Skin cancer incidence has been continuously increasing during the past decades and skin cancer is currently the most common malignancy in Caucasians. However, the morbidity of skin cancer and the health burden associated have been underestimated on different levels (politicians, health care officials and general population) and diverse treatment algorithms have been followed in different countries around Europe. The diagnosis and management of skin cancer in Europe has been in the hand of dermatologists. However, according to the high incidence and limited availability of dermatologists, general practitioners will have to be involved in the care of skin cancer patients, especially those with non melanoma skin cancer. Non melanoma skin cancer includes basal cell carcinoma, actinic keratoses and squamous cell carcinoma. Non melanoma skin cancer shows a much higher incidence than melanoma and a significantly lower mortality. However these tumours usually occur multiple in sun exposed areas and repetitive surgical procedures are causing morbidity for the patients and high costs for the health care system. Recently, novel treatment modalities have been introduced that are able to treat non melanoma skin cancer non invasively in an early stage of the disease and furthermore prevention strategies have been shown to be effective.
The European Skin Cancer Foundation as well as Epiderm (an EU-Project) aim to develop and provide standardized prevention strategies and treatment guidelines on a European level, contributing thus to better primary and secondary prevention of these malignancies as well as to dissemination of best treatment practices through training and exchange of knowledge.
It is anticipated that synergy between partners with complementary skills on skin cancer will induce a significant multiplier effect, enabling the accumulation, evaluation and dissemination of knowledge in the field of Public Health.
Nevertheless the rising incidence of skin cancer and the clear association to sunburn demonstrate an urgent call for action. Since day-care centres supervise children during the hours of the most intense and potentially most harmful UV, the knowledge and attitudes of staff members greatly affect the children's prospective sun exposure.
A second aspect is the fact, that the earlier a habit is established in an individual, the more likely it is to maintain that habit in adulthood. Therefore, day-care centres are excellent places to implement a feasible program of primary skin cancer prevention. Despite these facts there exist an astonishing low number of interventional studies for primary prevention of skin cancer in child day-care centres in Europe. These statistics give evidence for a clear UV-overexposure of children in Europe. In Australia, the country with the highest skin cancer incidence of the world, there exist national-wide successful sun-protection campaigns such as the multimedia SunSmart campaign, which was launched late in 1988 and which was directed especially at children and adolescents regarding their behaviour in the sun. Later on, Australian day-care centres received the possibility to become ‘SunSmart’ by applying a standardised sun protection policy. In Germany, to our knowledge, there are no such national-wide organised programs which institutionalize sun-protection practices in child day-care centres.