14-Knowledge00165_3-PRIMARY.

qxd 3/14/21 12:09 PM Page 212

ORIGINAL ARTICLE

Knowledge, attitude, practice and perception on sunscreen

and skin cancer among doctors and pharmacists

Qin Jian Low, MRCP(UK)1, Kuo Zhau Teo, MBBS1, Tzyy Huei Lim, MRCP(UK)1, Seng Wee Cheo, MRCP(UK)2, Wen
Yee Evelyn Yap, MRCP(UK)3

1
Department of Internal Medicine, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia, 2Department of Internal
Medicine, Hospital Lahad Datu, Lahad Datu, Sabah, Malaysia, 3Department of Dermatology, Hospital Pakar Sultanah Fatimah
Muar, Muar, Johor, Malaysia

ABSTRACT
Introduction: Excessive ultraviolet light (UV) can cause
inducing erythema.3 Ultraviolet A is responsible for skin

premature skin aging and potentially skin cancer. Currently

pigmentation and photoaging.3,4 Measures such as avoiding

there is a lack of awareness among health care

peak hours of sun, sun protective clothing and sunscreen

professionals and the public on sun protection. The

applications are crucial to reduce the potential harm due to

objectives of this study were to determine knowledge on

UV exposure.5

sunscreen and skin cancer among health care

professionals, to evaluate the knowledge, attitude, practice
Sunscreen lotions are topical preparations which contain

and perception of doctors and pharmacists toward the

filters that reflect or absorb radiation in the UV wavelength.

usage of sunscreen as protection against UV radiation.

They can be categorized into organic or inorganic filters.2
Organic filters such as cinnamates and salicylates are

Materials And Methods: This is a cross-sectional study

aromatic compounds that absorb UV radiation and convert it

conducted among doctors and pharmacists in Hospital

to a negligible amount of heat.2 Inorganic filters such as zinc

Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

oxide and titanium dioxide reflect and scatter UV light over

Questionnaires were used in this study.

a wide range of wavelengths.2,6 A broad-spectrum sunscreen
combines filters of different ultraviolet absorption spectra

Results: A total of 384 participants completed the

and is able to absorb both UVA and UVB radiation. The sun

questionnaires. The participants consisted of 323 doctors

protection factor (SPF) is a measurement used to measure a

(84.1%) and 61 pharmacists (15.9%). The age group of the

sunscreen ability to protect one from sunburn which is

participants ranged between 25 till 55 years old. Ninety

primarily caused by UVB.7,8

doctors (27.9%) and thirty-one pharmacists (51.0%) reported

used sunscreen daily (p<0.001). This finding showed that
Geographically, Malaysia is located on the equatorial and

there was a deficit in the practice of sun protection.

experiences hot and humid weather throughout the year.

Pharmacists scored a higher knowledge score of median 12

Malaysians are exposed to sunlight daily and it is imperative

(IQR=3.0) while the doctors scored 11 (IQR=2.0). This study

for health care professionals to be competent and

showed a significant association between ethnicity and skin

comfortable to advice their patients correctly about sun

cancer knowledge (p<0.05).

protection. There is limited published data of knowledge of
sun protection among health care professionals locally.

Conclusion: This study demonstrated a lack of knowledge of

Ammar Ihsan Awadh et al. reported that final year

sunscreen and skin cancer prevention among health care

pharmacists displayed better sunscreen knowledge and

practitioners. This finding supports better medical

perception on sunscreen usage than final year medical

education program on this topic.

students from the International Islamic University Malaysia.9
Internationally, there are reported population-based study on

KEYWORDS:
sunscreen use and perception.12

Sunscreen, skin cancer, knowledge, practice, perception The objectives of this study were to explore knowledge on
sunscreen and skin cancer, attitude, practice and perception

INTRODUCTION
among health care professionals on sunscreen and skin
cancer.
Exposure to sunlight is required for vitamin D synthesis.

