PROGRAMME

Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
Brigitte Boonen, President, Euroskin, Belgium

08:30-08:35 Introduction by Session Chair, David Whiteman, Acting Director and Senior Scientist, QIMR Berghofer Medical Research Institute, Melanoma and Skin Cancer Research Centre, Brisbane, Australia

08:35-09:00 Keynote Address: Skin cancer and climate change
Prof. Dr. Robyn Lucas, Emeritus Professor, Research School of Population Health, College of Health and Medicine, The Australian National University, Australia
Skin cancer is primarily caused by exposure to UV radiation that is inappropriately high for the individual’s skin type. ‘Exposure’ is determined by the level of UV radiation and the individual’s behaviour in relation to sun exposure and protection. Future changes in atmospheric composition and dynamics will affect recovery of stratospheric ozone, and thus also affect levels of UV radiation at Earth’s surface. Changing weather – particularly temperature and precipitation – will alter sun exposure behaviour. Thus, climate change will alter skin cancer risk –not uniformly across the globe, but determined by tropospheric and stratospheric composition and current temperature (and acclimatisation).

09:00-09:15 Speaker Presentation 1: Sunscreen use, indoor tanning and skin cancer
Prof. Dr. Marit.B. Veierød, Department of Biostatistics, University of Oslo, Norway
Recommendations to reduce skin cancer risk include protection from solar ultraviolet radiation (UVR) and avoidance of artificial UVR from indoor tanning. Sunscreen use is recommended for sun protection in addition to clothing and shade. Assessing the association between sunscreen use and skin cancer risk is challenging, and the main body of evidence comes from observational studies. This presentation will present recent results, and discuss important challenges when studying sunscreen use and risk of cutaneous squamous cell carcinoma (cSCC) and melanoma in observational studies. Indoor tanning is an avoidable risk factor and characterizing the risk of cSCC and melanoma associated with indoor tanning is important to set the stage for policies regulating indoor tanning.

09:15-09:30 Speaker Presentation 2: Trends in Fatal Cancers, the results of a European study on melanoma and future challenges for NMSC
Dr Stefano Rosso, Director, Piedmont Cancer Registry, Italy
The epidemic of skin melanoma in Europe was largely due to an increase in thin lesions. However, it is difficult to disentangle the effects of early diagnosis or misclassification from a true increase in risk. We proposed to analyse trends of fatal cases (at 1 and 3 years from diagnosis). Incidence and mortality data were collected from population-based European cancer registries. A significant fraction of fatal cases (24%) occurred in thin melanomas. After controlling for confounding factors, rates showed a slight decrease (-18% in years 2001-2006 and -21% in 2007-2012 compared to 1995-2000). There was no decrease in cases fatal at 3 years in the last period. The detected decrease in fatal cases at 1 year supports the hypothesis that a higher diagnostic pressure may show a beneficial effect on more aggressive melanoma. However, it seems still insufficient in the long run, not reducing overall mortality or late case-fatality rates. A similar methodological approach can be proposed for fatal NMSC.

09:30-09:45 Q&A & Recommendations
Live Q&A session with the presenters for Session I

David Whiteman (Chair), Acting Director and Senior Scientist, QIMR Berghofer Medical Research Institute, Melanoma and Skin Cancer Research Centre, Brisbane, Australia

10:00-10:10 Abstract Presentation 1 | Ultraviolet radiation exposure and melanoma: evidence for gene-environment interaction in a large prospective cohort
Presenter: Catherine Olsen, QIMR Berghofer Medical Research Institute, Australia
The relationship between sun exposure and melanoma is complex, and exposure effects are highly modified by host factors and behaviours.  The role of genotype on the relationship between UV radiation exposure and melanoma risk is poorly understood. We found that country of birth, age at migration, sunburns in childhood/adolescence, and history of keratinocyte cancer/actinic lesions were significantly associated with melanoma risk, while other measures of continuous or more intermittent patterns of sun exposure were not. We found suggestive evidence that people at low genetic risk require more sunlight than people at high genetic risk to develop melanoma.
Authors: Catherine Olsen, Nirmala Pandeya, Matthew Law, Stuart MacGregor, Mark Iles, Bridie Thompson, Adele Green, Rachel Neale and David Whiteman

10:10-10:20 Abstract Presentation 2 | Physical activity and melanoma risk: a population-based cohort study
Presenter: Flavie Perrier, University of Oslo, Norway
Physical activity (PA) is a cornerstone in cancer prevention. PA and risk of melanoma has been explored with inconsistent findings, which included generally a low information on ultraviolet radiation (UVR). UVR during outdoor PA is a plausible explanation for a positive association. We investigated the association between PA and risk of melanoma in the Norwegian Women and Cancer (NOWAC) cohort study with comprehensive data on UVR exposure. PA was self-reported for 145,708 women, using a validated global 10-scale and seasonal variables, at enrolment and during follow-up. Our findings do not support the hypothesis that physical activity increases melanoma risk.
Authors: Flavie Perrier, Simon Lergenmuller, Reza Ghiasvand, Corina S. Rueegg, Trude E. Robsahm, Adele C. Green, Torkjel M. Sandanger, Elisabete Weiderpass, Kristin B. Borch Borch and Marit B. Veierød

10:20-10:30 Abstract Presentation 3 | Optimizing childhood sun safety interventions: the identification of improvable and relevant socio-cognitive determinants of parental sun safety behaviour.
Presenter: Karlijn Thoonen, Maastricht University, The Netherlands
This study presents identification of relevant and changeable behaviour-specific socio-cognitive determinants of parental sun safety behaviours during various sun exposure situations in order to enhance and target parental sun protection interventions more specifically.
Authors: Karlijn Thoonen, Rik Crutzen, Francine Schneider, Hein de Vries, Bart De Wolf, Kim Kruijt and Liesbeth van Osch

10:30-10:55 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 1

Workshop 1 | Occupational Skin Cancer & UV Protection at the Workplace (Seminar)
Chairs: Prof Dr Swen Malte John, Head, Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University Osnabrück, Germany
Mark Wittlich, Head of Radiation Unit, Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University Osnabrück, Germany
Occupational activity is one of the most relevant factors influencing solar radiation (SR) exposure. Alone in Europe about 14.5 million outdoor workers (OW) are exposed to SR for at least 75 % of their working time. Primary prevention is thus essential to avoid longer-term costs and decrease the disease burden. In professions with increased sun exposure, specific measures of awareness, protection and systematic dermatological screening provide value for money in terms of a healthy work environment. Currently, 90 per cent of medical costs related to skin cancer are spent on treatment, while less than 10 per cent go to prevention. This session will present new evidence of the magnitude of the challenge for outdoor professions and look into various workplace prevention strategies in orderto appraise the importance of preventive action.
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Workshop 2 | Secondary Prevention of Skin Cancer: What can we learn from our experiences with skin cancer screening? Insights and international future developments
Chair: Prof Dr Eckhard Breitbart, Association of Dermatological Prevention (ADP), Germany
Skin cancer screening has been discussed controversy. Projects around the world have tested and evaluated skin cancer screening procedures. So far, Germany is the only country with a population-based skin cancer screening. The workshop will provide insights into previous experiences with screening and evidence using multiple perspectives and disciplines and aims to generate future developments and prospects.

