Introduction
Surfing and swimming are two popular recreational aquatic activities in
Australia, with an estimated 2.7 million
surfers1 and three
million swimmers
nationwide.2 These
activities are associated with intermittent exposure to ultraviolet
radiation (UVR), which is recognized as a causal mechanism in the
development of non-melanoma (NMSC) and melanoma skin cancer
(MSC).3 Intermittent
exposure to UVR has been well documented to lead to development of
actinic keratosis (AK) lesions, non-melanoma basal cell carcinoma (BCC),
squamous cell carcinoma (SCC) and melanoma skin cancer
(MSC).4 Australia is
recognized as having the highest incidence (per 100,000) of NMSC and MSC
in the world.5
Ultraviolet radiation in southeast Queensland is the second highest with
a UVR range 4-12 and a mean of 7.9. A UVR index of three or greater is
recognized as requiring sun protection strategies for the prevention of
skin cancer.6
Skin Cancer Australia reported approximately one-third of Australians
(30.8%) had skin cancer, making it the most common type of cancer in
Australia.7 Of skin
cancers, NMSC, particularly BCC was reported to have the highest
age-standardized rate (1,541 per 100,000) followed by SCC (1,035 per
100,000) and MSC (53.5 cases per
100,000).8,9Melanoma skin cancers were the costliest in Queensland with the highest
proportion of total paid Medicare services related to MSC
(~ 30%) compared to the proportion of Australian’s
living in Queensland.10
The prevalence of skin cancer in swimmers is poorly reported in the
literature, with only a single study conducted in the
Netherlands11 and none
to date conducted in Australia. The paucity of research in swimmers is
also mirrored when investigating skin cancer in Australian surfers.
Climstein et al., 12conducted an online survey of 1,348 Australian surfers and reported BCCs
as the most prevalent (6.8%, 9,124 per 100,000) followed by MSC (1.4%,
1,854 per 100,000) and SCCs (0.6%, 2,670 per 100,000). The MSC rate was
more than 34-fold that of the Australian general population (53.5 per
100,000).9 It should be
noted that this study used a retrospective design and relied on the
participant’s ability to self-report diagnosed skin cancers. Given the
limited evidence and the lack of objective testing methods we therefore,
sought to determine the point prevalence of NMSC and MSC in surfers and
outdoor swimmers in southeast Queensland and Northern New South Wales
through whole-body skin cancer examination. Confirmation of skin cancer
was attained via histopathology.