Sunscreen and Skin Cancer Prevention: Photobiology, Clinical Evidence, and Emerging Controversies

Document Type

Article

Publication Date

6-4-2026

Publication Title

Arch Dermatol Res

Abstract

Ultraviolet radiation (UVR) is the principal environmental carcinogen associated with keratinocyte cancers and cutaneous melanoma, making sunscreen the primary public health strategy for skin cancer chemoprevention. In this review, we examine cutaneous photobiology, sunscreen mechanisms, and clinical evidence to evaluate the efficacy of photoprotection. We describe the wavelength-dependent action spectra governing erythema, melanogenesis, immunosuppression, and photocarcinogenesis, and explain how the UVA-rich solar spectrum drives meaningful biological injury through chronic suberythemal exposures. Because debate has intensified recently regarding the efficacy of sunscreens, we carefully review the clinical evidence supporting their use. Randomized controlled trials demonstrated significant reductions in actinic keratoses and squamous cell carcinoma with consistent sunscreen use, while data for melanoma prevention, though biologically plausible and directionally consistent, remain statistically limited. Observational studies supported these findings but were constrained by behavioral confounding. Finally, ten research gaps are identified, encompassing long-term durability of protection, underrepresentation of skin of color, ambiguity in basal cell carcinoma outcomes, pediatric data, molecular endpoints, vitamin D effects, and regulatory innovation. Addressing these gaps is essential to optimizing sunscreen as an equitable, evidence-based tool for global skin cancer prevention.

Volume

318

Issue

1

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