鼓励应用防晒措施来抵御紫外线辐射,包括应用覆盖中长波紫外线谱的防晒产品,防晒霜(例如二氧化钛,二氧化锌),利用衣物帽子进行物理防晒,以及避免日晒。[51]Farmer KC, Naylor MF. Sun exposure, sunscreens, and skin cancer prevention: a year-round concern. Ann Pharmacother. 1996 Jun;30(6):662-73.http://www.ncbi.nlm.nih.gov/pubmed/8792954?tool=bestpractice.com[52]Gordon LG, Scuffham PA, van der Pols JC, et al. Regular sunscreen use is a cost-effective approach to skin cancer prevention in subtropical settings. J Invest Dermatol. 2009 Dec;129(12):2766-71.https://www.jidonline.org/article/S0022-202X(15)34166-X/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/19536149?tool=bestpractice.com[53]Lin JS, Eder M, Weinmann S. Behavioral counseling to prevent skin cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Feb 1;154(3):190-201.http://www.ncbi.nlm.nih.gov/pubmed/21282699?tool=bestpractice.com 同样不提倡进行室内紫外线照射。
流行病学研究清晰地展示了儿童时期反复紫外线暴露与皮肤癌发病率升高之间的关系,特别是在白色皮肤的人群中。[43]Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol. 1994 May;30(5 Pt 1):774-8.http://www.ncbi.nlm.nih.gov/pubmed/8176018?tool=bestpractice.com 从理论上说,减少对紫外线辐射的暴露将减少由于紫外线诱导的DNA损伤而导致的癌变,进而降低鳞状细胞癌的发病率。 一些随机对照试验表明常规应用防晒霜的人群鳞状细胞癌发病率呈持续下降。[53]Lin JS, Eder M, Weinmann S. Behavioral counseling to prevent skin cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Feb 1;154(3):190-201.http://www.ncbi.nlm.nih.gov/pubmed/21282699?tool=bestpractice.com[54]Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinoma of the skin: a randomised controlled trial. Lancet. 1999 Aug 28;354(9180):723-9.http://www.ncbi.nlm.nih.gov/pubmed/10475183?tool=bestpractice.com[55]Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993 Oct 14;329(16):1147-51.https://www.nejm.org/doi/full/10.1056/NEJM199310143291602http://www.ncbi.nlm.nih.gov/pubmed/8377777?tool=bestpractice.com[56]Darlington S, Williams G, Neale R, et al. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses. Arch Dermatol. 2003 Apr;139(4):451-5.https://jamanetwork.com/journals/jamadermatology/fullarticle/479276http://www.ncbi.nlm.nih.gov/pubmed/12707092?tool=bestpractice.com鳞状细胞癌的发病率:中等质量证据表明日常应用防晒霜比随意应用或安慰剂对于减少鳞状细胞癌的发病率和新发日光性角化风险更有效果。[53]Lin JS, Eder M, Weinmann S. Behavioral counseling to prevent skin cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Feb 1;154(3):190-201.http://www.ncbi.nlm.nih.gov/pubmed/21282699?tool=bestpractice.com[54]Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinoma of the skin: a randomised controlled trial. Lancet. 1999 Aug 28;354(9180):723-9.http://www.ncbi.nlm.nih.gov/pubmed/10475183?tool=bestpractice.com[55]Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993 Oct 14;329(16):1147-51.https://www.nejm.org/doi/full/10.1056/NEJM199310143291602http://www.ncbi.nlm.nih.gov/pubmed/8377777?tool=bestpractice.com[56]Darlington S, Williams G, Neale R, et al. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses. Arch Dermatol. 2003 Apr;139(4):451-5.https://jamanetwork.com/journals/jamadermatology/fullarticle/479276http://www.ncbi.nlm.nih.gov/pubmed/12707092?tool=bestpractice.com受试者<200名的随机对照临床试验(RCT)、受试者>200名且方法学存在缺陷的随机对照临床试验(RCT)、方法学存在缺陷的系统评价或者高质量的观察性(队列)研究。
皮肤癌的治疗费用在白种人群中异常的高,然而他们可以通过加强防晒措施来降低。因此长期来说,积极加强日照强地区白种人的日常防晒对于政府和消费者都是一种成本效益较高的投资。[57]Hirst NG, Gordon LG, Scuffham PA, et al. Lifetime cost-effectiveness of skin cancer prevention through promotion of daily sunscreen use. Value Health. 2012 Mar-Apr;15(2):261-8.http://www.ncbi.nlm.nih.gov/pubmed/22433757?tool=bestpractice.com
新的证据表明,在存在多发日光性角化的患者当中,塞来考昔可能是一种降低非黑色素瘤皮肤癌发病率的有效的化学预防剂。[58]Elmets CA, Viner JL, Pentland AP, et al. Chemoprevention of nonmelanoma skin cancer with celecoxib: a randomized, double-blind, placebo-controlled trial. J Natl Cancer Inst. 2010 Dec 15;102(24):1835-44.https://academic.oup.com/jnci/article/102/24/1835/916557http://www.ncbi.nlm.nih.gov/pubmed/21115882?tool=bestpractice.com 尽管全身性类维生素A和防晒霜是两种预防鳞状细胞癌行之有效的干预措施,但某个研究表明大剂量的外用维A酸对于降低鳞状细胞癌的发病风险无明显效果。[59]Weinstock MA, Bingham SF, Digiovanna JJ, et al; Veterans Affairs Topical Tretinoin Chemoprevention Trial Group. Tretinoin and the prevention of keratinocyte carcinoma (Basal and squamous cell carcinoma of the skin): a veterans affairs randomized chemoprevention trial. J Invest Dermatol. 2012 Jun;132(6):1583-90.http://www.ncbi.nlm.nih.gov/pubmed/22318383?tool=bestpractice.com