Workshop 3 | Sunbeds - Basics and News (BaN)
Chairs: Prof Dr Philippe Autier, VP Population Research, International Prevention Research Institute (iPRI), University of Strathclyde, UK
Prof. Dr. Jean-François Doré, Emeritus Research Director, INSERM, France
The workshop will be animated by researchers who have made significant contributions to the field and will encompass recent basic biological aspects of UV-induced carcinogenesis as well as public health issues. The impact of prevention policies will be addressed. It will open with a review of melanomas attributable to sunbed exposure and a discussion of the prognosis of these melanomas. The amazing “natural experiment” of a melanoma epidemic in Iceland will be used to illustrate the links between sunbed use and melanoma incidence. Sunbed use in Europe, and the resulting ultraviolet exposure will be discussed. The burden of skin cancers attributable to sunbed use and the cost savings generated by a reduction of exposure to indoor tanning will be discussed. Finally, sunbeds regulations will be discussed. The important issue of vitamin D will not be missed.
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Workshop 4 | Social Marketing - CANCELLED

Workshop 5 | Sunscreens
Chair: Prof Dr Anthony Young, Professor Emeritus, United Kingdom
Speakers: Curtis Cole & Shaun Hughes | Sunscreen SPFs - Indoors or Outdoors?
Uli Osterwalder | How well should sunscreens protect against visible light?
Christian Surber | Nano is Big! Issues and challenges with nanoparticulate UV-filters
Yasmine Watkins | UV Filters as a potential threat to coral reef ecosystems: What are the big questions?
Karl Lawrence | Mycosporine-like amino acids - biocompatible sunscreens from nature?
Antony R Young | The effect of sunscreens on vitamin D synthesis
The health benefits of sunscreens are established. If used correctly, they can prevent DNA photodamage and sunburn, and there are data that show that regular sunscreen use can inhibit skin cancer and photoageing. However, there is evidence that laboratory testing may overestimate sun protection factor (SPF) and increasing concern that sunscreens may have adverse effects on health such as systemic toxicity and inhibition of vitamin D synthesis. There has been much recent media coverage on sunscreen ecotoxicity and the search for natural alternatives. This workshop will explore some of these concerns and their possible solutions.
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Workshop 6 | Basics of Prevention - New Insights in Skin Cancer Etiology
Chair: Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
Speakers: Prof. M. Esteller, Josep Carreras Leukemia Research Institute (IJC), Barcelona, Spain | Epigenetics in Skin Cancer and Aging
We are more and more getting deeper insight into the etiology of skin cancers. However, we’re still far away from understanding details, which could help us to use them for (may be) better recommendations and info in primary and secondary prevention of skin cancer. In my talk, I’ll give a short summary about new and up-coming scientific evidence and modern methods to study etiology of skin cancer in more detail.
This will include the use of NGS, epigenetic (bio-) markers, single cell analysis and others. The talk is mainly thought to start an intensive discussion in our workshop.

Workshop 7 | UV index – measurement, modelling, communication
Chair: Dr Cornelia Baldermann, Scientific Senior Councilor, Federal Office for Radiation Protection, Germany
Dr Sebastian Lorenz, Scientific Expert, Federal Office for Radiation Protection, Germany
The Global Solar UV Index (UVI) is a simple measure of the erythema weighted UV irradiance at the Earth’s surface and an indicator of the potential sunburn risk. In this workshop, an overview of different measurement methods and the state of the art of UV index modelling will be introduced and discussed. Subsequently, a combined measurement and modelling method to improve the accuracy of area-wide messages about the current UV exposure will be presented, and it’s transferability to a worldwide application will be discussed. UV index publication and modern communication methods will be the third main subject of this workshop.
The goal of the workshop is to collect knowledge about methodical and communication methods, to identify scientific gaps, and to formulate recommendations for improving UV monitoring, UV index modelling and UV index communication as part of effective skin cancer prevention.
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Workshop 8 | Childhood sun safety: From problem to solution (Seminar)
Chair: Karlijn Thoonen, University of Maastricht, The Netherlands
UVR-exposure and sunburns during childhood are important risk factors for developing skin cancer in later life and should therefore be limited. This seminar will provide insight in various topics concerning UVR-exposure and sun protection of children and adolescents. Recent scientific findings regarding UVR dosimetry measurements, individual and environmental behavioural determinants, intervention implementation and cost-effectiveness of those interventions will be presented and discussed. Moreover, different settings in which children are exposed to UVR, and where intervention programs can therefore be of great relevance, such as the family setting (UVR exposure and sun protection behaviours of parents and the child itself), the school setting (implementation and evaluation of sun safety programs) and the physical environment (effective environmental interventions), will be discussed.
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David Buller (Chair), Klein Buendel, United States

16:30-16:40 Abstract Presentation 4 | Smart Sunscreen Stations for the Workplace
Presenter: Dr Elke Hacker, Griffith University, Brisbane, Australia
Authors: Helen Ford, Caitlin Horsham, Jeremy Herbert, Alexander Wall and Elke Hacker
Skin cancer is the most prevalent but also most preventable cancer in Australia. Outdoor workers are at increased risk of developing skin cancer with improvements in sun protection needed. The primary aim of this study was to test an Internet of Things (IoT) approach by developing and deploying a smart sunscreen station to a regional outdoor workplace. During the deployment key technological considerations including connectivity, security, and data management systems were examined. This study highlights an IoT technology approach can successfully measure sunscreen usage and temperature storage conditions.

16:40- 16:50 Abstract Presentation 5 | Photoprotection by Workwear: Ultraviolet Protection Factors for Artificial Radiation from Welding Arcs
Presenter: Dr Stefan Bauer, Federal Institute for Occupational Safety and Health (BAuA), Germany
Photoprotection by clothing is one of the most effective protective measures against solar ultraviolet radiation (UVR), and the concept of UV protection factors (UPF) for fabrics has proven itself for decades. Although immense work has been carried out regarding factors influencing textile sun protection, the idea of UPFs for artificial UVR at workplaces is payed little attention. Hence, a modified UPF equation is proposed for workwear utilizing welding arcs and ICNIRP's weighting function for UVR hazards.
Authors: Dr Stefan Bauer

16:50- 17:00 Abstract Presentation 6 | Integrating sun safety in a workplace’s OHS Management System
Presenter: Thomas Tenkate, Ryerson University, Canada
In a workplace setting, it is common for hazard-specific prevention programs to be implemented separately from their Occupational Health and safety Management System (OHSMS). However this leads to the programs being unsustainable, overlooked and ineffective. In this presentation we will describe the development and trial of a sun safety program that was designed to be embedded within an organization's OHSMS. The approach taken was found to be effective and may be considered a model for other hazard-specific programs.
Authors: Thomas Tenkate and Peter Strahlendorf

