Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2025;15(2): 4996 1 Sun Protection Knowledge and Practices in Fifth-year Medical Students: Impact of Gender, Sunburn Experience and Sunscreen Use Funda Tamer1, Emre Guven1, Esra Adisen1 1 Gazi University School of Medicine, Department of Dermatology, Ankara, Turkey Key words: Behaviors, Gender differences, Medical students, Sun protection, Sunburn Citation: Tamer F, Guven E, Adisen E. Sun Protection Knowledge and Practices in Fifth-year Medical Students: Impact of Gender, Sunburn Experience and Sunscreen Use. Dermatol Pract Concept. 2025;15(2): 4996. DOI: https://doi.org/10.5826/dpc.1502a4996 Accepted: November 24, 2024; Published: April 2025 Copyright: ©2025 Tamer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Ethical Approval and Informed Consent: Gazi University Ethics Committee approved this study (approval number: 2023-1185, Date:10.03.2023). Informed consent was obtained from the participants. Corresponding Author: Funda Tamer. Address: Gazi Universitesi Hastanesi. Emniyet Mahallesi, No:29, 06560 Ankara/ Turkey. ORCID ID: 0000-0003-4157-5583. E-mail: fundatmr@yahoo.com. Introduction: Ultraviolet exposure is the most important modifiable risk factor for developing skin cancer. Objectives: We evaluated the knowledge and behaviors of medical students regarding sun protection. Methods: Between October 2023 and May 2024, fifth-year medical students filled a questionnaire on sun protection. Results: This study included 255 students: 134 males and 121 females. Among them, 100 (39.2%) students stated that they always used sunscreen, 43.1% used sunscreen on sunny days and in the win- ter, whereas 42% applied it only to the face. Of the 135 students who knew the two-finger technique, 99 stated that they had learned this information from social media, and 218 (85.5%) took at least one other sun protection measure. In females, wearing sunscreen (P<0.001), reapplying it (P=0.003), using it in winter (P<0.001), knowing the two-finger technique (P<0.001), and taking other sun protection measures (P=0.020) were more frequent and duration of sunscreen use was longer (P<0.001) compared to males. Sunburn was more common in males and in those who stated that they did not go out during peak sun time (P=0.013, P=0.017, respectively). Statements on sun protection were similar in both sexes. For instance, 95.9% of females and 96.3% of males revealed that sun protection prevents skin cancer. Conclusion: Although females used sunscreen and applied other sun protection methods more fre- quently than did males, appropriate sunscreen use was inadequate among all students. Updating the curriculum and providing educational social media sites where reliable information can be obtained may improve medical students’ sun protection habits. ABSTRACT 2 Original Article | Dermatol Pract Concept. 2025;15(2): 4996 Introduction Skin cancers are common malignancies and are grouped as melanoma and non-melanoma skin cancers. It has been re- ported that the incidence of melanoma and non-melanoma skin cancers has been increasing. Ultraviolet (UV) radiation is the main factor in the development of cutaneous malig- nancies [1]. Excessive sun exposure has been implicated as a causative agent in approximately 90% of patients with melanoma [2]. Especially getting sunburned and sun expo- sure during adolescence and adulthood have a direct rela- tionship with increased risk of melanoma in one’s lifetime. Although various factors such as family history, Fitzpat- rick skin type, and immunosuppression play a role in the etiopathogenesis of cutaneous malignancies, UV exposure is the most important modifiable risk factor for melanoma occurrence [1,2]. Various methods have been suggested to prevent the harmful effects of UV radiation, such as using sunscreen, seeking shade, and wearing protective clothing. Proper use of sunscreen not only prevents skin cancer but also delays photoaging and contributes to the treatment of various skin diseases such as pigmentation disorders. Efforts are being made to raise awareness about sun protection through social projects and educational programs [3]. However, it has been suggested that more than half of