Importance of Melanoma Education on Adolescents

Hannah Goldstein
River Hill High School
Amanda Macleod, PhD
Duke University Department of Dermatology
Mary Jane Sasser

Goldstein, 1
Without proper protection, sun exposure can transform from a simple aspect of everyday
life to having fatal repercussions. Every day adolescents spend an abundance of time outdoors,
through athletic or extracurricular activities and leisure time. The suns ultraviolet radiation has
been observed through recent studies to play a major role in skin cancer development. Teaching
todays youth on implementing preventative habits, these methods can become an aspect of
everyday life thus reducing the onset of UV-induced damage that can result in Melanoma
development. Furthermore, continual education on these preventative habits and on atmospheric
conditions resulting in increased UV radiation levels, improved knowledge base and progress can
be made to further minimize the effects of Melanoma. Through education on skin cancer and UV
radiation, the importance of skin protection methods, and ozone layer depletion, the occurrence
of Melanoma and other skin cancers can be significantly reduced in the long-term.
The ozone layer protects earths surface from harmful solar radiation. However,
human actions have led to a decrease in the ozone layer. Even though the ozone layer size
fluctuates depending on the month and time of year (during the past 35 years) the ozone layer
has been observed to be sustaining a constant thinning out. This in turn increased UV levels at
the earths surface.
Satellite imaging within the past 30-40 years has shown that the overall ozone layer has
been diminishing. Projects observing the Antarctic areas mapped the ozone layer to document the
changes over time. In 1985 spring values of ozone over the Antarctic were observed to have
declined by 40% between 1974- 1984 (J. B. Kerr and C. T. McElroy). This data would later
become known to be the discovery of the Ozone Hole, which served as a basis for future ozone
mapping projects and political decisions about human actions of the ozone depletion.

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Due to human actions in the late 1980s and early 1990s, more aerosols have entered
Earths atmosphere depleting the ozone layer. The existence of aerosols and other airborne
particles, such as chlorofluorocarbons and Freon, which inhibit ozone separation, was not known
until recent discovery. Chlorofluorocarbons deplete the ozone through processes by which
bromine, chlorine, and fluorine are all catalysts of breaking down ozone into its oxygen
molecules (Goldstein, Evan K. Personal Interview). The elements in these aerosols cause
reactions with the ozone which cause it to decompose back into oxygen molecules. With his
discovery, nations started to realize that they were essentially destroying the atmosphere through
the usage of these products. Therefore, during the year 1987, 43 nations agreed to substantially
decrease the amount of chlorofluorocarbons used by 50% before 2000 by signing the Montreal
Protocol. (Space-based Observations of the Earth) The Montreal Protocol was signed with the
hopes of saving the atmosphere by decreasing the usage of chlorofluorocarbons. Despite this
landmark decision, the effects of chlorofluorocarbons and other aerosols are still damaging the
ozone layer due to the fact that the ban on earths surface doesnt affect the aerosols that already
were released into the atmosphere. Furthermore, the Upper Atmosphere Research Satellite
measured the chlorine monoxide levels in the stratosphere in 1991 demonstrating the direct link
between the formation of chlorine monoxide during the winter in the Southern Hemisphere and
ozone depletion.
The ozone depletion within recent history has led to an increase in the amount of UV
radiation reaching Earths surface. During the 1980s, satellites measuring UV radiation levels
reaching earth's surface, discovered that at 300 nm, where there is a relatively large amount of
absorption due to ozone, the data shows increases in radiation of 35% per year for winter and
6.7% per year for summer (J. B. Kerr and C. T. McElroy). With 300 nm being included in the

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spectrum of light that is most damaging to human skin, there proved to be an increase in levels.
Decreased absorption of UV radiation by the ozone layer was observed; therefore, more UV
radiation was observed to be reaching earths surface.
Satellite imaging has discovered that ozone depletion within the past 30-40 years
has been directly influenced by human actions and the aerosols and particles that we expose to
the atmosphere. Despite efforts to decrease these exhausts, ozone depletion continues as a result
of harmful particles and aerosols that were already present in the atmosphere. Resulting from this
depletion, UV radiation from the sun has shown an observed increasing. With less ozone to
absorb the UV radiation, more radiation reaches earths surface and causes an increase in
damage.
Protecting the skin from any possible damage is most beneficial in preventing
Melanoma and other skin cancers. Various forms of skin protection are available and have been
proven to prevent further damage; however, todays adolescents and young adults do not practice
these safety measures, and when these practices are followed, proper protection may not be in
use.
The primary method of preventing skin damage is a physical blocker, such as glasses,
clothing, hats, and other accessories that should be worn to prevent the UV radiation from even
reaching the skins surface. However, observations have led to the discovery that these protective
measures are not being practiced. Primarily, clothing such as long sleeved shirts provide
coverage of skin that will therefore prevent UV exposure; however, a study in Florida involving
2,086 students found that only 15.0% wore long-sleeve shirts during times where UV exposure
was at a high. Furthermore, the study found that only 32.0% wore sunglasses before leaving their