17:00-17:10 Abstract Presentation 7 | “The same but oh so different:” Occupational Skin Cancer Prevention for Departments of Transportation and Tattoo Studios
Presenter: Mary Buller, President & AOR, Klein Buendel, Inc., United States
Occupational skin cancer prevention education is an essential tool that can reduce skin cancer risk for large segments of the population, including outdoor workers and young adults. An interactive, online training program on skin cancer prevention was developed for two distinct workplaces, Departments of Transportation and tattoo studios. The programs employed a basic script using similar messages, production techniques, and prevention frameworks but took into account the unique nature of the workplace environment and population. Program resources can be leveraged for occupational skin cancer prevention programs to effectively reach more than one occupational type.
Authors: Mary Buller, Barbara Walkosz and David Buller

17:10-17:20 Abstract Presentation 8 | Solar ultraviolet radiation exposure among outdoor workers in Alberta, Canada
Presenter: Cheryl Peters, University of Calgary, Canada
Outdoor workers are at risk of significant solar UVR exposure. Little is known about workers’ exposures in Canada. Our objectives were to characterize outdoor workers’ exposures to UVR in Alberta, Canada, and investigate the determinants of exposure.
Authors: Cheryl Peters, Elizabeth Rydz, Andrew Harper, Brandon Leong, Victoria Arrandale, Sunil Kalia, Thomas Tenkate, Lindsay Forsman-Phillips and Linn Holness

17:20-17:30 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 2: Occupational Skin Cancer and Protection at the Workplace

Peter Dalum (Chair), Executive Project Manager, Danish Cancer League, Denmark

16:30-16:40 Abstract Presentation 9 | Social media for health promotion and skin cancer prevention
Presenter: Prof Monika Janda, University of Queensland, Australia
This study analysed Twitter posts in Australia over the summer of 2016/17 and the summer of 2018/19 to establish a baseline of skin cancer and sun-related communication trends and sentiments. The results showed that Australians use Twitter to communicate about their sun-related and skin cancer experiences, however, not so often to communicate about skin cancer prevention campaigns. It also showed a large presence of controversial and potentially misleading information on Twitter. Findings highlighted the need to share evidence-based and truthful information and expand the use of social media for public health research and skin cancer prevention.
Authors: Monika Janda, Carina Vasconcelos Silva and Dilke Jayasinghe

16:40- 16:50 Abstract Presentation 10 | Using mobile teldermoscopy for the early detection of skin cancer by patients in the home
Presenter: Prof Monika Janda, University of Queensland, Australia
Mobile teledermoscopy-enhanced skin self-examinations (SSEs) may be useful for the early detection of lesions suspicious for skin cancers. This Australian randomized controlled trial aimed to assess the results of patient-selected mobile teledermoscopy-enhanced SSE compared to naked-eye SSE. Sensitivity, specificity, diagnostic concordance, satisfaction with use and partner engagement were assessed. Overall, 199 participants completed the study (98 intervention; 101 control group). Adding mobile teledermoscopy did not improve sensitivity for skin cancer compared to naked-eye SSE. Participants were largely satisfied with the technology, required the assistance of a partner and most participants were motivated to conduct SSEs more regularly.
Authors: Monika Janda, Caitlin Horsham, Dimitrios Vagenas, Lois J Loescher, Nicole Gillespie and Peter Soyer

16:50-17:00 Abstract Presentation 11 | 12-month Outcomes of a Social Media Campaign to Prevent Indoor Tanning: A Randomized Trial
Presenter: David Buller, Klein Buendel, United States
A social media campaign was tested on reducing mothers’ permissiveness regarding daughter’s IT, mother’s IT, and mothers’ support for bans on IT by minors. Mothers (n=869) of teenage daughters aged 14-17 in 34 U.S. states were enrolled in a randomized comparing a 12-month Facebook feed with posts aimed at preventing IT (intervention) or prescription drug misuse (control). In a posttest at the end of the Facebook feed, mothers in intervention group were less permissive toward daughters’ IT, had less positive attitudes toward IT, had lower intentions to indoor tan, communicated more with daughters about avoiding IT, and were more willing to advocate for a ban on IT by minors. Social media campaigns may be used to improve IT public policies.
Authors: David Buller, Sherry Pagoto, Katie Baker, Barbara Walkosz, Joel Hillhouse, Kimberly Henry, Julia Berteletti and Jessica Bibeau

17:00-17:10 Abstract Presentation 12 | Can a virtual reality experience change behaviour and  prevent skin cancer?
Presenter: Dr Elke Hacker, Griffith University, Brisbane, Australia & Dr Ken Dutton-Regester, Excite Science
Authors: Elke Hacker
Can a virtual reality experience change behaviour and prevent skin cancer, co-presenter-Dr Elke Hacker, Griffith University, Brisbane, Australia and Dr Ken Dutton-Regester Excite Science, Brisbane, Australia 
Summary: Skin cancer is preventable, however young adults in Australia still get regularly sunburnt. Our challenge is to develop new, innovative and creative ways to reach people with health messaging. This study explored the potential of a virtual reality (VR) game to engage, educate and elicit sun protection behaviours in young adults. The VR game was created using a user-centred design approach and tested by 20 end users in focus groups to gather feedback on tolerance, safety, satisfaction with use and behaviour change. VR technology may provide a channel to deliver health behaviour changing experiences to young adults in an immersive and entertaining format.

17:10-17:30 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 2: The Application of Social Media and Digital Techniques & Developments for SC Prevention

Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
Brigitte Boonen, President, Euroskin, Belgium

Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
Brigitte Boonen, President, Euroskin, Belgium

08:20-08:25 Introduction by Session Chair
Craig Sinclair, Head Prevention Division, Cancer Council Victoria, Australia

08:25-08:50 Keynote Address: WHO – Worldwide skin cancer prevention (successes and needs)
Dr Emilie Van Deventer, Team Leader Radiation and Health Unit, Department of Environment, Climate Change and Health, World Health Organization, Switzerland
As much as 24% of deaths are estimated to be attributable to environmental risks to health which are largely preventable. Between 30-50% of cancers are preventable by healthy lifestyle choices, and as much as 21% of cancers could be prevented through environmental improvements globally. A number of interventions to prevent skin cancers from UV exposure have been compiled in a newly published compendium, developed by WHO and other UN agencies. Examples of successes at national and local level will be highlighted in the presentation as well as foreseen needs to achieve a reduction by a third of cancer deaths by 2030 as mentioned in SDG3.

08:50-09:05 Speaker Presentation 3: Climate Change and UV Radiation - German Situation and Policy
Dr Cornelia Baldermann, Scientific Senior Councilor, Federal Office for Radiation Protection, Germany
We receive daily reports of catastrophes as a result of climate change, such as floods, storms, droughts or heat waves, which lead to impoverishment and death. However, there are also effects of climate change that do not trigger acute catastrophes per se, but could worsen the situation due to their climate change-related, increased and constant lasting influence on humans and nature. One of these is the climate change-induced change of UV radiation. In this presentation, the currently known climate change-related influences on ground-level UV exposure in Germany will be highlighted. The resulting health consequences will be briefly described and it will be presented how this knowledge is introduced on a political and scientific level. Influence of changing UV radiation exposure on flora and fauna is another important issue that should not be neglected, but must be discussed elsewhere.