college students reported sunburn in the previous year [2]. Improper use of sunscreens and inadequate photoprotection have been reported in uni- versity students, even in countries that receive high levels of UV radiation. Despite advances in medicine and high access to information, skin cancers remain an important public health problem due to their increasing frequency and the high mortality rate, especially in melanoma. Therefore, considering the knowledge especially of young individuals on the effects of UV radiation on health and sun protection practices is crucial to developing successful educational pro- grams [4]. Objectives Within this study, we aimed to evaluate the knowledge and behaviors of fifth-year medical students regarding sun pro- tection. Since sun protection habits in this age group signifi- cantly affect the risk of developing skin cancer in the future, and medical doctors who will work in primary health care institutions immediately after graduation play an important role in raising the awareness of society about sun protection and in the management of skin cancer, our study aimed to provide useful information to review and update the medical school curriculum on dermatology and to contribute to skin cancer management. Methods Gazi University Ethics Committee approved this study (ap- proval number: 2023-1185, date: 10.03.2023). It takes six years to graduate from medical school in our country. The dermatology course is given to all 5th-year medical students for a 3-week period during each academic year. Between Oc- tober 2023 and May 2024, fifth-year medical students were included in this study, before the course in dermatology. The study was conducted prospectively. Age, sex, past medical history of skin diseases, systemic diseases and sunburn, so- larium use, regular medication use, and family history of skin cancer or other skin diseases were noted. Fitzpatrick skin phototypes of the students were also examined [5]. The students completed a 14-item questionnaire assessing their knowledge and behaviors on sun protection, as stated below. • Question 1 (Q1): Do you wear sunscreen? (yes/ no). • Q2: How long have you been wearing sunscreen? • Q3: Do you wear sunscreen in winter? (yes/ no). • Q4: How often do you wear sunscreen? (always/ sometimes). • Q5: Do you apply sunscreen on sun-exposed body areas other than the face? (yes/ no). • Q6: How long before going out do you apply sunscreen? (just before going out/ within 30 minutes before going out/ after more than 30 minutes). • Q7: Do you reapply sunscreen throughout the day? (yes/ no). • Q7: What sun protection factor (SPF) do you use? (SPF less than 50/ SPF 50 and over). • Q8: Do you know the “two-finger” technique used to ap- ply adequate sunscreen? (yes/ no) [6]. • Q9: From what source did you learn the “two-finger” technique? (academic publications/ social media/ family/ friends/ other). • Q10: Do you use the “two-finger” technique when apply- ing sunscreen? (yes/ no). • Q11: On which part of your body do you use the “two-finger” technique when applying sunscreen? (face/ other body parts). • Q12: Do you take any sun protective measures other than using sunscreen? (yes/ no). • Q13: If yes, specify: Wide-brimmed hats/ UV protective glasses/ umbrella/ long-sleeved and -legged clothes/ prefer- ring shady areas/ not going out in peak sun time (yes/ no). • Q14: Please mark your opinion regarding statements on sun protection: Sun protection prevents skin cancer/ Sun protection reduces skin aging/ Sunscreen use is recom- mended for the treatment of some skin diseases/ When you apply sunscreen and go out in the sun, the harmful Original Article | Dermatol Pract Concept. 