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.