A., Harris A.R., Hinckley M.R., Feldman S.R., Fleischer A.B., Coldiron B.M. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch. Dermatol. 2010;146:283–287. doi: 10.1001/archdermatol.2010.19. - DOI - PubMed

[8] Rogers H.W., Weinstock M.A., Harris A.R., Hinckley M.R., Feldman S.R., Fleischer A.B., Coldiron B.M. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch. Dermatol. 2010;146:283–287. doi: 10.1001/archdermatol.2010.19. - DOI - PubMed

[9] Goldenberg G., Karagiannis T., Palmer J.B., Lotya J., O’Neill C., Kisa R., Herrera V., Siegel D.M. Incidence and prevalence of basal cell carcinoma (BCC) and locally advanced BCC (LABCC) in a large commercially insured population in the United States: A retrospective cohort study. J. Am. Acad. Dermatol. 2016;75:957–966.e2. doi: 10.1016/j.jaad.2016.06.020. - DOI - PubMed

[10] Goldenberg G., Karagiannis T., Palmer J.B., Lotya J., O’Neill C., Kisa R., Herrera V., Siegel D.M. Incidence and prevalence of basal cell carcinoma (BCC) and locally advanced BCC (LABCC) in a large commercially insured population in the United States: A retrospective cohort study. J. Am. Acad. Dermatol. 2016;75:957–966.e2. doi: 10.1016/j.jaad.2016.06.020. - DOI - PubMed

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Skin Cancer Knowledge, Sun Exposure, Photoprotection Behavior, and Perceived Barriers Associated with Skin Cancer Types in a Greek Cohort: A Cross-Sectional Study on the Island of Crete

Affiliations

Skin Cancer Knowledge, Sun Exposure, Photoprotection Behavior, and Perceived Barriers Associated with Skin Cancer Types in a Greek Cohort: A Cross-Sectional Study on the Island of Crete

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Abstract

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