2025;15(2): 4996 3 effects of the sun are completely blocked/ Applying sun- screen blocks vitamin D synthesis (yes/ no/ no idea). In the “two-finger” technique, the amount of sunscreen applied along the index finger and middle finger constitutes a sufficient amount applied to 9% of the body surface area, such as the face, head, and neck region [6]. Statistical analy- sis was performed using SPSS version 29. Quantitative vari- ables are expressed as mean ± standard deviation or median (interquartile range). Categorical variables are presented as counts and percentages. Kolmogorov-Smirnov test was used to assess the normality of the distribution of the data. The Mann- Whitney test, chi-squared test, and independent-samples t-test were used to determine the differences between the groups. P-values of <0.05 were considered statistically significant. Results This study included 255 students: 134 (52.5%) males and 121 (47.5%) females. The mean age of the students was 23±1.22 years (range: 21-32 years). The students mostly (40.4%) had Fitzpatrick skin phototype 3. The characteris- tics of the participants are stated in Table 1. A total of 185 (72.5%) students wore sunscreen. The median duration of sunscreen use was three years (range: 1-15 years); 172 (67.5%) students stated that they used sunscreen with SPF values of 50 and over. Nevertheless, 90 (35.3%) participants revealed that they had sunburn. The sun protection behav- iors of the participants are stated in Table 2. When students’ knowledge and behaviors regarding sun protection were evaluated by sex, it was determined that sunscreen use was more frequent in females than in males (P<0.001). Further- more, sunscreen use in winter (P<0.001) and reapplying it throughout the day (P=0.003) were more frequent in females (Table 3). Student characteristics and sun protection habits were also evaluated according to whether they had sunburn or not (Table 4). Among the students who developed sun- burn, 33 (27.3%) were females and 57 (42.5%) were males (P=0.013). No significant difference in Fitzpatrick skin types was observed between students with and without sunburn (P=0.063). Nevertheless, 29 (32.2%) students with sun- burn and 29 (17.6%) without sunburn had comorbidities (P=0.008). When students who used and those who did not use sunscreen were compared, it was determined that those who used sunscreen also took other sun protection mea- sures more frequently (P=0.007). Sunscreen use was more frequent among students who stated that sun protection reduces skin aging (P=0.009) (Table 5). The mean duration of sunscreen use was 4.54±2.96 years in those who always used sunscreen and 2.68±1.91 years in those who sometimes used it (P<0.001). No statistically significant difference was observed between students with and without skin disease Table 1. Characteristics of the Fifth-Year Medical Students Included in This Study. Participants (N=255) Sex, N (%) Male: 134 (52.5) Female: 121 (47.5) Age (mean±SD) (range), years 23±1.22 (21-32) Fitzpatrick skin phototype, N (%) 2: 60 (23.5) 3: 103 (40.4) 4: 79 (31) 5: 11 (4.3) 6: 2 (0.8) Medical history, N (%) Unremarkable: 197 (77.3) Acne: 21 (8.2) Seborrheic dermatitis: 6 (2.4) Urticaria: 5 (2) Depression: 5 (2) Hypothyroidism: 5 (2) Atopic dermatitis: 3 (1.2) Contact dermatitis: 3 (1.2) Diabetes: 2 (0.8) Vitiligo: 2 (0.8) Migraine: 2 (0.8) Alopecia areata: 1 (0.4) Lichen planopilaris: 1 (0.4) Keloid: 1 (0.4) Keratosis pilaris: 1 (0.4) Medication use, N (%) None: 233 (91.4) Levothyroxine: 5 (2) Antidepressants: 5 (2) Oral isotretinoin: 4 (1.6) Antihistamines: 4 (1.6) Metformin: 2 (0.8) Topical tretinoin: 2 (0.8) Family history, N (%) Unremarkable: 221 (86.7) Psoriasis: 10 (3.9) Contact dermatitis: 6 (2.4) Vitiligo: 4 (1.6) Seborrheic dermatitis: 4 (1.6) Atopic dermatitis: 3 (1.2) Rosacea: 3 (1.2) Basal cell carcinoma: 2 (0.8) Lichen planus: 1 (0.4) Melanoma: 1 (0.4) Most of the students (40.4%) had Fitzpatrick skin phototype 3, followed by phototype 4 (31%). Of the 255 students, 197 had un- remarkable medical history, whereas the most common comorbidity was acne. Abbreviation: SD = standard deviation. or between students with and without a family history of skin disease in terms of Fitzpatrick skin phototype (P=0.324, P=0.567, respectively), taking other sun protection measures (P=0.404, P=0.578, respectively), use of sunscreen in win- ter (P=0.757, P=0.376, respectively), frequency of sunscreen use (P=0.685, P=0.614, respectively), sunscreen use on areas other than face (P=0.154, P=0.429, respectively), reapplying 4 Original Article | Dermatol Pract Concept. 