Strengths and limitations
To the best of our knowledge this was the first study in Australia
assessing the prevalence of skin cancer in surfers and swimmers via
total body skin checks conducted by a clinician. Further strengths
include that screening was conducted by a specialist as opposed to
recall via a survey. Additionally, the confirmation of all (100%)
histopathology samples by commercial laboratory analysis.
Our participants had a high degree of homogeneity as they were from a
limited geographic locale; however, this restrictive inclusion criteria
limited the ability to extrapolate our findings to other surfers and
swimmers within Australia or elsewhere. However, intermittent exposure
to UVR is well documented in the literature as a casual mechanism for
the development of NMSC and MSC and we believe our findings have wide,
geographic relevance.
It has however, been reported that Fitzpatrick skin type is a
confounding variable for the development of NSMC and
MSC31. Although
Fitzpatrick skin type was assessed by a clinician, we cannot determine
the effect Fitzpatrick skin type had on the development of NMSC and MSC
in our participants, rather recognize that skin type is recognized as
contributory to the development of skin cancer. Additionally, we did not
note ethnicity, which may account for the skew in our skin types of
participants in our study.
A limitation of the present study was that the sample size was
relatively small however, when compared to the very limited number of
skin cancer screening studies that incorporated clinician screening, we
did however, exceed the participant numbers in previously published
similar studies. We also recognize that we did not account for
confounding factors such as occupational and other UVR exposure (i.e.,
other outdoor activities) which would have contributed to the point
prevalence’s reported. Also, with regard to our Fitzpatrick skin typing,
we did not inquire into ethnicities, which may account for the skew in
skin types. This study was self-selected, as it was not possible to
attain a complete list of surfers in the area, we were therefore not
able to utilize random sampling and as such selection bias may have
occurred. Additionally, as the total number of surfers and swimmers in
the region is unknown, we cannot assess nor calculate a response rate
and therefore determine the representativeness of our participants to
their respective aquatic groups. We believe there is no confounding bias
as we did not investigate casual relationships.