RICHARD F. WAGNER, JR.* DOUGLAS J. HEINER*, DONALD B. WARREN, TATSUO UCHIDA
UTMB-Galveston, Dept. of Dermatology 301 University Blvd Galveston,, TX 77555-0783, USA
*Corresponding authors

Abstract

The damaging effects of ultraviolet radiation (UVR) on the skin and the importance of using photo protective sunscreen and other sun-protective measures for the prevention of UVR skin injury is well recognized. However, it is currently unknown if UVR is recognized by men as a modifiable risk factor for scalp cancer and if photo protection for the skin and the scalp are used to the same extent in a setting of high UVR exposure. To evaluate UVR scalp protection and knowledge about the role of UVR as a risk factor for scalp cancer in men, an anonymous questionnaire was given to a convenience sample of male beachgoers on Galveston Island, Texas.
Of the 248 survey responses, subjects with mild hair loss were more likely and subjects with advanced hair loss were even more likely to use sunscreen on their scalp than those who did not have hair loss (21 and 38 percent, respectively, vs. 7 percent, p<0.0001). Those whose scalp was visible when looking in the mirror were more likely to use a hat than those subjects whose scalp was not visible in the mirror (43 vs. 25 percent, p=0.0035). Survey respondents demonstrated greater knowledge about UVR damage to the skin than UVR scalp damage (p<0.0001). The later finding supports the view that additional public education focused on UVR scalp protection is needed.

INTRODUCTION
Ultraviolet radiation (UVR) exposure is well-recognized as a risk factor for developing skin cancer, and media campaigns in recent years have emphasized the importance of protecting the skin from UVR damage. Despite this effort, research has shown that certain body areas, such as the lips, are less likely to benefit from UVR protective behaviour (1). Although UVR is a major risk factor for scalp cancer (Figure 1), public protective behaviour and awareness about the risks of scalp cancer remain less studied, especially in men who have experienced hair loss. A cross-sectional survey was designed to compare the awareness and protective behaviours of male beachgoers.
Scalp cancer can be a devastating disease. Cancers of the scalp may behave aggressively, can metastasize, and may eventually lead to death. Although Mohs surgery achieves high cure rates, similar to eyelid cancer (2), treatment can be costly and time-consuming, and may result in cosmetic deformity. The American Cancer Society reports that there are well over a million cases of skin cancer each year and approximately 2 percent occur on the scalp (3-7). A strong relationship ...