2025;15(2): 4996 Table 2. Knowledge and Behaviors of Medical Students Regarding Sun Protection. Participants (N=255) Sunburn, N (%) Yes: 90 (35.3) No: 165 (64.7) Indoor tanning use, N (%) Yes: 3 (1.2) No: 252 (98.8) Sunscreen use, N (%) Yes: 185 (72.5) No: 70 (27.5) Duration of sunscreen use, median (IQR) 3 (3) years (range: 1-15 years) The frequency of sunscreen use, N (%) Always: 100 (39.2) Sometimes: 85 (33.3) Time of applying sunscreen before going out, N (%) Within 30 minutes before going out: 124 (48.6) Just before going out: 48 (18.8) More than 30 minutes: 13 (5.1) SPF value of the sunscreen used, N (%) SPF ≥50: 172 (67.5) SPF <50: 13 (5.1) Reapplying sunscreen throughout the day, N (%) Yes: 35 (13.7) No: 150 (58.8) Sunscreen use on areas other than face, N (%) Yes: 78 (30.6) students apply sunscreen on the body areas exposed to sun other than face No: 107 (42) apply sunscreen only to the face Sunscreen use in winter, N (%) Yes: 110 (43.1) students use sunscreen both on sunny days and in the winter No: 75 (29.4) use sunscreen only in the summer Know the “two fingers” technique, N (%) Yes: 135 (52.9) No: 120 (47.1) Sources that “two-finger” technique was learned, N (%) Social media: 99 (38.8) Friends: 14 (5.5) Academic publications: 13 (5.1) School: 8 (3.1) Family members: 1 (0.4) Using “two-finger” technique when applying sunscreen, N (%) Yes: 101 (39.6) No: 34 (13.3) Body areas where the “two-finger” technique is used when applying sunscreen, N (%) Face: 101 (39.6) Other body parts: 0 Taking other sun protection measures, N (%) No: 37 (14.5) Yes: 218 (85.5) • Wide-brimmed hats Yes: 68 (26.7) No: 187 (73.3) • UV protective glasses Yes: 104 (40.8) No: 151 (59.2) • Umbrella Yes: 14 (5.5) No: 241 (94.5) • Long-sleeved and -legged clothes Yes: 93 (36.5) No: 162 (63.5) • Preferring shady areas Yes: 207 (81.2) No: 48 (18.8) • Not going out in the sun Yes: 159 (62.4) No: 96 (37.6) Original Article | Dermatol Pract Concept. 2025;15(2): 4996 5 Participants (N=255) Statements on sun protection, N (%) • Sun protection prevents skin cancer Yes: 245 (96.1) No: 4 (1.6) No idea: 6 (2.4) • Sun protection reduces skin aging Yes: 248 (97.3) No: 3 (1.2) No idea: 4 (1.6) • Sunscreens are used to treat skin diseases Yes: 215 (84.3) No: 7 (2.7) No idea: 33 (12.9) • Sunscreens completely block the harmful effects of the sun Yes: 6 (2.4) No: 225 (88.2) No idea: 24 (9.4) • Sunscreens block vitamin D synthesis Yes: 70 (27.5) No: 130 (51) No idea: 55 (21.6) While 72.5% of students revealed that they used sunscreen, the rate of those who always used it was only 39.2%. On the other hand, 99 of 135 students stated that they learned the “two-finger” technique from social media. It is also noteworthy that indoor tanning use was quite rare among students (1.2%). Abbreviations: IQR: interquartile range; SPF: sun protection factor; UV: ultraviolet. Table 2. Knowledge and Behaviors of Medical Students Regarding Sun Protection. (continued) Table 3. Comparison of Knowledge and Behaviors of Female and Male Students on Sun Protection. Females, N (%) Males, N (%) P-value Age, mean±SD (range) years 23.06±1.09 (22-28) 23.39±1.32 (21-32) 0.051 Medical history Unremarkable: 92 (76) Had a comorbidity: 29 (24) Unremarkable: 105 (78.4) Had a comorbidity: 29 (21.6) 0.659 Family history Unremarkable: 104 (86) Remarkable for a skin disease: 17 (14) Unremarkable: 117 (87.3) Remarkable for a skin disease: 17 (12.7) 0.750 Fitzpatrick skin phototype 2: 32 (26.4) 3: 46 (38) 4: 40 (33.1) 5: 3 (2.5) 2: 28 (20.9) 3: 57 (42.5) 4: 39 (29.1) 5: 8 (6) 6: 2 (1.5) 0.372 Sunburn Yes: 33 (27.3) No: 88 (72.7) Yes: 57 (42.5) No: 77 (57.5) 0.011 Sunscreen use Yes: 119 (98.3) No: 2 (1.7) Yes: 66 (49.3) No: 68 (50.7) <0.001 Duration of sunscreen use, median (IQR) 3 (3) years (range: 1-15) 2 (2.25) years (range: 1-10) <0.001 The frequency of sunscreen use Always: 91 (76.5) Sometimes: 28 (23.5) Always: 9 (13.6) Sometimes: 57 (86.4) <0.001 Time of applying sunscreen before going out Within 30 minutes before going out: 92 (77.3) Just before going out: 18 (15.1) More than 30 minutes: 9 (7.6) Within 30 minutes before going out: 32 (48.5) Just before going out: 30 (45.5) More than 30 minutes: 4 (6.1) <0.001 SPF value of the sunscreen used SPF ≥50: 113 (95) SPF <50: 6 (5) SPF ≥50: 59 (89.4) SPF <50: 7 (10.6) 0.157 Table 3 continues 6 Original Article | Dermatol Pract Concept. 