MATERIALS AND METHODS

Ultraviolet (UV) radiation (290 to 400 nm) is responsible for
sunburn, photoaging and skin malignancy. Ultraviolet B
(UVB) radiation (280-320nm) represent five percent of UV Study Design and Setting
radiation reaching the surface of the earth which causes sun This is a cross sectional questionnaire-based study among
burn, pigmentation, inflammation and can induce doctors and pharmacists conducted by a team of doctors from
melanoma and skin cancer. Ninety five percent of UV the internal medicine department of Hospital Sultanah Nora
radiation arriving at the earth surface is ultraviolet A (UVA) Ismail, Batu Pahat, Johor, Malaysia between 1st July to 31st
(320 to 400 nm).1,2 UVA consists of UVA1 (340 to 400 nm) and November 2019. Exclusion criteria included doctors and
UVA2 (320 to 340 nm). UVA1 is less potent than UVA2 in pharmacists who were unable or refused to provide consent.
This article was accepted: 05 January 2021
Corresponding Author: Low Qin Jian
Email: [email protected]

212 Med J Malaysia Vol 76 No 2 March 2021

14-Knowledge00165_3-PRIMARY.qxd 3/14/21 12:09 PM Page 213

Knowledge, attitude, practice and perception on sunscreen and skin cancer among doctors and pharmacists

A content and face validity method were conducted by the completed questionnaires. Five questionnaires were rejected
investigators. because they were incomplete. Thus, a total of 384 completed
questionnaires were collected. This study sample consisted of
The questionnaire was developed according to earlier studies 175 male and 209 female participants. The age of our
and approved by our Clinical Research Committee of participants ranged from 20 to 60 years old. Table I and II
Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.9 describe the demographic data of participants. Table III
The content of the questionnaire was reviewed and approved summarizes the attitude, practice and perception of
by our expert dermatologist. The design of the questionnaire participants among doctors and pharmacists towards
contained practices of sunscreen use, attitude and knowledge sunscreen use. Table IV and V describe the knowledge on
on sunscreen and skin cancer. The first section of the sunscreen questionnaires.
questionnaire consisted of demographic profile of the doctors
and pharmacists. As the medical education of both medicine The total number of returned questionnaires were from 323
and pharmacy undergraduate programs are conducted in the (68.3%) doctors and 61 (76.0%) pharmacists. Among the 323
English language in Malaysia, the English version of the doctors who completed the questionnaires, 142 (44.0%) were
questionnaire was distributed without the need for house officers, 149 (46.1%) were medical officers and 32
translation. The study protocol was approved by the Ministry (9.9%) were specialists. Sixty-one pharmacists which consists
of Health Research Ethics Committee (MREC) and the of 20 (33.0%) provisionally registered pharmacists and 41
National Medical Research Registry with the registration (67.0%) fully registered pharmacists returned the completed
number NMRR-19-1470- 48459. questionnaires. The majority of the doctors and pharmacists
were of the female gender and were from the 20 to 30 years
Sample and Setting age group. Two hundred and eighteen (67.5%) doctors and
The prevalence of any response (items from KAP) may be low, 44 (72%) pharmacists had Fitzpatrick skin type IV and V.
moderate or high. The sample size calculation was based on
a formula to determine prevalence in a targeted population We interviewed all our participants about their practice of
where prevalence of 50.0% will always yield the largest daily sunscreen use. Seventy-eight doctors (74.0%) and 23
sample size based on fixed margin of error. Therefore, the (38.0%) pharmacists do not have the practice of daily
sample size calculation is based on to determine a prevalence sunscreen usage. Twenty-six (68.0%) male and 75.0 (59.0%)
of 50.0% with margin of error of 5.0% for any response of the female participants did not have the practice of daily
KAP items. Thus, the minimum required sample size for 95% sunscreen usage. Majority of doctors (70.0, 66.0%) and
confidence interval is 384 respondents. Sample size was pharmacists (37.0, 61.0%) answered correctly about the
calculated using epiinfo software version 7.2.0.1. Doctors and timing of sunscreen application before sunlight exposure. In
pharmacists were recruited from each of the department. The the doctor’s cohort, media (33.0, 32.0%) was the top
participants filled up the questionnaires individually after influencer for daily sunscreen use while in the pharmacist’s
receiving the written instructions. cohort, family (18.0, 30.0%) was the top influencer. Mass
media exposure with sun-protection information positively
Content validity was conducted among two senior medical influenced the perception and sunscreen use among the
doctors and one dermatologist to ensure all the questions are doctor’s cohort.
valid and relevant to the patients. No amendments were

