Scarce Sun Protection in Iraq, Afghanistan Put Troops at Risk

by U.S. Medicine

December 4, 2015

NASHVILLE, TN — It wasn’t only the climate that increased the risk of skin cancer for military personnel serving in Iraq and Afghanistan. Lack of sun protection also was a contributing factor, according to a new study.

Results published recently in the Journal of Investigative Dermatology also pointed out that length of sun exposure day to day was a critical factor — making the lack of education about sun exposure and limited access to sunscreen even more dangerous.1

“The past decade of United States combat missions, including operations in Iraq and Afghanistan, have occurred at a more equatorial latitude than the mean center of the United States population, increasing the potential for ultraviolet irradiance and the development of skin cancer,” explained Jennifer Powers, MD, of Vanderbilt University in Nashville, TN.

For the study, researchers analyzed anonymous survey data from 212 veterans regarding sun exposure and protection during their last deployment. Only 13% of respondents said they routinely used sunscreen, while 87% reported their sunscreen use as “sporadic” or “sometimes.”

In addition, only 23% of the veterans indicated that they had been made very aware of the risks of skin cancer.

Yet, 77% of respondents reported spending four or more hours per day working in bright sun, and 63% had at least one sunburn during deployment.

Powers noted in a Vanderbilt University Medical Center press release that the study indicates a potential deficiency for access to sun protection that could translate to long-term health risks.

“Our study has identified factors that put veterans at risk for skin cancer, including melanoma, but we need to better understand the ‘why’ of sun protection in the field,” she said. “There is a suggestion that there are times when the lack of availability was associated with lack of use. Understanding how to provide practical and effective sun protection to servicemen and women in warm climates is the next step.”

1 Powers JG, Patel NA, Powers EM, Mayer JE, Stricklin GP, Geller AC. Skin Cancer Risk Factors and Preventative Behaviors among United States Military Veterans Deployed to Iraq and Afghanistan. J Invest Dermatol. 2015 Jun 25. doi: 10.1038/jid.2015.238. [Epub ahead of print] PubMed PMID: 26110376.

In-Person Examination Better for Detecting Skin Malignancies

MINNEAPOLIS — The VA’s national telehealth programs served more than 690,000 veterans during fiscal year 2014, 12% of the overall patient population, in more than 44 clinical specialties. That represented more than 2 million telehealth visits, with about 55% involving veterans living in rural areas with limited access to VA healthcare.

For all of the advantages of telehealth, it also can have limitations — as pointed out by a study published recently in the Journal of the American Academy of Dermatology.1

Noting that few studies have evaluated the detection of incidental skin cancers, researchers from the Minneapolis VAMC and the University of Minnesota sought to evaluate the rate of incidental cutaneous malignancies in routine dermatology consults.

To do that, they retrospectively reviewed charts of all dermatology consults at the Minneapolis VAMC for more than eight years. Inclusion criteria included an in-person clinic visit within 18 months of the initial consult date.

Of 28,405 consults sent during the study period, 17,174 met inclusion criteria. Overall, 13.1% of patients had one or more biopsied incidental lesions. Half of the biopsied incidental lesions were malignant, involving 1,187 patients.

Results indicate that the per-person detection rate for an incidental malignant lesion was 6.9%, with 87 incidental melanomas identified in 84 patients. The per-person detection rate for an incidental melanoma was 0.5%.

Study authors note that the most frequent locations for biopsied incidental malignancies were the head and neck, 5.9%, while incidental melanomas were most frequently located on the back, 33.3%.

“An in-person skin examination by a trained dermatologist is important for detection of skin malignancies,” the researchers wrote. “This may have implications for teledermatology.”

1 Kingsley-Loso JL, Grey KR, Hanson JL, Raju SI, Parks PR, Bershow AL, Warshaw EM. Incidental lesions found in veterans referred to dermatology: the value of a dermatologic examination. J Am Acad Dermatol. 2015 Apr;72(4):651-5.e1. doi:10.1016/j.jaad.2014.12.027. Epub 2015 Jan 23. PubMed PMID: 25619205.

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