2025;15(2): 4996 Females, N (%) Males, N (%) P-value Reapplying sunscreen Yes: 30 (25.2) No: 89 (74.8) Yes: 5 (7.6) No: 61 (92.4) 0.003 Sunscreen use on areas other than face Yes: 50 (42) No: 69 (58) Yes: 28 (42.4) No: 38 (57.6) 0.957 Sunscreen use in winter Yes: 98 (82.4) No: 21 (17.6) Yes: 12 (18.2) No: 54 (81.8) <0.001 Know the “two-finger” technique Yes: 106 (87.6) No: 15 (12.4) Yes: 29 (21.6) No: 105 (78.4) <0.001 Using “two-finger” technique when applying sunscreen Yes: 87 (82.1) No: 19 (17.9) Yes: 14 (48.3) No: 15 (51.7) <0.001 Taking other sun protection measures Yes: 110 (90.9) No: 1 (9.1) Yes: 108 (80.6) No: 26 (19.4) 0.020 Wide-brimmed hats Yes: 35 (28.9) No: 86 (71.1) Yes: 33 (24.6) No: 101 (75.4) 0.439 UV protective glasses Yes: 58 (47.9) No: 63 (52.1) Yes: 46 (34.3) No: 88 (65.7) 0.028 Umbrella Yes: 4 (3.3) No: 117 (96.7) Yes: 10 (7.5) No: 124 (62.5) 0.146 Long-sleeved and -legged clothes Yes: 54 (44.6) No: 67 (55.4) Yes: 39 (29.1) No: 95 (70.9) 0.010 Preferring shady areas Yes: 106 (87.6) No: 15 (12.4) Yes: 101 (75.4) No: 33 (24.6) 0.013 Not going out in the sun Yes: 76 (62.8) No: 45 (37.2) Yes: 83 (61.9) No: 61 (38.1) 0.886 Statements on sun protection Sun protection prevents skin cancer Yes: 116 (95.9) No: 2 (1.7) No idea: 3 (2.5) Yes: 129 (96.3) No: 2 (1.5) No idea: 3 (2.2) 0.869 Sun protection reduces skin aging Yes: 118 (97.5) No: 1 (0.8) No idea: 2 (1.7) Yes: 130 (97) No: 2 (1.5) No idea: 2 (1.5) 0.810 Sunscreens are used to treat skin diseases Yes: 102 (84.3) No: 3 (2.5) No idea: 16 (13.2) Yes: 113 (84.3) No: 4 (3) No idea: 17 (12.7) 0.981 Sunscreens completely block the harmful effects of the sun Yes: 1 (0.8) No: 115 (95) No idea: 5 (4.1) Yes: 5 (3.7) No: 110 (82.1) No idea: 19 (14.2) 0.077 Sunscreens block vitamin D synthesis Yes: 39 (32.2) No: 61 (50.4) No idea: 21 (17.4) Yes: 31 (23.1) No: 69 (51.5) No idea: 34 (25.4) 0.051 Males were more prone to sunburn (P=0.011), while sunscreen use was more common in females (P<0.001). Females used sunscreen for longer periods of time than did males (P<0.001) and reapplied it more frequently (P=0.003). Furthermore, females were more likely to use the “two-finger” technique when applying sunscreen (P<0.001). Abbreviations: IQR = interquartile range; SD = standard deviation; SPF = sun protection factor; UV = ultraviolet. Table 3. Comparison of Knowledge and Behaviors of Female and Male Students on Sun Protection. (continued) sunscreen (P=0.766, P=0.925, respectively), and SPF value of the sunscreen used (P=0.285, P=0.687, respectively). Stu- dents who knew the “two-finger” technique were more likely to use sunscreen in winter, always use sunscreen, and take other sun protection methods than those who did not know the “two-finger” technique (P<0.001, each). Furthermore, of the participants who used sunscreen in winter, 96 (87.3%) always used sunscreen; of the participants who did not use sunscreen in winter, four (5.3%) always used it (P<0.001); 26 (23.6%) of those who used sunscreen in winter and nine (12%) of those who did not state that they reapplied sun- screen (P=0.048). Twenty-six (33.3%) students who applied Original Article | Dermatol Pract Concept. 2025;15(2): 4996 7 Table 4. Sun Protection Behaviors of Participants According to Whether They Have Had a Sunburn or Not. Had sunburn, N (%) No sunburn, N (%) P-value Sex Female: 33 (27.3) Male: 57 (42.5) Female: 88 (72.7) Male: 77 (57.5) 0.013 Medical history Unremarkable: 61 (67.8) Had a comorbidity: 29 (32.2) Unremarkable: 136 (82.4) Had a comorbidity: 29 (17.6) 0.008 Family history Unremarkable: 78 (86.7) Remarkable for a skin disease: 12 (13.3) Unremarkable: 143 (86.7) Remarkable for a skin disease: 22 (13.3) 1.000 Sunscreen use Yes: 59 (31.9) No: 31 (44.3) Yes: 126 (68.1) No: 39 (55.7) 0.078 The frequency of sunscreen use Always: 30 (50.8) Sometimes: 29 (49.2) Always: 70 (55.6) Sometimes: 56 (44.4) 0.550 Time of applying sunscreen before going out Within 30 minutes before going out: 40 (67.8) Just before going out: 15 (25.4) More than 30 minutes: 4 (6.8) Within 30 minutes before going out: 84 (66.7) Just before going out: 33 (26.2) More than 30 minutes: 9 (7.1) 0.953 SPF value of the sunscreen used SPF ≥50: 54 (91.5) SPF <50: 5 (8.5) SPF ≥50: 118 (93.7) SPF <50: 8 (6.3) 0.599 Reapplying sunscreen Yes: 12 (20.3) No: 47 (79.7) Yes: 23 (18.3) No: 103 (81.7) 0.736 Sunscreen use on areas other than face Yes: 23 (39) No: 36 (61) Yes: 55 (43.7) No: 71 (56.3) 0.550 Sunscreen use in winter Yes: 34 (57.6) No: 25 (42.4) Yes: 76 (60.3) No: 50 (39.7) 0.729 Know the “two-finger” technique Yes: 42 (46.7) No: 48 (53.3) Yes: 93 (56.4) No: 72 (43.6) 0.139 Taking other sun protection measures Yes: 79 (87.8) No: 11 (12.2) Yes: 139 (84.2) No: 26 (15.8) 0.445 Wide-brimmed hats Yes: 23 (25.6) No: 67 (74.4) Yes: 45 (27.3) No: 120 (72.7) 0.767 UV protective glasses Yes: 39 (43.3) No: 51 (56.7) Yes: 65 (39.4) No: 100 (60.6) 0.542 Umbrella Yes: 6 (6.7) No: 84 (93.3) Yes: 8 (4.8) No: 157 (95.2) 0.543 Long-sleeved and -legged clothes Yes: 29 (32.2) No: 61 (67.8) Yes: 64 (38.8) No: 101 (61.2) 0.299 Preferring shade areas Yes: 76 (84.4) No: 14 (15.6) Yes: 131 (79.4) No: 34 (20.6) 0.325 Not going out in the sun Yes: 65 (72.2) No: 25 (27.8) Yes: 94 (57) No: 71 (43) 0.017 Statements on sun protection Sun protection prevents skin cancer Yes: 87 (96.7) No: 0 No idea: 3 (3.3) Yes: 158 (95.8) No: 4 (2.4) No idea: 3 (1.8) 0.745 Sun protection reduces skin aging Yes: 87 (96.7) No: 0 No idea: 3 (3.3) Yes: 161 (97.6) No: 3 (1.8) No idea: 1 (0.6) 0.651 Sunscreens are used to treat skin diseases Yes: 77 (85.6) No: 3 (3.3) No idea: 10 (11.1) Yes: 138 (83.6) No: 4 (2.4) No idea: 23 (13.9) 0.659 Table 4 continues 8 Original Article | Dermatol Pract Concept. 2025;15(2): 4996 Had sunburn, N (%) No sunburn, N (%) P-value Sunscreens completely block the harmful effects of the sun Yes: 1 (1.1) No: 81 (90) No idea: 8 (8.9) Yes: 5 (3) No: 144 (87.3) No idea: 16 (9.7) 0.823 Sunscreens block vitamin D synthesis Yes: 27 (30) No: 39 (43.3) No idea: 24 (26.7) Yes: 43 (26.1) No: 91 (55.2) No idea: 31 (18.8) 0.705 Sunburn was more common in males (42.5%) than in females (27.3%) (P=0.013). In addition, healthy participants were more likely to get sunburned compared to those with comorbidities (P=0.008). Abbreviations: SPF = sun protection factor; UV = ultraviolet. Table 4. Sun Protection Behaviors of Participants According to Whether They Have Had a Sunburn or Not. (continued) Table 5. Comparison of Students Who Stated That They Used and Did Not Use Sunscreen. Use sunscreen, N (%) No sunscreen use, N (%) P-value Medical history Remarkable for a skin disease: 35 (18.9) Unremarkable: 150 (81.1) Remarkable for a skin disease: 8 (11.4) Unremarkable: 62 (88.6) 0.155 Family history Remarkable for a skin disease: 22 (11.9) Unremarkable: 163 (88.1) Remarkable for a skin disease: 12 (17.1) Unremarkable: 58 (82.9) 0.272 Sunburn Yes: 59 (31.9) No: 126 (68.1) Yes: 31 (44.3) No: 39 (55.7) 0.065 Fitzpatrick skin phototype 2: 43 (23.2) 3: 77 (41.6) 4: 61 (33) 5: 4 (2.2) 2: 17 (24.3) 3: 26 (37.1) 4: 18 (25.7) 5: 7 (10) 6: 2 (2.9) 0.456 Taking other sun protection measures Yes: 165 (89.2) No: 20 (10.8) Yes: 53 (75.7) No: 17 (24.3) 0.007 Wide-brimmed hats Yes: 54 (29.2) No: 131 (70.8) Yes: 14 (20) No: 56 (80) 0.139 UV protective glasses Yes: 91 (49.2) No: 94 (50.8) Yes: 13 (18.6) No: 57 (81.4) <0.001 Umbrella Yes: 12 (6.5) No: 173 (93.5) Yes: 2 (2.9) No: 68 (97.1) 0.257 Long-sleeved and -legged clothes Yes: 76 (41.1) No: 109 (58.9) Yes: 17 (24.3) No: 53 (75.7) 0.013 Preferring shady areas Yes: 157 (84.9) No: 28 (15.1) Yes: 50 (71.4) No: 20 (28.6) 0.014 Not going out in the sun Yes: 119 (64.3%) No: 66 (35.7%) Yes: 40 (57.1%) No: 30 (42.9%) 0.292 Statements on sun protection Sun protection prevents skin cancer Yes: 179 (96.8) No: 2 (1.1) No idea: 4 (2.2) Yes: 66 (94.3) No: 2 (2.9) No idea: 2 (2.9) 0.371 Sun protection reduces skin aging Yes: 183 (98.9) No: 0 No idea: 2 (1.1) Yes: 65 (92.9) No: 3 (4.3) No idea: 2 (2.9) 0.009 Sunscreens are used to treat skin diseases Yes: 158 (85.4) No: 5 (2.7) No idea: 22 (11.9) Yes: 57 (81.4) No: 2 (2.9) No idea: 11 (15.7) 0.428 Original Article | Dermatol Pract Concept. 