DISCUSSION
made at this stage. Next, face validity was conducted among
ten respondents consisting of pharmacists and medical
doctors. No amendment was made also at this stage. No pilot Our findings showed that 51.0% pharmacists and 28.0%
study was conducted since the earlier researchers concluded doctors reported to have the practice of daily use of
the questionnaire is appropriate, reliable and valid since sunscreen. Ammar Ihsan Awadh et al. reported a similar
previously the study using the same questionnaire was finding where final year pharmacy students (47.5%) use
published elsewhere.9 Basis of validity was determined based more sunscreen than final year medical students (36.6%).9
on content and face validity only. This was possibly related to the fact that pharmacists are
more familiar with sunscreen products. The majority of
Data Collection and analysis pharmacist respondents were females (92.0%) and they were
The questionnaires were distributed to the participants. A generally more aware of the importance of sun protection. In
brief description of the study and an invitation to participate our cohort, the practice of sunscreen use showed no
was provided in writing. After completing the questionnaires, significant differences between both genders as the majority
the participants were asked to return the questionnaire. of male (67.5%) and females (57.9%) do not have the
Participants were asked to convey any problems they face to practice of daily sunscreen use.
the investigator so that immediate changes can be made to
facilitate data collection. Responses to the questionnaire The assessment of knowledge about the use of sunscreen
items and questions were entered into IBM SPSS Statistics for showed that female respondents scored a higher percentage
Windows, Version 25.0. Armonk, NY: IBM Corp. for analysis of correct answer than the male respondents with a
of descriptive statistics. statistically significant association (p=0.011). This is possibly
due to the fact that females are more concerned on sun

RESULTS
protection and sunscreen use. There is a famous Asian belief
that ‘a fair skin can hide three facial flaws’.10 Asian females
Out of the total of 473 doctors and 80 pharmacists, 323 have long considered being fair as a desirable trait.10
(68.3%) doctors and 61 (76.3%) pharmacists returned the Therefore, they are more compliant to sun protection

Med J Malaysia Vol 76 No 2 March 2021 213

14-Knowledge00165_3-PRIMARY.qxd 3/14/21 12:09 PM Page 214

Original Article

Table I: Socio-demographic background of participants (N=384)

Doctors (n=323) Pharmacists (n=61)
Position– no. (%) House officers 142 (44.0) †PRP: 20 (33.0)
Medical officers 149 (46.1) ‡FRP: 41 (67.0)

Age– no. (%)

Specialist: 32 (9.9)

20 till 30 years old 206 (63.8) 44 (72.0)

31 till 40 years old 109 (33.7) 15 (25.0)
41 till 50 yeas old 7 (2.2) 2 (3.0)

Gender – no. (%)

51 till 60 years old 1 (0.3) 0 (0)

Male 170 (52.6) 5 (8.0)

Ethnicity – no. (%)

Female 153 (47.4) 56 (92.0)

Malay 172 (53.3) 24 (39.0)

Chinese 131 (40.5) 34 (56.0)
Indian 16 (5.0) 3 (5.0)

Status – no. (%)

Biracial/Others 4 (1.2) 0 (0)

Single 127 (39.3) 50 (82.0)

Married 138 (42.7) 11 (18.0)

Fitzpatrick Type – no. (%)

In a relationship 58 (18.0) 0 (0)

Type II & III 105 (32.5) 17 (28.0)

Type IV & V 218 (67.5) 44 (72.0)
Data are presented as number (%) of participants.
†PRP = Provisionally registered pharmacists; ‡FRP = Fully registered pharmacists.

Table II: Socio-demographic background of participants who completed the questionnaire (N=384)
Occupation – no. (%)
Doctor 323 (84.1)

Doctors – no. (%)

Pharmacist 61 (15.9)

House officers 142 (44.0)

Medical Officers 149 (46.1)

Pharmacist – no. (%)

Specialist 32 (9.9)

†PRP 20 (32.8)

Age – no. (%)

‡FRP 41 (67.2)

20 till 30 years old 250 (65.1)

31 till 40 years old 124 (32.3)
41 till 50 yeas old 9 (2.3)

Gender – no. (%)

51 till 60 years old 1 (0.3)

Male 175 (45.6)

Ethnicity – no. (%)

Female 209 (54.4)

Malay 196 (51.0)

Chinese 165 (43.0)
Indian 19 (4.9)

Status – no. (%)

Others 4 (1.1)

Single 177 (46.0)

Married 149 (38.9)

Fitzpatrick Type – no. (%)

In a relationship 58 (15.1)

Type II & III 122 (31.8)

Type IV & V 262 (68.2)
Data are presented as number (%) of participants.
†PRP = Provisionally registered pharmacists; ‡FRP = Fully registered pharmacists.