Goldstein, 4
home for school (Hunter, Seft et al.). A majority of the students were not properly protecting
their eyes from UV exposure damage. In addition to clothes and glasses, hats provide protection
to the scalp and neck that would otherwise be subjected to daily UV exposure. However, in the
study, only 16.4% wore wide-brimmed hats when outside, but not in school (Hunter, Seft et al.).
In each of these cases, students were not properly covering their body, and therefore were
exposing their bodies to harmful radiation on a daily basis.
Following physical barriers to UV exposure, sunscreen and sun protection lotions, sprays,
and gels have been proven to prevent UV-induced damage. Despite this information, adolescents
do not wear sunscreen enough to prevent the damage. The 2006 Florida study found that a mere
32.8% of students reported wearing sunscreen, and a survey of elementary students from palm
Beach County, Florida found that only about 36% of non-Hispanic white students wore
sunscreen most of the time or at all times (Hunter, Seft et al., Julie S. Townsend, et al.) A
majority of the students in these studies not wearing sunscreen on a daily basis would result in
routine skin damage that could have otherwise been prevented if proper methods of protection
were in place.
Despite a majority of students not wearing sunscreen, those who do may not be actually
preventing possible damage. Recent studies have shown that some sunscreens may not provide
as much protection as prior beliefs, with only certain kinds of sunscreen being most effective. A
scientific study conducted by Stephen E. Ullrich found that ultraviolet A radiation is necessary
for the suppression of established immune reactions. UVA radiation has been proven to be a
catalyst of tumor suppressor genes being suppressed, and therefore increasing the risk of
cancerous lesion development. This confirmed the idea that a sunscreen that absorbs UVA
radiation provides complete immune protection. (Ullrich, Stephen E., Margaret L. Kripke, and

Goldstein, 5
Honnavara N) Whereas sunscreens that provided protection against UVB radiation, a type of
ultraviolet radiation with a different wavelength on the light spectrum, may not be as protective
as these products claim to be. Therefore, those who wear sunscreen must be aware of the
ingredients that actually protect skin from damage in order to buy sunscreens that contain these
ingredients.
Sun protection methods, both physical and chemical based, have been available to the
public for use. Yet, when it comes to adolescents practicing measures to protect their skin,
observations have found that adolescents do not take precautionary measures to protect their
skin. Even those who do wear sunscreen and wear covering clothes may not be properly
protecting their skin due to recent discoveries on how types of UV radiation effect skin cells
through varying ways. Educating youth on recent evidence of protective measures can increase
the amount of adolescents and young adults protecting their skin.
Educating adolescents on recent discoveries regarding UV-induced damage and
melanoma prevention practices will have a positive long-term influence on reducing the amount
of melanoma cases reported annually. Due to significant lack of protection adolescents
experience and the significant time they spend outdoors, adolescents are the most influential
audience to implement evidence-based lessons on melanoma and preventative measures that
should be taken.
During the formative years into adolescence, children and adolescents have shown to
spend the most time outdoors through sports or school activities, yet there is minimal education
on the dangers they face when outside. On average, young children are reported to spend an
average of 2.5- 3 hours outdoors daily (Dadlani, Chicky, and Seth J. Orlow). Without proper

Goldstein, 6
protective methods, the sun exposure during this time can prove to become fatal. Because of the
immense amount of time children spend outdoors; protective measures must be taken in order to
reduce the chances of gene damage due to exposure. Statistically, approximately 25-50 percent
of a persons lifetime exposure is said to occur before 18-21 years of age (Dadlani, Chicky, and
Seth J. Orlow). Therefore, targeting children and teens will be most effective in reducing
melanoma rates later on. Children and young adults are most influenced by UV induced skin
damage as a result from the excess amount of time spent outdoors. Into adulthood, the damage
that was sustained during adolescence can be influential in the chances of developing melanoma,
therefore educating todays youth will in turn reduce melanoma rates.
Primarily, youth education is essential because habits are formed during the developing
stages of childhood and adolescence. Therefore, sun protection habits learned from a young age
during these stages will increase the amount of people protecting their skin and in turn reduce
melanoma rates. A study conducted in 2006 of third through fifth grade students in Florida,
found that only approximately 36% of Caucasian students used sunscreen a majority of the time
or all of the time that they spent outdoors (Julie S. Townsend, et al.). Even in the states where sun
exposure is at a maximum, children are not practicing sun-safety measures. However, this rate
can be increased with youth based education. Education can be important to affecting
adolescence actions beginning in second or third grade. Studies have shown that children start
to differentiate between chance and controlled outcome and may begin to recognize their own
ability to affect their health by 8 years of age (Dadlani, Chicky, and Seth J. Orlow). Therefore,
educating children on the dangers of UV radiation will increase the likelihood of positive habits
forming. The proactive practices resulting in increased protection that can be implemented at a
young age will in turn reduce melanoma rates. Furthermore, the repetition of these practices from