09:05-09:20 Speaker Presentation 4: Sunbed use in Europe
Dr Mariano Suppa, Prof (MD, PhD), Hopital Erasme Brussels, Italy
Background. Sunbeds are first-group carcinogen but are still commonly used in Europe. Euromelanoma is a pan-European skin cancer prevention campaign.
Objectives. To compare several European countries in terms of prevalence, determinants and risks of sunbed use.
Methods. Euromelanoma participants filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses were employed to assess factors independently associated with sunbed use in each country.
Results. In total, 227 888 individuals from 30 countries participated. Prevalence of sunbed ever use was 10.6%, with high geographic variability according to latitude, sunshine, cultural and economic factors. Ever sunbed use was independently associated with nevus count >50, atypical nevi, lentigines and suspicion of melanoma.
Conclusions. Sunbed use is significantly associated with well-recognized risk factors for melanoma. Our data on prevalence of use may have public health relevance for future, tailored interventions aimed at reducing sunbed use in Europe.

09:20-09:35 Q&A & Recommendations
Live Q&A session with the presenters for Session II

Craig Sinclair (Chair), Head Prevention Division, Cancer Council Victoria, Australia

09:50-10:00 Abstract Presentation 14 | Implementing skin cancer prevention management of a  broad range of regulations in Norway
Presenter: Ingeborg Elise Nakken, Norwegian Radiation and Nuclear Safety Authority, Norway
The Norwegian Radiation and Nuclear Safety Authority (DSA) published in 2019 a National UV and Skin Cancer Strategy. One of the instruments to achieve the goal of reversing the increasing incidence of skin cancer, is through Governmental, county and municipal administration. DSA has mapped the existing legislation and has chosen the Health administration as a starting point for implementing skin cancer prevention in the administrative level.
Authors: Ingeborg Elise Nakken, Lill Tove Nilsen and Hanne Kofstadmoen

10:00-10:10 Abstract Presentation 15 | Developing and Implementing a Skin Cancer Prevention Plan for Ireland: A Collaborative Approach
Presenter: Maria McEnery, National Cancer Control Programme
Skin cancer is the most common cancer in Ireland. There are over 1,000 melanomas and over 10,000 non-melanoma skin cancers diagnosed each year.
The National Cancer Strategy (2017-2024) identified skin cancer prevention as a priority action. In light of this, the Department of Health in Ireland has developed and published a skin cancer prevention action plan (2019-2022). The focus is on children and young people, outdoor workers, sunbed users and those who pursue outdoor leisure activities.
Our priority is to work together to develop and implement a co-ordinated, evidence-based approach to increase awareness and support adoption of skin cancer prevention behaviours.
Authors: Dr. Barbara McGrogan, Kevin O'Hagan, Dr. Triona McCarthy, Aine Lyng and Kate O'Flaherty

10:10-10:30 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 3: Policy (Regulations) and Advocacy and Skin Cancer

Dr Wendy Yared (Chair), Director, Association of European Cancer Leagues (ECL), Belgium/United States

09:50-10:00 Abstract Presentation 18 | Results from a meta-analysis on sunbed use after the IARC’s statement on carcinogenicity of artificial tanning devices
Presenter: Dr Louisa Gordon, QIMR Berghofer Medical Research Institute, Australia
Exposure to artificial tanning devices is carcinogenic to humans and government regulations to restrict or ban indoor tanning appear to be increasing. We evaluated changes in the international prevalence of indoor tanning among adolescents and adults after 2009, when the IARC classified artificial tanning devices as carcinogenic. A systematic review and meta-analysis was undertaken. A total number of 43 studies that reported ever or past-year indoor tanning exposure after 2009 were identified.Global prevalence of indoor tanning in adolescents in 2013-2018 was 6.5% (95% CI: 3.3%-10.6%), 70% lower than the 22.0% (95% CI: 17.2%-26.8%) prevalence in 2007-2012 (reported in Wehner 2014). Among adults, prevalence was 11.9% (95% CI:8.7%- 15.6%) in 2012-2017, a decrease of 35% from 18.2% in 2007-2012. Prevalence of indoor tanning has declined substantially and significantly in adolescents and adults since the 2009 IARC statement on carcinogenicity.
Authors: Dr Louisa Gordon, Astrid Rodriguez-Acevedo, Craig Sinclair, Emilie van Deventer and Adele Green

10:00-10:10 Abstract Presentation 19 | Volunteer’s observational report of information and misinformation from a sample of 159 sunbed studios in Denmark
Presenter: Peter Dalum, Danish Cancer Society, Denmark
In Denmark, a sunbed legislation was introduced in 2014 with no specific protection of minors. We aimed to map the information that visitors of sunbed studios are exposed to on site and to examine compliance of the Danish sunbed legislation including registration and mandatory warning signs.
In the majority of Danish sunbed facilities, users are met with lack of information or misinformation that can lead to people being exposed to the health risks from sunbed use unknowingly. Especially children and young people can be confused by the opposed health messages.
Authors: Christine Behrens, Brian Køster and Dorte Dahl

10:10-10:20 Abstract Presentation 20 | "I think there should be photos": Indoor tanners' perceptions of health warning labels for tanning beds
Presenter: Jennifer McWhirter, University of Guelph, Canada
Many jurisdictions legally mandate health warning labels (HWLs) on indoor tanning equipment. These HWLs are typically text-only. Using focus groups we explored indoor tanners’ perceptions of the current, text-only Canadian HWL for tanning equipment, as well as 10 pictorial alternative HWLs. While the current Canadian HWL was seen as informative, several participants did not recognize it, and were unmotivated to read it due to small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective, but should be accompanied by informative text for believability, relatability, and comprehensibility.
Authors: Jennifer McWhirter, Sydney Gosselin, Seema Mutti-Packer, Scott McEwen, Andrew Papadopoulos, Cheryl Rosen and Jennifer Beecker

10:20-10:30 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 3: Indoor Tanning: Basics and News (BaN)

14:00-14:10 Introduction by Session Chair: Lill Tove Nilsen, Senior Advisor Optical Radiation, Norwegian Radiation and Nuclear Safety Authority, Norway

14:10-14:30 Keynote Address: What can we learn from other cancer screening programs?
Prof Dr Harry de Koning, Dept of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands

14:30-14:45 Speaker Presentation 5: What can we learn from social marketing for skin cancer prevention?
Prof Jeff French, Strategic Social Marketing and University of Brighton, UK
In this session Professor Jeff French will set out tips to avoid wasting time, money and effort in the design of health promotion programmes. The learning presented in this session is based on a distillation of on evidence and experience from the fields of health promotion, social marketing, community engagement, behavioural sciences and management science. The session will be illustrated with practical real life examples from around the world. Participants will leave the session with understanding, tools and techniques for ensuring the development of effective, efficient and community supported programmes of action.

