1 Recommendations

This guideline replaces recommendations 1–5 in skin cancer prevention NICE guideline PH32 (2011).

The guideline should be read together with NICE's guideline on vitamin D: increasing supplement use among at-risk groups and any recommendations made by the Scientific Advisory Committee on Nutrition (SACN) on vitamin D.

At‑risk groups

1.1.1 All public health activities related to over‑ or underexposure to sunlight should focus on:

  • Groups of people who should take extra care to avoid skin damage and skin cancer, including:

    • children (particularly babies) and young people

    • people who tend to burn rather than tan

    • people with lighter skin, fair or red hair, blue or green eyes, or who have lots of freckles

    • people with many moles

    • people who are immunosuppressed (that is, they have less resistance to skin problems as a result of a disease or use of particular drugs)

    • people with a personal or family history of skin cancer (even if their natural skin colour is darker than that of the family member who had cancer).

  • Groups who spend a lot of time in the sun and so are at increased risk of skin cancer, such as:

    • outdoor workers

    • those with outdoor hobbies, for example, sailing or golf.

  • Groups with high, but intermittent, exposure to sunlight and who are therefore at increased risk of skin cancer. This includes people who sunbathe or take holidays in sunny countries.

  • Groups who have little or no exposure to the sun for cultural reasons or because they are housebound or otherwise confined indoors for long periods. For example, people who are frail or in institutions, or people who work indoors all day. These people are at increased risk of low vitamin D status (for more information see NICE's guideline on vitamin D: increasing supplement use among at-risk groups).

Message content

The following recommendations are for health and social care practitioners.

1.1.2 Whenever the opportunity arises make people aware that, although sunlight exposure is a normal part of everyday life and some sunlight is good for health, there are risks from excessive exposure.

1.1.3 Communicate consistent, balanced messages about the risks and benefits of sunlight exposure and the groups at risk (for the latter, see recommendation 1.1.1). Include:

1.1.4 Follow the principles of behaviour change when conveying sunlight exposure messages (see NICE's guideline on behaviour change: general approaches). This includes ensuring that messages:

  • specify the recommended actions

  • explain the benefits of changing behaviour

  • try to enhance people's belief in their ability to adopt the recommended actions.

1.1.5 Use existing community health promotion programmes or services to raise awareness of the risks and benefits of sunlight exposure.

1.1.6 Offer one‑to‑one or group‑based advice, as appropriate, tailored to the type of risks the person or group faces.

1.1.7 Encourage and support people at increased risk of low vitamin D status or skin cancer to contribute to awareness‑raising activities.

Mass media campaigns

The following recommendations are for commissioners of public health campaigns.

1.1.8 Develop, deliver and sustain national and local media campaigns to raise awareness of the risks and benefits of sunlight exposure.

1.1.9 Campaign messages should:

  • Aim to make people aware of the need to think about their daily exposure to sunlight.

  • Target at‑risk groups (see recommendation 1.1.1) and be consistent (see section 2).

  • Address common misconceptions about keeping safe in the sun and the risks and benefits of sunlight exposure.

  • Present a balanced picture of the risks and benefits, explaining how to enjoy the sun safely.

  • Emphasise how the risks and benefits will vary depending on the individual.

  • Relate to leisure activities and holidays as well as daily life.

1.1.10 Campaigns should:

  • Use different channels to communicate simple and more complex messages. For example, population‑wide messages may focus on sun protection and enjoying the sun safely. More nuanced messages, such as the risk of over‑ or underexposure for subgroups and individuals, could be included in supporting resources such as leaflets, press statements and websites.

  • Be delivered in a way that meets the target audience's preferences. For example, via radio, social media, texts, posters or leaflets.

  • Be displayed at prominent locations. For example, airports, schools, pharmacies, travel vaccination clinics, leisure and sporting events, and on travel websites and in magazines.

  • Be repeated over time and regularly altered to keep the audience's attention.

  • Be timed for maximum effect. For example, so they take place during spring and summer when the risk of sunburn is highest in the UK, or when people are more likely to travel abroad.

1.1.11 Ensure that the format and content of national campaigns are developed and piloted with the target audience. If feasible, do the same for local activities and supporting resources.

1.1.12 Ensure that campaigns tackle health inequalities by taking into account cultural, religious and social norms about sunlight exposure. Outline what different groups should do to minimise their risks and maximise their benefits and how this may vary on an individual basis. Messages should also be conveyed in languages spoken locally.

1.1.13 Integrate and coordinate campaign messages with existing national and local health promotion programmes or services to keep costs as low as possible. (Examples of initiatives they could be integrated with include Sure Start, Change4Life and community pharmacy public health services.)

Local strategic approach

The following recommendations are for commissioners and senior managers in local authorities.

1.1.14 Adopt a consistent, multiagency approach. Focus on making at‑risk groups aware of the risks and benefits of sunlight exposure (see recommendation 1.1.1).

1.1.15 Work with the NHS, council leaders, elected members, public health teams, local businesses and voluntary and community organisations to:

  • address local needs, as identified by the joint strategic needs assessment and other local, regional or national data

  • identify local opportunities to increase public awareness about the risks and benefits of sunlight exposure

  • ensure the content of all messages is consistent (see section 2)

  • target health, social care and other practitioners in contact with at‑risk groups (see recommendation 1.1.1)

  • carry out culturally appropriate activities (for example, to develop messages that local at‑risk groups can relate to)

  • ensure that messages related to skin type are relevant for the target audience.

1.1.16 Work with local and national media to present a balanced view of the health risks and benefits of sunlight exposure.

1.1.17 Establish clear, measurable objectives for prevention and awareness‑raising activities.

1.1.18 Work with practitioners in specific settings such as residential care, schools and workplaces to implement prevention and awareness‑raising activities (see section 4).

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