2025;15(2): 4996 9 Use sunscreen, N (%) No sunscreen use, N (%) P-value Sunscreens completely block the harmful effects of the sun Yes: 3 (1.6) No: 168 (90.8) No idea: 14 (7.6) Yes: 3 (4.3) No: 57 (81.4) No idea: 10 (14.3) 0.361 Sunscreens block vitamin D synthesis Yes: 52 (28.1) No: 93 (50.3) No idea: 40 (21.6) Yes: 18 (25.7) No: 37 (52.9) No idea: 15 (21.4) 0.815 Students who used sunscreen (89.2%) took other sun protection measures more frequently than students who did not use sunscreen (75.7%) (P=0.007). Among them, wearing UV protective glasses (P<0.001), long-sleeved and -legged clothes (P=0.013), and preferring shady areas (P=0.014) were prominent. Abbreviation: UV = ultraviolet. Table 5. Comparison of Students Who Stated That They Used and Did Not Use Sunscreen. (continued) sunscreen on areas other than the face and nine (8.4%) of those who applied sunscreen only to the face stated that they reapplied sunscreen (P<0.001). Taking other sun pro- tection measures was also more common in those who used sunscreen on body areas other than the face (97.4%) than in those who applied sunscreen only to the face (83.2%) (P=0.002), for example, wearing a hat (P=0.042), using an umbrella (P=0.018), and seeking shade (P=0.005). Conclusions Studies have been published investigating the knowledge and behaviors of medical students on sun protection and the factors affecting them [7]. These studies generally included students in all years of medical school [8-10]. However, be- coming senior students of the school has been associated with better knowledge on sun protection and the negative effects of the sun [11]. Moreover, it has been suggested that female students are more likely to use sunscreen than males [8, 12, 13]. Nevertheless, low levels of sunscreen use and a lack of knowledge on ultraviolet radiation have been re- ported in both sexes [14]. Within this study, we evaluated 255 fifth-year medical students with a mean age of 23±1.22 years. Although 72.5% of students stated that they used sunscreen, only 39.2% always used it. Most of the students (67.5%) used sunscreen with an SPF value of at least 50; however, only 13.7% reapplied, and 43.1% of students used sunscreen both on sunny days and in the winter, whereas 42% applied it only to the face. In addition, 135 (52.9%) students stated that they knew the “two-finger” technique, and it is noteworthy that 99 of them learned this informa- tion from social media. While most students (85.5%) took at least one other sun protection measure, the most common among them was a preference for shaded areas. In females, wearing sunscreen, reapplying it, using it in winter, knowing the “two-finger” technique, and taking other sun protection measures were more frequent, and the duration of sunscreen use was longer compared to males. Moreover, males (42.5%) were more likely to get sunburn than females (27.3%). Sun- burn was also more common in those who stated that they did not go out during peak sun time (P=0.017). However, statements on sun protection were similar in both sexes. For instance, the majority of the females and males revealed that sun protection prevents skin cancer and reduces skin aging. On the other hand, 32.2% of females and 23.1% of males revealed that sunscreens block vitamin D synthesis. Never- theless, the consideration of whether sunscreen inhibits vita- min D synthesis did not influence sunscreen use. However, in addition to the female sex, sunscreen use was more frequent among those who took other sun protection measures, such as wearing UV protective glasses, wearing clothing with long sleeves and legs, and preferring shaded areas. Besides sex dif- ferences, the results we obtained from the study may have been affected by various factors such as the general cultural structure of the participants, their behavioral assumptions, personality, and socioeconomic level. The fact that males had higher rates of sunburn and poorer sun protection habits may be due to sociocultural factors and barriers to sunscreen use, such as perceived stigma. Moreover, when compared to females, males may be less careful about their skin and less likely to follow a daily skin care routine. They may care less about sun effects such as premature aging, spots, and wrinkles. They may not like using cosmetic products such as creams and lotions and may do outdoor activities more often in the summer. The need to improve males’ sunscreen use habits