14:45-15:00 Speaker Presentation 6: Can the increasing melanoma rates in the European countries be changed? Learnings from The Danish Sun Safety Campaign 2007 – 2017
Presenter: Peter Dalum, Executive Project Manager, Danish Cancer League, Denmark
Melanoma Incidence rates in populations with European descendants have increased ever since cancer registration began. Main preventable reasons for the increase is the changed behavior in  the natural sun and the use of sunbeds. In Australia and New Zealand, broad uv-prevention campaigns was launched in the eighties and have shown to be effective. The methods and experience from these countries may not be directly transferred to a European setting since conditions are not similar regarding uv-exposure and norms of sun protection behaviors. In 2007, the Danish Sun Safety Campaign was launched in a partnership between the Danish Cancer Society and the philanthropic foundation TrygFonden as Denmark had the highest incidence rates of skin cancer outside the Australian continent. The campaign was based on the learnings from Australia but modified to a European setting. The aim of this presentation is to describe the overall campaign model and the main results from the campaign period.

15:00-15:15 Speaker Presentation 6a: Digital Interventions: Successes and failures in skin cancer prevention and early detection across the continents
Presenters: Dr. Monika Janda, Professor for Behavioural Science, the University of Queensland and Dr. Carolyn Heckman, Associate Professor of Medicine, Co-Leader of the Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, USA
Increasingly, behavioural skin cancer interventions are delivered directly to a person’s personal digital devices, including mobile phones, tablets and laptop devices, using text messaging, mobile apps or online web-based platforms. At the same time, communication via social media platforms such as Facebook, Twitter, Instagram and others is increasing and is often used to share information and advice from health professionals, consumer organisations, and people outside the health and medical fields. This presentation will provide a review of important recent developments, provide examples of relevant work, and discuss how new interventions should be designed and delivered for maximal engagement and effect.

15:15-15:35 Q&A & Recommendations
Live Q&A session with the presenters for Session III

Brigitte Boonen (Chair), President, Euroskin, Belgium

15:45-15:55 Abstract Presentation 21 | What the data is telling us after 30 years of sun protection campaigns in Melbourne Australia – where to next?
Presenter: Craig Sinclair, Head Prevention Division, Cancer Council Victoria, Australia
SunSmart is a multi-component population-based skin cancer prevention program supported in all states and territories in Australia. As a result of long term investments over 3 decades, melanoma rates are declining in younger groups and sun protection policies and practices are common place, particularly in primary schools.
This presentation will outline the trends in sun protection behavior and attitudes after tracking the Melbourne (Victoria, Australia) population from 1987 to 2017, and also importantly focus on where we need to go next to ensure the population health gains are sustained going forward.
Authors: Craig Sinclair, Tamara Tabbakha, Suzanne Dobbinson and Melanie Wakefield

15:55-16:05 Abstract Presentation 22 | Evaluation of the Melbourne Sun Observation Study for monitoring sun protection behaviour: Sustaining data quality and embracing innovation
Presenter: Clover Maitland, Centre for Behavioural Research in Cancer, Cancer Council Victoria, Australia
Commenced in 1992, the Sun Observation Study observes sun protection behaviours in outdoor settings over summer weekends in Melbourne, Australia. We used multiple approaches to evaluate the study methods, including the introduction of mobile technology and a sunscreen intercept survey, to inform future monitoring of sun protection behaviour.  The evaluation found  the study methods, settings and instruments are relevant and reliable for collecting high quality behavioural data on use of hats, sunglasses, clothing, and potentially sunscreen, in outdoor public settings. Data collection using the mobile phone application was highly efficient, creating opportunities for collecting additional program-relevant data in future.
Authors: Andrea Nathan, Clover Maitland and Melanie Wakefield

16:05-16:15 Abstract Presentation 24 |Beyond the National Sun Protection Survey: alternative methods to measure sun protection in Victoria
Presenter: Heather Walker, Cancer Council Australia, Australia
Cancer Council Australia conducted the National Sun Protection Survey (NSPS) between 2003 and 2017 to gather data on Australians' sun protection knowledge, attitudes and behaviours. This methodology is no longer feasible due to declining response rates. New methods were compared to the NSPS to understand how best to provide new baseline and trends data to inform sun protection policies and programs in future. A combination of methods are required to fill this gap.
Authors: Heather Walker and Anna Nicholson

16:15-16:25 Abstract Presentation 25 | Skin Cancer Prevention or Early Detection?  Insights from formative research to develop a new mass media campaign targeting older men
Presenter: Clover Maitland, Centre for Behavioural Research in Cancer, Cancer Council Victoria, Australia
This research informed a new SunSmart campaign in Victoria (Australia) targeting older men to improve skin cancer prevention and early detection. Cancer registry and population data were reviewed, and focus groups were conducted to gather insights and test key messages and concepts.  Evidence confirmed older men are a high-risk group for skin cancer.  Focus group findings indicated men do not percieve skin cancer as a personal or serious threat and knowledge was lacking. Sun protection was not a high priority especially during ‘everyday’ sun exposure. Although some were concerned about skin spots, there was little urgency to visit a doctor.
Authors: Clover Maitland, Michael Murphy and Heather Walker

16:30-16:40 Abstract Presentation 27 | Sun-tanning behavior in the Norwegian population
Presenter: Lill Tove Nilsen, Norwegian Radiation and Nuclear Safety Authority, Norway
The sun-tanning behavior of the Norwegian population were explored using: 1) a modified Health Belief Model (HBM) and 2) a hypothesized model suggesting impact by host risk factors on perceived risk and thereafter on sun behavior.
The modified HBM model explained 31% of the variation in sun-tanning behavior. Significant predictors were perceived barriers to sun protection, severity of melanoma, empowerment and benefits of tanning.
Path analyses revealed that how skin reacted to sun exposure had impact on sun-tanning behavior. All host risk factors, except hair color, significantly impacted perceived risk, whereas perceived risk did not significantly impact sun behavior. 
Authors: Lill Tove Nilsen, Hanne Støle, Anna Tallerud and Pål Joranger

16:40-16:50 Abstract Presentation 28 | Solar UV Monitoring Network – from Past to Future
Presenter: Dr Sebastian Lorenz, Federal Office for Radiation Protection, Germany
In Germany, the ground solar UV radiation is measured since 1993, and the determined UV index is communicated as daily maximum value since 1995. However, more intense prevention work and increasing requirements on communication made it necessary to build up a closer meshed network of measurement stations, and to go new communication ways. With the example of the German solar UV monitoring network it will be presented how UV-monitoring networks can be extended and adapted in order to achieve necessary improvements, better understanding and applicability of the UV-index, and to support current and future scientific work.
Authors: Sebastian Lorenz, Cornelia Baldermann and Daniela Weiskopf

16:50-17:00 Abstract Presentation 29 | Wave-band: A new tool for UV dosimetry, behavioral monitoring, and intervention
Presenter: Zim Sherman, Scienterra Ltd., New Zealand
By actively monitoring multiple health parameters that are often convolved, Wave-band enables researchers and health agencies to eliminate uncertainties, track at-risk populations, perform interventions, and reduce the rate of skin cancer.
Research-grade measurements of erythemally-weighted UVB, UVA, blue, green, red, and broadband white light are relayed from a dosimeter to a secured cloud database in real-time.  A smartphone app displays exposure data, records clothing and sunscreen use, monitors compliance, and provides reinforcing messages to guide behaviour.  UV measurements are validated against a radiative transfer model.  Pedometry and physical activity are evaluated, using methods adapted from the scientific accelerometry package GGIR. 
Authors: Zim Sherman