214 Med J Malaysia Vol 76 No 2 March 2021

14-Knowledge00165_3-PRIMARY.qxd 3/14/21 12:09 PM Page 215

Knowledge, attitude, practice and perception on sunscreen and skin cancer among doctors and pharmacists

Table III: Practice of sunscreen usage among doctors and pharmacists (N=384)
Questionnaires Doctors (n=323) Pharmacists (n=61) p values
Do you use sunscreen? – no. (%)
Yes 90 (27.9) 31 (51.0) <0.001
No 209 (64.7) 23 (38.0)

How frequently do you apply your sunscreen? – no. (%)

Occasionally 24 (7.4) 7 (11.0)

Occasionally 103 (31.9) 20 (33.0) <0.001

Every morning or evening 33 (10.2) 10 (16.0)
Once a day 122 (37.8) 25 (41.0)

When do you apply your sunscreen before sunlight

Every 4 hours 65 (20.1) 6 (10.0)

exposure? – no. (%)

Immediately before 55 (17.0) 14 (23.0) <0.001
30 minutes before 210 (65.0) 37 (61.0)

Influence to use sunscreen– no. (%)

60 minutes before 58 (18.0) 10 (16.0)

Media 128 (39.6) 16 (26.0) <0.001

Family 50 (15.5) 18 (30.0)
Friends 87 (27.0) 6 (10.0)
Health care professionals 41 (12.7) 12 (20.0)

Will you recommend the usage of sunscreen to others? – no. (%)

Others 17 (5.2) 9 (14.0)

Yes 209 (64.7) 42 (69.0) <0.001

No 76 (23.5) 4 (7.0)
Unsure 38 (11.8) 15 (24.0)
Data are presented as number (%) of participants.
p values are calculated based on Pearson Chi-square test.

Table IV: Attitude of sunscreen use among doctors and pharmacists (N=384)
Questionnaire Doctors (n=323) Pharmacists (n=61) p values
Will you encourage parents to apply sunscreen to their
< 6 months old baby? – no. (%)
Yes 131 (40.6) 6 (10.0) <0.001
No 173 (53.5) 55 (90.0)

Sunscreen is effective at preventing sunburn. – no. (%)

Unsure 19 (5.9) 0 (0)

Agree 256 (79.3) 58 (95.0) 0.012

Disagree 56 (17.3) 3 (5.0)

Sunscreen is effective in preventing skin cancer. – no. (%)

Unsure 11 (3.4) 0 (0)

Agree 302 (93.5) 58 (95.0) 0.008

Disagree 7 (2.2) 3 (5.0)

Sunscreen is effective at preventing skin aging. – no. (%)

Unsure 14 (4.3) 0 (0)

Agree 302 (93.5) 54 (89.0) 0.126

Disagree 7 (2.2) 7 (11.0)

Sunscreen is required on a cloudy or rainy day. – no. (%)

Unsure 14 (4.3) 0 (0)

Agree 227 (70.3) 44 (72.0) 0.035

Disagree 67 (20.7) 17 (28.0)

Sunscreen should be applied when going for outdoor activities

Unsure 29 (9.0) 0 (0)

during a cloudy day. – no. (%)

Agree 287 (88.9) 49 (80.0) <0.001
Disagree 19 (5.8) 12 (20.0)

Sunscreen should be applied when going for outdoor activities

Unsure 17 (5.3) 0 (0)

during a sunny day. – no. (%)

Agree 318 (98.5) 61 (100.0) 0.620
Disagree 1 (0.3) 0 (0)
Unsure 4 (1.2) 0 (0)
cont..... pg 216

Med J Malaysia Vol 76 No 2 March 2021 215

14-Knowledge00165_3-PRIMARY.qxd 3/14/21 12:10 PM Page 216

Original Article

cont from..... pg 215

Sunscreen should be applied when going swimming at the pool,
beach or waterfall. – no. (%)
Agree 315 (97.5) 61 (100.0) 0.462
Disagree 1 (0.3) 0 (0)

Sunscreen should be applied when attending lectures,

Unsure 7 (2.2) 0 (0)

working in hospital or any indoor activities. – no. (%)

Agree 230 (71.2) 45 (74.0) 0.003
Disagree 62 (19.2) 16 (26.0)

Sunscreen should be applied when attending any occasions

Unsure 31 (9.6) 0 (0)

at night. – no. (%)

Agree 114 (35.3) 21 (34.0) 0.142
Disagree 178 (55.1) 40 (66.0)

What does SPF stand for? – no. (%)

Unsure 31 (9.6) 0 (0)

