From Knowledge to Action: Skin Cancer Prevention for Service Members

Introduction

Members of the military experience greater morbidity and have a higher likelihood of experiencing skin cancer, and melanoma in particular, compared to the general US population due to prolonged sun exposure during deployments, special­ized training, and everyday outdoor duties.^1-3 Despite these findings, there is a lack of knowledge about differences in UV exposure across military occupations, operational roles, and locations served.⁴ In addition, the military does not track and analyze the UV exposure of its personnel, which poses a challenge and negatively impacts the ability to develop and implement strategies such as prevention programs, surveillance programs, early-detection pro­grams, and educational initiatives.⁴ This article highlights gaps in knowledge and potential educational and prevention initiatives, along with implementation challenges and limitations, from a recent publication entitled “Bridging the Knowledge-Action Gap in Skin Cancer Prevention Among US Military Personnel.”⁴

Recommendations for Skin Cancer Preventive Measures for Military Leadership to Implement⁴

Education

Because military leadership and service people often lack knowledge and understanding about UV exposure, the consequences, and how to protect themselves from developing cancer, education is a key strategy. The authors suggest increasing signage and/or visual reminders in training areas, bases, and deployment zones, as well as using health fairs and command orientations to emphasize sun protection and basic skin cancer prevention in geographic locations with high UV exposure. These educational efforts should focus on proper use of sunscreen and ways to integrate sun protection into daily routines without negatively affecting operational efficiency.

Primary Prevention Measures

Primary prevention measures include those that are individually focused, such as using sunscreen and clothing, and group focused, such as incorporating shade structures and knowledge of the UV index into activities, to protect from UV exposure.

Practical challenges currently hinder widespread use of sunscreen due to accessibility and the need for consistent reapplication. Recommendations include updating basic medical supply requirements to include sunscreen purchasing and allowing service members easy access to sunscreen. Implementing free sunscreen dispensers and including sunscreen in standard-issue gear are other potential ways to help increase use. In terms of using clothing as protection, recommendations are to modify uniforms to include broad-brimmed hats and sun protective clothing, and to keep sleeves rolled down.

During extended outdoor activities, the use of shade structures is recommended for protection. Lastly, the authors recommend that leadership should take into account UV index measurements when planning operational activities, and when the index is high, they should consider modifying training schedules and making sun protection mandatory. These recommendations are in line with restrictions put in place for physical training when the heat index is high.

“Education is a key strategy, focusing on proper sunscreen use and integrating sun protection into daily routines without affecting operational efficiency.”

Policy Changes to Support Sun Protection Measures⁴

Annual Risk Factor Screening

The goal of secondary prevention efforts is to prevent disease progression or recurrence and improve outcomes through early detection and treatment initiation. Military dermatologists play an important role in these efforts; however, the diversity of military occupational specialties and associated occupational risks, as well as the limited availability of active-duty dermatologists, pose challenges. Screening measures to assess sun exposure history, family cancer history, and other personal risk factors are significantly needed. One suggestion is to incorporate questions to assess sun exposure and risks in the ePHA, an online screening tool to assess overall health that is used annually by military service members. Data collected in this way could be used to determine individual risk factors and the need to refer to specialists, as well as provide population data to address knowledge gaps and to support the need for widespread preventive strategies.

Development of Military-Specific Screening Guidelines

Development of a standardized skin cancer screening algorithm or risk assessment tool by military dermatologists that would be used on a command level is one recommendation. This tool would provide primary care providers with useful information to evaluate those at higher risk for skin cancer without adding to the burden of the limited number of military dermatologists. The goals would be early detection of skin cancer and streamlining the referral process.

Importantly, the United States Preventive Services Task Force does not universally recommend routine skin cancer screenings for asymptomatic adults. However, military ser­vice members are exposed to higher occupational risks than the general population, so there is reason to believe that screening for this population would be beneficial. In addition, there are no standardized screening guidelines. For these reasons, developing basic standardized screening guidelines that adjust for military-specific UV exposure and occupational risks is important to improve early detection and to optimize treatment outcomes.

“Developing military-specific screening guidelines would enable early detection of skin cancer and streamline referrals, even with limited access to dermatologists.”

Challenges Related to Implementation of Educational and Prevention Measures⁴

While emphasizing skin cancer awareness, prevention, early diagnosis, and treatment in the US military is important, a variety of challenges and limitations need to be considered if large-scale initiatives are to be successful. One consideration is determining an appropriate level of resources that should be allocated. Addressing potential cultural and operational barriers to making widespread changes is another consideration. The impact of adding skin cancer risk questions in the ePHA that is already quite extensive, which could lead­ to reduced compliance, rushed responses, and/or survey fatigue, also needs to be taken into consideration. In addition, balancing raising awareness of skin cancer risk with ensuring that there are adequate healthcare resources, such as access to dermatologists and other specialists is required. It is also important to note that getting buy-in from current service members to protect their skin may be challenging because the threat is not imminent—skin cancer often develops years after exposure. Even with these challenges and limitations, it is important to continue efforts to identify and address knowledge gaps and to focus on educational and prevention efforts during and after military service.

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REFERENCES

1. Betancourt JA, Granados PS, Pacheco GJ, et al. Exploring health outcomes for US veterans compared to non-veterans from 2003 to 2019. Healthcare (Basel). 2021;9(5):604. 

2. Rezaei SJ, Kim J, Onyeka S, et al. Skin Cancer and Other Dermatologic Conditions Among US Veterans. JAMA Dermatol. 2024;160(10):1107-1111.

3. Riemenschneider K, Liu J, Powers JG. Skin cancer in the military: A systematic review of melanoma and nonmelanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel. J Am Acad Dermatol. 2018;78(6):1185-1192.

4. Anderson SR, Zhang SX, Crotty AM, Logemann NF. Bridging the Knowledge-Action Gap in Skin Cancer Prevention Among US Military Personnel. Cutis. 2025;115(5):146-149.