Goldstein, 7
a young age increases the likelihood of these habits to carry forward as the child enters
adulthood. Preventative habits learned during a child's formative years are less resistant to
change than those acquired in adulthood (Dadlani, Chicky, and Seth J. Orlow). The habits
formed prior to adulthood are more likely to remain in ones daily routine due to less resistance.
Habitual practices being formed at a young age not only decrease childhood gene damage, but
also increase the chance of protective practices being continued into adulthood.
Education through evidence based methods has shown to be most effective, and therefore
this method should be utilized to teach students about melanoma and environmental factors
contributing to the number of cases annually. Evidence based methods are educational lessons
taught using scientific evidence collected to educate on a topic. A program conducted in New
Mexico from 2006- 2009 analyzed an evidence based sun-safety education plan that was
implemented in 69 classrooms containing about 3,600 students. The study found that there were
positive changes between a pretest and posttest of the students knowledge, beliefs, and behavior
towards sun-safety (Julie S. Townsend, et al.). The study showed the importance of educating
adolescents because of the observation that adolescents showed an increase in their sun-safety
knowledge and practices.
The formative years of adolescents is the most essential period of teaching evidencebased lessons due to the development of habits and the abundance of time this age group spends
outdoors. These factors further reinforce the necessity for children and young adults to be
educated with facts and data in order to reduce the occurrence of childhood UV-induced skin
damage.
To learn more about the knowledge base of adolescents, a survey was conducted at River
Hill High School that tested the knowledge of student athletes on ozone depletion, skin damage

Goldstein, 8
resulting from UV-radiation exposure, and the preventative measures that they practice. The
survey found that a majority of the 66 respondents knew that protecting their skin was important,
yet didnt actively practice sun-safety practices, had minimal knowledge on the specifics of
Ozone Depletion, and werent adequately protecting their skin. Primarily, when asked when sun
exposure should be avoided, 92% of the respondents said that between 10:00 a.m. - 4:00 p.m.
should be avoided, yet 62% responded saying the spent between one to three hours outside
during this time and 20% spent three to four hours outside during this time, and 12% spent four
to five hours outside during this time. A steep majority spent time outside during the exact time
they said sun-exposure should be avoided. Furthermore, the respondents showed that they didnt
consistently reapply sunscreen during practice/competitions with 88% saying that they reapply
less than 50% of the time, yet all the respondents said they either somewhat agreed or strongly
agreed that sunscreen would help protect them from getting Melanoma. Next, when it came to
Ozone depletion, about half of the respondents didnt know whether chlorofluorocarbons cased
ozone depletion showing that half of the respondents didnt know about one of the major causes
of ozone depletion. Then, the respondents were asked whether a reduced number of ozone
Particles in the atmosphere will increase the greenhouse warming effect, and about 55% of the
respondents said yes and 30% said they didnt know showing that the knowledge on the effects
of ozone depletion wasnt very strong. Finally, when the respondents were questioned about the
SPF they used, there was a wide range of responses with about 58% saying that they used SPF
less than 30, proving that they werent properly protect their skin. The survey showed that
despite knowing a general knowledge on UV-induced damage, the specific processes and various
factors that impact UV-exposure were generally unknown resulting in a lack of practicing proper
sun-protection methods.

Goldstein, 9
Education is the key to unlocking an improved future where Melanoma is no longer
killing thousands of people each year. Evidence based implementation of education about the
specific processes of UV-induced Melanoma and Ozone depletion, as well as how protective
measures, such as sunscreen, actually protect ones skin would be most beneficial. This is
because this information showed to be unknown to the majority of adolescents who participate in
outdoor sports and are exposed to sun-exposure regularly. By incorporating education on UVinduced melanoma into the everyday lives of todays youth, melanoma rates will decrease in the
long-term. Despite the fact that the effects of the implementation would be more long-term,
prevention now leads to saved lives later.

Goldstein, 10

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