Originally published by our sister publication Specialty Pharmacy Continuum

By Karen Blum
Counseling survivors of melanoma on sun protection and skin health is an important role for pharmacists, said Lisa Holle, PharmD, BCOP, FHOPA, FISOPP, a clinical professor of pharmacy practice at the University of Connecticut School of Pharmacy, in Storrs.

“This cannot be emphasized enough,” Dr. Holle said. “There’s good evidence that … [regular] use of sunscreen can decrease the development of subsequent melanomas, because once you’ve had a melanoma, you’re at risk for developing secondary melanomas.”

Family members of people who have had melanoma often also are at risk, especially if they have lighter-colored skin, hair or eyes, she said.

“Pharmacists are often involved in educating patients about their treatment, so this gives a good opportunity to also educate about sun safety,” Dr. Holle said. They also can speak with patients about these points during follow-up exams after active treatment is finished.

Here are some important points to cover:

• Try to avoid the peak hours of sunlight, typically between 10 a.m. and 2 p.m.
• If you have to be in the sun during the peak period, use a broad-spectrum sunscreen with an SPF of 30 or higher that covers both ultraviolet A and B (UVA and UVB) light. Sunscreen should be reapplied every two hours and after any swimming or significant sweating. “There’s no such thing as a waterproof or sweatproof sunscreen,” Dr. Holle said. “They all have to be reapplied, and the amount has to be 1 ounce, which I often describe as a full shot glass.” Don’t forget areas like the ears, feet, lips, neck and head if a person has thinning hair.
• Apply sunscreen 15 minutes before being in the sun to allow time for absorption by the skin. Rub in thoroughly. If someone is using a spray, cover every part of the exposed skin until it glistens, and then rub it in. Avoid using sprays on windy days, when it could blow away or get inhaled, and do not use them near open flames because they are flammable, she added. Do not use expired sunscreen, as it may no longer be effective.
• Sunglasses also are important because a person can get melanoma of the eye. Make sure to wear sunglasses that protect against UVA and UVB light.

It’s also very important for patients who have had a history of melanoma, and their family members, to perform regular checks of their skin. Check all parts of the body, Dr. Holle advised, including both sides of the arms, the palms of the hands, in between fingers and toes, in fingernails and toenails, in the buttocks and genital areas, and the scalp. Employ a hand mirror to help view spots like the back that may be challenging to see otherwise, or enlist a friend or family member to help. If they notice anything new like a bump, discoloration, a bleeding spot or crusty patch that doesn’t resolve in a few weeks, they should see their provider or dermatologist.

People who have had melanoma also should do a lymph node exam, she said, touching underneath their arms or chin, above the collarbone, and the groin. If they notice any lumps, they should contact their healthcare provider right away.

A common misconception is that the sun is worse in the summer months, Dr. Holle said. But a person doing winter activities in the snow or ice also can burn. The American Academy of Dermatology and American Cancer Society have good information for patients, some in Spanish, about sun protection.

Pharmacist Counseling

At the University of Colorado Cancer Center, in Aurora, clinical pharmacy specialist Christina Davis, PharmD, BCOP, counsels people with melanoma when they are starting medications. “We go over everything—what the drugs are, how they work, how to take them, expected side effects and how to manage them,” Dr. Davis said. Some medications for melanoma, such as the combination of B-Raf proto-oncogene (BRAF) and mitogen-activated protein kinase kinase (MEK) inhibitors, can be photosensitizing, she said, so it’s important to let patients know to keep their skin covered completely and wear hats with a brim because they are at increased risk for sunburn.

 

Almost every patient asks about what diet to follow or supplements to take, Dr. Davis added. One study demonstrated that eating a high-fiber diet could improve melanoma patients’ responses to immunotherapy (Science 2021;374[6575]:1632-1640), so she recommends patients follow a well-balanced, healthy diet and look for ways to increase fiber.

Drs. Davis and Holle reported no relevant financial disclosures.