Go to AAD Home
Donate For Public and Patients Store Search

Go to AAD Home

Largest study of skin cancer prevention in American Indians and Alaskan natives shows UV protection lacking

Use of tanning beds and inadequate sun protection increases skin cancer risk

ROSEMONT, Ill. (August 16, 2022) — Ultraviolet (UV) protection from the sun and avoiding indoor tanning play an important role in reducing a person’s risk for skin cancer — the most common cancer in the U.S. and one of the most preventable cancers. A new article published in the Journal of the American Academy of Dermatology reveals that UV protective behaviors are lacking in American Indians/Alaskan Natives, highlighting the importance of educating this population about the need to protect themselves from harmful UV rays.

“We conducted this study to learn about the skin cancer risk of the 9 million American Indians/Alaskan Natives living in the United States so we could identify their sun protection habits and determine how to decrease their risk of skin cancer,” said board-certified dermatologist and co-author of the study Vinod E. Nambudiri, MD, MBA, FAAD, Brigham and Women’s Hospital in Boston. “We found that American Indians/Alaskan Natives needed to better protect themselves from UV rays to reduce their risk of skin cancer.”

The analysis involved more than 360,500 participants and compared data from American Indian/Alaskan Natives to other racial and ethnic groups on skin cancer screenings, risk factors, and prevention behaviors from the National Health Interview Survey from 2005, 2008, 2010, 2013, and 2015.

The research found that American Indians/Alaskan Natives less frequently use sun protective behaviors, including wearing hats on a sunny day and seeking shade when outdoors compared to other racial and ethnic groups. American Indians/Alaskan Natives also reported less frequent sunscreen use compared to Non-Hispanic Whites and Asians, but more frequent use than African Americans.

In addition to less frequent use of sun protection, American Indians/Alaskan Natives also reported using indoor tanning devices more frequently than other minority groups. Indoor tanning can increase users’ risk of developing squamous cell skin cancer by 58% and basal cell skin cancer by 24%1.

In addition to avoiding tanning beds, the American Academy of Dermatology and Dr. Nambudiri recommend that people take the following steps to protect themselves from damaging UV rays when outside:

  • Seek shade. Seek shade when appropriate, remembering that the sun’s rays are the strongest between 10 a.m. and 2 p.m. You can also look at your shadow. Anytime your shadow appears shorter than you, seek shade.

  • Wear sun-protective clothing. Wear a lightweight and long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses with UV protection, when possible. For more effective protection, select clothing with an ultraviolet protection factor (UPF) number on the label.

  • Apply sunscreen. Apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to all skin not covered by clothing. Remember to reapply every two hours or after swimming or sweating.

“When you look at the lack of sun protection and use of tanning beds, it’s not surprising to see that American Indians/Alaskan Natives are reporting more severe sun damage to their skin, such as sunburns, when spending over an hour in the sun as compared to Non-White respondents” said Dr. Nambudiri. “While some people may be most concerned about the freckles, age spots and wrinkles that develop on their skin from UV exposure, it’s the increasing risk of skin cancer, including melanoma, the deadliest form of skin cancer, which is the most alarming.”

American Indians/Alaskan Natives were also reported to have a significantly higher rates of melanoma compared to other minority groups. When American Indian/Alaskan Native patients develop melanoma, they experience lower-5-year survival rates compared to non-Hispanic whites. In addition, fewer American Indians/Alaskan Natives reported ever receiving full-body skin exams by a dermatologist than non-Hispanic whites. While it is estimated that one in five Americans will be diagnosed with skin cancer in their lifetime, when caught early, skin cancer is highly treatable.

“Our results suggest American Indians/Alaskan Natives need to increase their use of sun protection and avoid using tanning beds to decrease their risk of skin cancer, including melanoma,” said Dr. Nambudiri. “In addition, performing a skin self-exam is a critical part of identifying melanoma early when it’s most treatable.”

The American Academy of Dermatology urges everyone to examine their skin regularly and follow the ABCDE rule, which outlines the warning signs of melanoma:

  • A stands for ASYMMETRY. One-half of the spot is unlike the other half.

  • B stands for BORDER. The spot has an irregular, scalloped, or poorly defined border.

  • C stands for COLOR. The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red, or blue.

  • D stands for DIAMETER. While melanomas are usually greater than 6 mm, or about the size of a pencil eraser, when diagnosed, they can be smaller.

  • E stands for EVOLVING. The spot looks different from the rest or is changing in size, shape, or color.

“While skin cancer can be deadly, you can reduce your risk by protecting yourself from UV rays and performing skin self-exams to identify the sign of skin cancer early when it’s most treatable.” said Dr. Nambudiri. “If you notice a spot that is different from others, or that changes, itches or bleeds, or if you have questions about how to reduce your risk of skin cancer, make an appointment to see a board-certified dermatologist.”

To find a board-certified dermatologist in your area, visit aad.org/findaderm.

# # #


Angela Panateri, apanateri@aad.org

Rhys Saunders, rsaunders@aad.org

Media Relations, mediarelations@aad.org

More information:

About the AAD

Headquartered in Rosemont, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 20,000 physicians worldwide, the AAD is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the AAD at (888) 462-DERM (3376) or aad.org. Follow the AAD on Facebook (American Academy of Dermatology), Twitter (@AADskin), Instagram (@AADskin1), or YouTube (AcademyofDermatology).

About JAAD

The Journal of the American Academy of Dermatology is the most widely read dermatology journal in the world, according to Kantar Media. JAAD was the first most-cited dermatology journal in 2021, according to impact factor rankings from Clarivate’s Journal Citation Reports (JCR) Web of Science Group. JAAD also has two open-access companion titles: JAAD Case Reports and JAAD International. Follow @JAADJournals on Facebook, Twitter, and Instagram.

Editor’s note: The AAD does not promote or endorse any products or services. This content is intended as editorial content and should not be embedded with any paid, sponsored or advertorial content as it could be perceived as an AAD endorsement.

1. An S, Kim K, Moon S, et al. Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis. Cancers (Basel). 2021;13(23):5940. Published 2021 Nov 25. doi:10.3390/cancers13235940