17:00-17:10 Abstract Presentation 31 | Sun Safety trial at Summer Festivals
Presenter:  Dr Elke Hacker, Griffith University, Brisbane, Australia & Dr Jodie Antrobus, Queensland Health
Authors: Caitlin Horsham, David Abernethy, Jodie Antrobus, Helen Ford and Elke Hacker
Sun Safety trial at Summer Festivals, co-presenter- Dr Elke Hacker, Griffith University, Brisbane, Australia and Jodie Antrobus, Queensland Health, Brisbane, Australia
Summary: Many young Australians still get sunburnt on a regular basis, despite having good knowledge and sun-protective intentions.  In Australia, over 18,000 school leavers celebrate the end of school and exams at an outdoor festival on the Gold Coast each year. To raise awareness of UV exposure during the week long outdoor festival the official wristband for entry to events had a UV-indicator included. The UV-indicator showed the user when their skin required sun protection by changing colour from white to purple. The findings from this trial testing the effectiveness of UV-indicator wristbands will be presented.

17:10-17:20 Abstract Presentation 32 | Living with the sun at school (Education to the sun program)
Presenter: Pierre Cesarini (FR), Associatin Sécurité Solaire, France
Living with the Sun is a primary school education program launched in France in 2006 by the not-for-profit organization Sécurité Solaire with the help of the Academy of Sciences and the Ministry of Education. Teachers carries out, with their pupils, scientific activities which allow them to discover the effects of the sun on health and the means of protection. More than 1,000,000 pupils have been involved for an individual cost below 1.5€. Furthermore, a randomised trial has shown a positive impact on knowledge and behaviour. The program and its methodology are currently experimented among several countries (Spain, Portugal, Canada…).
Authors: Pierre Cesarini

17:20-17:40 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 4: Reducing Skin Cancer Risk by Behavioural and Environmental Prevention

Dr Arjan van Dijk (Chair), Researcher, Dutch National Institute for Public Health and the Environment, The Netherlands

15:45-15:55 Abstract Presentation 33 | Skin exposure to blue light from the sun, common light sources and electronic screens. Do we need a blue-blocking sunscreen?
Presenter: Terje Christensen, Norwegian Radiation and Nuclear Safety Authority/University of South-Eastern Norway, Norway
We aimed to identify the blue light exposures from different indoor sources and outdoor conditions that result in doses that can induce damage to the skin.
Time to reach threshold levels of blue light and UV was calculated under different conditions.
Emission from domestic sources and screens do not result in skin damaging radiant exposures of blue light. The threshold dose for UV-induced erythema outdoors is reached long before any blue light effects can be expected.
There is no need for sunscreens to include protection against indoor or outdoor blue light in contrast to the urgent need for UV-protection.
Authors: Terje Christensen, Bjørn Johnsen and Ellen Bruzell

15:55-16:05 Abstract Presentation 34 | Challenges in Sun Protection – Proposed Risk Assessment Approach
Presenter: Uli Osterwalder, Sun Protection Facilitator, Switzerland
Despite tremendous development in UV filters with broader protection, sunscreen formulations with better acceptability, and a variety of new formats that make them easier to use, there is controversy about sunscreens, such as which wavelengths they should protect against, that UV filters may be harmful, whether sunscreens are effective at all in preventing skin cancer, or whether they just block the production of vitamin D in the skin. Such conflicting messages undermine the benefits and acceptability of sunscreen use. This paper identifies how these challenges should be addressed and how the current problems might be resolved.
Authors: Uli Osterwalder, Sun Protection Facilitator, Switzerland

16:05-16:15 Abstract Presentation 35 | Visual Aids for Sunscreen Quantity Estimation
Presenter: Anne Julian, National Cancer Institute, USA
Sunscreen application rarely meets the requirements for effectiveness. One type of application failure is a thinner than necessary layer of sunscreen. This may be because consumers misinterpret sunscreen application quantity direction on labels. In the U.S., label terms to communicate application quantity are vague (i.e., apply generously). An image or a brief video (GIF) embedded in a Quick Response (QR) code may be prefered by consumers to  determine application quantity. Our aim was to feasibility-test image- and GIF-based visual aids for communicating sunscreen application quantity.
Authors: Anne Julian, Calvin Tribby and Frank Perna

16:15-16:25 Abstract Presentation 36 | Validation of Alternative SPF-Methods
Presenter: Uli Osterwalder, Sun Protection Facilitator, Switzerland
For ethical and cost-effectiveness reasons, alternative methods for sun protection factor (SPF, ISO 24444) have been sought for decades. The following alternatives exist: in vitro, in silico, and HDRS a hybrid in vivo/in vitro method. Before a replacement can be made, a thorough validation process should be conducted. Bland-Altman pointed out more than 30 years ago that a simple correlation is not sufficient to assess the agreement between two methods. Potential systematic errors, such as specific sunscreen types or test laboratories, must be identified. A state-of-the-art validation procedure is required to maintain the benefits of the current gold standard.
Authors: Uli Osterwalder, Sun Protection Facilitator, Switzerland

16:25-16:35 Abstract Presentation 37 | Protocol for a risk-benefit assessment of sunscreens
Presenter: Ellen Bruzell, Norwegian Scientific Committee for Food and Environment (VKM)/ NIOM, Norway
Due to the need for scientifically based advice on sunscreen use, a risk-benefit assessment is ongoing preceded by the publication of a protocol. Frequently used sunscreens and sunscreen ingredients, represented by UV filters, will be assessed. Exposure calculations will be performed based on sunscreens and/or sunscreen ingredient amounts used, use frequencies and concentrations extracted from literature findings instead of default values. Benefit assessment will be performed for products rather than for ingredients. 
Authors: Ellen Bruzell, Gro Haarklou Mathisen, Berit Granum, Eva Marie-Louise Denison, Tove Gulbrandsen Devold, Josef Daniel Rasinger, Jostein Starrfelt and Trine Husøy

16:35-16:45 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 4: Sunscreens

Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
Brigitte Boonen, President, Euroskin, Belgium

Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
Brigitte Boonen, President, Euroskin, Belgium

08:30-08:35 Introduction by Session Chair: Lill Tove Nilsen, Senior Advisor Optical Radiation, Norwegian Radiation and Nuclear Safety Authority, Norway