Correct 217 (67.2) 40 (66.0) 0.806

Which of the following has higher risk of skin cancer? – no. (%)
Incorrect 106 (32.8) 21 (34.0)

UVA 182 (56.3) 35 (57.0) 0.018

UVB 106 (32.8) 26 (43.0)

If one is working in-door (e.g. Office job), one does not

Unsure 35 (10.9) 0 (0)

need to wear sunscreen. – no. (%)

Agree 167 (51.7) 45 (74.0) <0.001
Disagree 128 (39.6) 16 (26.0)

Melanoma is a form of skin cancer. – no. (%)

Unsure 28 (8.7) 0 (0)

Agree 315 (97.5) 58 (95.0) 0.294

Disagree 8 (2.5) 3 (5.0)

Wearing sunscreen can cause vitamin D deficiency– no. (%)

Unsure 0 (0) 0 (0)

Agree 26 (8.1) 8 (13.0) 0.019

Disagree 264 (81.7) 53 (87.0)
Unsure 33 (10.2) 0 (0)
p values are calculated based on Pearson Chi-square test.

Table V: Sunscreen and skin cancer knowledge scores among different sub-group
Scores Sunscreen knowledge scores P values
Median (IQR)
Occupation– no. (%)
Doctors 11.0 (2.0) 0.008
Pharmacists 12.0 (3.0)
Gender– no. (%)
Male 11.0 (2.0) 0.011
Female 12.0 (3.0)
Age– no. (%)
20 till 30 years old 11.0 (3.0) 0.993
31 till 40 years old 11.0 (2.0)
41 till 50 yeas old 12.0 (3.0)
51 till 60 years old 13.0 §
Ethnicity– no. (%)
Malay 11.0 (3.0) <0.001
Chinese 11.0 (3.0)
Indian 9.0 (3.0)
Others 7.5 (4.0)
Status– no. (%)
Single 12.0 (3.0) 0.668
Married 11.0 (2.0)
In a relationship 11.0 (3.0)
Fitzpatrick Type– no. (%)
Type II & III 11.5 (4.0) 0.007
Type IV & V 11.0 (2.0)
p values are calculated based on Pearson Chi-square test.
We applied non parametric test since normality assumptions is not assumed.
§There is only one respondent in the 51 till 60 years old category.

216 Med J Malaysia Vol 76 No 2 March 2021

14-Knowledge00165_3-PRIMARY.qxd 3/14/21 12:10 PM Page 217

Knowledge, attitude, practice and perception on sunscreen and skin cancer among doctors and pharmacists

measures and sunscreen use. This finding was also reported 48459. All respondents gave their informed consent prior to
by Ammar Ihsan Awadh et. al where females in their cohort their participation in this study.
are more concerned about the usage of sunscreen use and

ACKNOWLEDGEMENT
tend to use it more regularly than male respondents.9 On the
other hand, pharmacists reported a higher percentage of
correct answer than doctors although this did not reach We would like to thank Mr. Mohd Adam Bin Hj. Bujang,
statistical significance (p=0.008). biostatistician of Clinical Research Centre (CRC), Hospital
Umum Sarawak, Kuching, Sarawak, Malaysia for his
Majority of the doctors (65.0%) and pharmacists (61.0%) guidance. The authors would like to thank our Director
were aware of the correct timing to apply sunscreen before General of Health Malaysia for his permission to publish this
sunlight exposure and the need to apply sunscreen even article.
when working indoors. The correct time required to apply

CONFLICT OF INTEREST
sunscreen before going out is 30 minutes. The majority of the
respondents in our cohort were well aware with the fact that
sunscreen is effective in preventing sunburn, skin cancer and The authors hereby certify that the work which was reported
skin aging. The benefits of sunscreen usage include herein had not received any financial support from any
prevention of sunburn, skin cancer, wrinkling, ageing, pharmaceutical company or other commercial source and
pigmentary disorder and photo-dermatoses.6,11 neither the authors nor any first degree relatives have any
special financial interest in the subject matter discussed in
Majority of the respondents (56.3% doctors and 57.0% our manuscript.
pharmacists) were unaware of that UVB is responsible for