08:35-09:00 Key Note Address:The solar spectrum and skin cancer
Presenter: Prof Dr Petra Boukamp MD, German Cancer Research Center, Heidelberg, and Institute for Environmental Medicine, Düsseldorf, Germany
Every year, the diagnosis of new skin cancer incidences exceeds the combined incidence rates of cancers from the breast, lung, prostate, and colon. In fact, Non-melanoma skin cancer (NMSC), and in particular the keratinocyte cancers, i.e. the basal cell carcinoma (BCC) and the cutaneous squamous cell carcinoma (cSCC), are the most common cancers in the Caucasian population worldwide. While BCCs, though highly destructive, only rarely metastasize, cSCCs and particular cSCC that develop in organ transplant recipients as a consequence of immunosuppression, are increasingly aggressive with a metastasis risk estimate of >10%. Once metastasized any successful treatment has yet to be identified. It is without doubt that exposure to sunlight is the leading cause of human skin cancer and the carcinogenic role of the two ultraviolet wavelengths of the solar spectrum, UVB (280-320 nm) and UVA (320 - 400 nm) are well documented. Meanwhile wavelengths beyond UV radiation, the visible light (VIS: 400 - 770 nm) and near infrared radiation (IRA: 771 - 1440 nm), have been shown to exert damage to human skin cells, thus also deserve attention for their potential contribution to human skin cancer. Commonly, the different wave lengths are analyzed individually in order to identify their specific signature. However, the solar spectrum as a whole may exert interactive regulatory mechanisms that are likely to modify the individual action spectra. Understanding the combined action of the different wavelength of the solar spectrum should, therefore, become an important aspect of future studies. Likewise, besides the well-studied mutagenic potential of UVA und UVB radiation, sunlight also counteracts tissue homeostasis, causing epidermal dysregulation (hyperkeratosis or acanthosis), modifying the stroma (solar elastosis) and influencing the immune system (immunosuppression), requesting also for a more global view for a better understanding and hopefully successfully combat of skin cancer initiation and progression.

09:00-09:15 Speaker Presentation 7: Treating UV-induced skin cancer by targeting the immune system
Presenter: Prof Dr Scott Byrne, PhD, FFSc (RCPA) by Research | Associate Professor, University of Sydney, Australia
When skin is exposed to UV, a cascade of cellular and molecular events are initiated that lead to the downstream activation of regulatory immune cells. As a consequence, both local cutaneous and systemic immunity is suppressed, particularly adaptive immune responses, which are required to detect and destroy cancer cells. We know from animal models and clinical trials in humans that interfering with one or more of these UV-triggered immunological events can have a profound effect on skin tumour incidence, growth and metastasis. Indeed, for aggressive skin cancers like melanoma, CTLA-4- and PD-1-targeted immunotherapy has proven highly successful. But these check-point inhibitors don’t work for everyone. Alternative approaches and new therapies, possibly ones that target other UV-activated immune pathways, are therefore urgently needed. Understanding the mechanisms by which UV drives immune suppression will allow for the development of new immune-targeted treatment options for UV-induced skin cancers.

09:15-09:30 Speaker Presentation 8: Skin Cancer (Risk-) Biomarkers
Presenter: Dr Rüdiger Greinert, Secretary General, Euroskin, Germany
There is an urgent need to find and validate biomarkers for skin cancer risks, development, diagnosis, prognosis and prediction of therapy outcome.
In the last decade evidence is increasing, that epigenetic biomarkers (especially microRNAs, miRNA) are suitable candidates for these kind of biomarkers.
miRNAs can be detected in (non-invasively taken) liquid biopsies (blood, urine, CSF, etc.) and can be connected to a variety of (skin) cancer associated pathways, as well as being involved in intercellular communication (e.g. with tumour microenvironment).
The talk will summarize latest results in the field of biomarker use in the field of primary and secondary skin cancer prevention.

09:30-09:45 Q&A & Recommendations
Live Q&A session with the presenters for Session IV

Dr Beate Volkmer (Chair), Treasurer, Euroskin, Germany

10:00-10:10 Abstract Presentation 38 | Impact of COVID-19 lockdown on sun exposure of UK office workers
Presenter: Katarzyna Baczynska, Public Health England, United Kingdom
The impact of lockdown due to the COVID-19 pandemic in April-June 2020 on UV exposure of office workers was assessed using an online survey on time spent outdoors and environmental data for different locations in the UK. Without the need for commuting and with the flexibility of homeworking, weekday time spent outdoors was higher in the 2020 lockdown than in the same period in 2017. The weekday erythema effective radiant exposure was higher in 2020 due to an additional 45 min outdoors in the late afternoon that was not observed in 2017 and high UV levels due to extremely sunny weather in spring.
Authors: John O'Hagan, Katarzyna Baczynska and Marina Khazova

10:10-10:20 Abstract Presentation 39 | In-flight UV-A exposure of commercial airline pilots
Presenter: Katarzyna Baczynska, Public Health England, United Kingdom
The objective of this study was to measure the UV exposure of commercial pilots on 312 flights to 31 European destinations from 4 UK airports in three seasons from August 2016-September 2017. The results confirmed conclusions of previous studies that UVR exposures were insufficient to cause erythema for all flights. However, on a small number of flights (13 out of 312), UV-A exposure could have exceeded the ICNIRP exposure limit guidance if sunglasses or visors weren’t used. On average it was lower than the UV-A exposure of a sample of UK office workers, including during weekends, over a similar period.
Authors: John O'Hagan, Katarzyna Baczynska and Marina Khazova

Abstract Session 5: New Insights/Approaches in Skin Cancer Etiology and Prognosis

10:20-10:30 Abstract Presentation 40 | Phenotypic characteristics and melanoma thickness
Presenter: Reza Ghiasvand, Cancer Registry of Norway, Norway
It has been hypothesized that melanoma patients’ phenotypic characteristics might be associated with tumor aggressiveness. However, the existing evidence is scarce. We aimed to study the associations between pigmentary characteristics, nevi and melanoma thickness in a large population-based cohort study. We found that fair pigmentary score was associated with thinner trunk melanomas but not the other sites, and thinner superficial spreading but not nodular melanomas, which suggest more vigilance and skin awareness among clinicians and women with fair pigmentation. ≥50 nevi was associated with thicker melanoma, which underscores the advice that women with many nevi should undergo routine skin examinations.
Authors: Reza Ghiasvand, Adele Green, Torkjel Sandanger, Elisabete Weiderpass, Trude Robsahm and Marit Veierød

10:30-10:40 Abstract Presentation 41 | Prediagnostic serum 25-hydroxyvitamin D and melanoma risk: A nested case-control study in the population-based Janus Serum Bank Cohort
Presenter: Jo S Stenehjem, Oslo Centre for Biostatistics and Epidemiology, Dept of Biostatistics, University of Oslo, Norway
Serum 25-hydroxyvitamin D (25(OH)D) has been hypothesized to be inversely related to melanoma risk based on laboratory studies, while epidemiological studies have shown conflicting results. We conducted a nested case-control study of 708 cases and 708 controls, using prediagnostically collected serum, to study 25(OH)D and melanoma risk in the Norwegian population-based Janus Serum Bank Cohort. Our data did not yield persuasive evidence for an association overall, although serum levels within the normal range might be associated with reduced risk. The overall positive association indicated confounding by UVR as high levels of 25(OH)D are unlikely to cause melanoma.
Authors: Jo S Stenehjem, Støer, Ghiasvand, Grimsrud, Babigumira, Rees, Nilsen, Johnsen, Thorsby, Veierød and Robsahm