REFERENCES
more skin cancers than UVA. SQ Wang, et al. reported that
majority of the participants in New Jersey did not understand
the subtle but crucial differences between UVA claim for a 1. Verena S, Oliver W, Amir Y, Frauke B, Klaus D, Martin R, et al.
product and the sun protection factor (SPF) value listed on the Prevention of polymorphic light eruption with a sunscreen of
product.13 Compared to UVA, UVB have a shorter wavelength very high protection level against UVB and UVA radiation under
standardized photodiagnostic conditions. Acta Derm Venereol
but higher energy which could damage the outermost skin
2008; 88(6): 555-60.
layers and directly lead to skin cancer.14 Sun protection factor 2. Divya RS, Desiree R. Sunscreens: An overview and update. J Am
(SPF) is a measure of effectiveness of sunscreen in preventing Acad Dermatol 2011; 64(4): 748-58.
UVB in reaching the skin. The majority of respondents (67.2% 3. Maria CBH, Gail MW, Peter B, Adele CG. Sunscreen and
doctors and 66.0% pharmacists) were aware of the meaning prevention of skin aging: a randomized trial. Ann Intern Med
of SPF and choose a sunscreen based on its SPF value. 2013; 158: 781(11): 781-90.
4. A Fourtanier, D Moyal, S Seite. UVA filters in sun-protection
The majority of doctors (81.7%) and pharmacists (87%) were products: Regulatory and biological aspects. Photochem
Photobiol Sci 2012; 11: 81.
well aware that wearing sunscreen does not cause vitamin D
5. Rob T, Joel H, Chelle G, Jennifer G. Examination of cognitive
deficiency. R. E. Neale et al. in the effect of sunscreen on variables relevant to sunscreen use. Journal of Behavioural
vitamin D: a review reported that there is little evidence that Medicine 1999; 22: 493-509.
sunscreen decreases 25(OH)D concentration and suggested 6. Redhwan AA, Thekra HA, Yuri VB. Perceptions and opinions
that skin cancer prevention advice should not be neglected.15 towards skin cancer prevention in Malaysia: A qualitative
approach. Asian Pac J Cancer Prev 2011; 12(4): 995-9.

STUDY LIMITATION
7. Sambandan DR, Ratner D. Sunscreens: an overview and update.
J Am Acad Dermatol 2011; 64: 748.
8. Brian D. Has the sun protection factor had its day? British
This is a single centre among doctors and pharmacists who
Medical Journal 2000; 320:176-7.
had participated voluntarily. This data does not reflect the 9. Ammar IA, Shazia J, Ramadan ME, Hazrina H. The use of
entire cohort of doctors and pharmacists working in this sunscreen products among final year medicine and pharmacy
centre. Thus, results are not representative of all the hospital students: A cross-sectional study of knowledge, attitude, practice,
in Johor or in Malaysia as a whole. and perception. J Res Pharm Pract Jul-Sep; 5(3): 193-9.
10. Angela KYM. Advertising whiteness: An assessment of skin color

CONCLUSION
preferences among urban Chinese. Visual Communications 2017
Q. 14: 144-57.
11. Stephan L, Hans CW, Mark RP. Photoprotection. Lancet 2007;
This study demonstrated that there is a lack of knowledge on
370(9586): 528-37.
sunscreen and skin cancer among health care providers in 12. Catherine MO, Bridie ST, Adele CG, Rachel EN, David CW. QSkin
this study. We propose a more structured continuous Sun and Health Study Group. Sun Protection and Skin
education programme to improve the sunscreen and skin Examination Practices in a Setting of High Ambient Solar
cancer knowledge among health care providers. With Radiation: A Population-Based Cohort Study. JAMA Dermatol
adequate sun protection and skin cancer knowledge, we can 2015; 151: 982.
disseminate the information to patients and together reduce 13. SQ Wang, SW Dusza. Assessment of sunscreen knowledge: A
the detrimental effects of sunlight on human skin. pilot survey. British Journal of Dermatol 2009 November; 161
Supplementary 3: 28-32.
14. Hao OY, Joseph S, Curtis C, Yohini A. An evaluation of ultraviolet

ETHICAL APPROVAL
A protection and photo-stability of sunscreens marketed in
Australia and New Zealand. Photodermatol Photoimmunol
This study was approved by the Ministry of Health Research Photomed 2010; 26(6): 336-7.
Ethics Committee (MREC) and the National Medical Research 15. RE Neale, SR Khan, RM Lucas, M Waterhouse, DC Whiteman,
Registry with the registration number of NMRR-19-1470- CM Oslen. The effect of sunscreen on vitamin D: a review. British
Journal of Dermatology 2019: 181(5): 907-15.

Med J Malaysia Vol 76 No 2 March 2021 217