10:40-10:55 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 5: Research on UV Radiation and Solar Spectrum & Abstract Session 5 New Insights

Craig Sinclair (Chair), Head Prevention Division, Cancer Council Victoria, Australia

10:00-10:10 Abstract Presentation 42 | Towards a model-based cost-effectiveness analysis of interventions to reduce skin cancers attributable to sunbed use: model conceptualisation
Presenter: Martin Eden, University of Manchester, United Kingdom
This study aimed to conceptualise a model-based cost-effectiveness analysis (CEA) of interventions to reduce skin cancers attributable to sunbed use in the United Kingdom (UK). A systematic review was used to identify and appraise existing relevant economic evaluations: six CEAs were appraised. This study identified knowledge gaps but also elements of good practice. It provided evidence on relevant pathways and model structure to use in a subsequent two-stage economic model. Findings from the review informed the development of an economic evaluation of proposed interventions to reduce sunbed use in the UK.
Authors: Martin Eden, Katherine Payne, Louisa Gordon, Richard Marais and Adele C Green

10:10-10:20 Abstract Presentation 43 | Benefit-Cost Analysis of the Danish Sun Safety Campaign 2007-2015: Cost Savings from Sunburn and Sunbed Use Reduction and Derived Skin Cancer Reductions 2007-2040 in the Danish Population
Presenter: Brian Køster, Danish Sunsmart Campaign, Danish Cancer Society, Denmark
The Danish Sun Safety Campaign has campaigned since 2007, targeting overexposure to ultraviolet radiation. During 2007–2015, the key indicators of skin cancer, i.e. sunbed use and sunburn, showed annual reductions of 6% and 1%, respectively. We aimed to examine the financial savings to society as a result of the campaign reductions in skin cancer cases (2007–2040), and to examine the campaign’s cost–benefit and return on investment (ROI). We show that skin cancer prevention in Denmark is cost-effective.
Authors: Brian Køster, Maria Meyer, Jes Søgaard and Peter Dalum

10:20-10:30 Abstract Presentation 44 | Novel sunprotection interventions to prevent skin cancer: a randomized study targeting Danes on staycation or on vacation to destinations with high UV index
Presenter: Brian Køster, Danish Sunsmart Campaign, Danish Cancer Society, Denmark
We conducted a RCT with 1548 Danes on vacation abroad and 909 on domestic vacation in 2018 for a 1-3 weeks. Study population included Danes aged 18-65 years. We tested two protection routines: 1) Avoidance of the sun during peak hours including shade by use of the UV-index and planning of indoor/outdoor activity respectively and 2) Coverage by increasing the advice hat and increasing sunscreen amount by application routine. Comparing intervention-users with non-users and controls, respectively indicates that knowledge from intervention material may improve sun protection behaviour among Danes.
Authors: Brian Køster, Maria Meyer, Pernille Borg and Peter Dalum

10:30-10:40 Abstract Presentation 45 | Upskilling and equipping Victorian General Practitioners in skin cancer prevention and early detection
Presenter: Shannon Jones, Cancer Council Victoria, Australia
New, one-off funding allowed for an innovative project equipping General Practitioners with dermatoscopes and training to prevent and better manage skin cancer with a focus on regional areas. Useful in the diagnosis of melanoma and benign lesions, dermoscopy provides a significant opportunity to reduce unnecessary excisions, leading to early detection of skin cancers. This presentation will review the implementation and immediate impacts of the Dermoscopy for Victorian General Practice Program.
Authors: Shannon Jones, Andrea Nathan, Clover Maitland and Heather Walker

10:40-10:50 Abstract Presentation 46 | Optimizing skin cancer detection in the general population: an early access lesion-directed consultation
Presenter: Sofie Mylle, Department of Dermatology, University Hospital Ghent, Belgium
Systematic screening of the general population for skin cancer has not been proven to be cost-effective. We examined a lesion-directed approach by introducing a lesion-directed early access consultation at our dermatology department. In 342 patients, 45 skin cancers (13.2%) have been confirmed. After total body examination in patients without a suspicious index lesion 1 additional BCC was detected (0.5% (1/79)). Anxiety dropped significantly after consultation in patients with or without a suspicious index lesion. This study demonstrates that a lesion-directed approach is feasible delivering value and high skin cancer detection rates. To reach a wider audience and optimize preselection, future studies should investigate the use of apps and teledermatology.
Authors: Sofie Mylle, Isabelle Hoorens, Beatrice Van de Maele, Evelien Verhaeghe and Lieve Brochez

10:50-11:05 Q&A & Recommendations
Live Q&A session with the abstract presenters for Abstract Session 5: Cost Effectiveness of Primary and Secondary Skin Cancer Prevention

David Buller (Chair), Klein Buendel, United States

13:30-13:45 Closing Keynote 1: Health economic evidence for skin cancer prevention – past, present and future
Dr Louisa Gordon, Team Head – Health Economics, QIMR Berghofer Medical Research Institute, Australia
As skin cancer rates continue to rise in many countries, investment in primary prevention initiatives are urgently required. To contribute to advocacy efforts, evidence on the cost burden, cost-effectiveness of skin cancer prevention interventions and return on investment analyses can inform and help persuade decision-makers to fund prevention programs. However, despite a growing body of work demonstrating the strong cost-effectiveness of prevention programs, economic evidence has had varying success in positively changing policy for skin cancer prevention. This presentation will outline how far health economics has come to contributing to policy impacts and the next challenges of producing and communicating economic findings to support skin cancer prevention.

13:45–14:00 Closing Keynote 2: The role of economics in advancing skin cancer prevention
Gery Guy Jr. PhD, MPH, Team Lead, Division of Overdose Prevention, Centers of Disease Control and Prevention (CDC), USA
Economics can play an important role in the prevention of skin cancer. Economics provides important tools such as cost-effectiveness and cost-benefit analysis, behavioral economics, quasi-experimental designs and simulation modeling. The application of these tools can help expand the empirical basis for decision making and help assure scare resources are used wisely. This presentation will examine the various economic tools available and provide examples of how these tools have been applied in helping to address the increasing burden of skin cancer.

14:00-14:15 Closing Keynote 3: European Code against Cancer
Dr Joachim Schüz, Head, Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC)
The European Code against Cancer is a set of recommendations on how to reduce your risk of cancer. First launched in 1987 its 4th edition was published in 2014 and the development of the 5th edition has just been announced as part of the European Union (EU) Beating Cancer Plan. Among the twelve recommendations one addresses sun/UV exposure, i.e. avoiding too much sun and not using sunbeds. A roadmap for the future of the European Code has just been published as well as an assessment of how well the Code is known in the European population. The ambition of the 5th edition is to significantly raise awareness for even greater success of this key cancer prevention instrument.

Do we still need skin cancer prevention? The skin cancer therapy revolution
David Whiteman, Acting Director and Senior Scientist, QIMR Berghofer Medical Research Institute, Melanoma and Skin Cancer Research Centre, Brisbane

Ruediger Greinert, Secretary General, Euroskin, Germany
Brigitte Boonen, President, Euroskin, Belgium