should be included in skin cancer awareness cam- paigns. In a study by Memon et al., which included medical students, the most of whom were female, 31.5% of the par- ticipants stated that they always or mostly used sunscreen, 30.7% of the students stated that they used sunscreen only in summer, and 57% did not reapply it. Sunscreen use was more common in females, who were more knowledgeable than males about the effectiveness of sunscreen in prevent- ing sunburn and skin aging [8]. Seetan et al. evaluated 1st- to 6th-year medical students and reported that the students’ sun protection behaviors were inadequate considering their 10 Original Article | Dermatol Pract Concept. 2025;15(2): 4996 Although the rate of sunscreen use among medical stu- dents was high in our study, its regular and proper use was insufficient. The fact that females were significantly more likely to apply sunscreen and use other sun protection meth- ods than males and that sunburns were more common in males indicated that male students were at higher risk of exposure to the harmful effects of the sun. Updating the curriculum on sun protection and bearing in mind the high learning rate from social media, providing educational so- cial media sites or platforms where reliable information can be obtained may improve medical students’ sun protection habits and thus increase their contribution to raising pub- lic awareness on this subject. However, since social media are not a reliable educational tool, they can be organized as platforms created by medical schools, featuring informative videos or articles by faculty members and available only to students. References 1. Gruber P, Zito PM. Skin cancer. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Patrick Zito declares no rele- vant financial relationships with ineligible companies.: StatPearls Publishing. 2024, StatPearls Publishing LLC.; 2024. PMID: 28722978. 2. Miller DT, Baccam Z, Harris RB. Association of sun safety be- haviors and barriers with sunburn history in college students in a region with high UV exposure. Curr Oncol. 2022;29(12):9671- 80. DOI: 10.3390/curroncol29120759. PMID: 36547173. 3. Łyko M, Kruzel M, Kuś A, et al. Sun protection among university students in Poland: a survey of awareness and attitudes. Postepy Dermatol Alergol. 2021;38(6):961-6. DOI: 10.5114/ada.2020 .96709. PMID: 35126001. 4. Urasaki MB, Murad MM, Silva MT, et al. Exposure and sun protection practices of university students. Rev Bras Enferm. 2016;69(1):114-21. DOI: 10.1590/0034-7167.2016690117i. PMID: 26871225. 5. Gupta V, Sharma VK. Skin typing: Fitzpatrick grading and oth- ers. Clin Dermatol. 2019;37(5):430-36. DOI: 10.1016/j.clinder- matol.2019.07.010. PMID: 31896400. 6. Taylor S, Diffey B. Simple dosage guide for suncreams will help users. BMJ. 2002;324(7352):1526. DOI: 10.1136/bmj.324.7352 .1526/a. PMID: 12077052. 7. Ivanov NN, Swan A, Guseman EH, et al. Medical students’ knowl- edge, attitudes, and behaviors with regard to skin cancer and sun-protective behaviors. J Am Osteopath Assoc. 2018;118(7): 444-54. DOI: 10.7556/jaoa.2018.098. PMID: 29889933. 8. Memon MM, Manzoor M, Ashrafi MM, et al. Prevalence and predictors of the use of sunscreen amongst medical students: a multi-center cross-sectional study. Cureus. 2019;11(6):e4926. DOI: 10.7759/cureus.4926. PMID: 31431832. 9. Seetan K, Khamees A, Migdadi A, et al. Knowledge, attitude, and practice toward skin cancer prevention and detection among Jor- danian medical students: a cross-sectional study. J Skin Cancer. 2022;2022:6989827. DOI: 10.1155/2022/6989827. PMID: 35198247. knowledge about skin cancer: 39.3% of students stated that they always used sunscreen, 20.3% avoided the sun during peak hours, 9.4% wore hats, 19.1% wore sunglasses, and 47.3% wore long pants and long-sleeved shirts [9]. Pearlman et al. reported that approximately 70.4% of 1st- to 4th-year medical students never used wide-brimmed hats, 53.2% did not wear protective clothing, and only 44.6% often or al- ways used sunscreen. Pearlman et al. suggested that social media could be used as an effective method to increase med- ical students’ sun protection practices since online media might affect sun protection behaviors, and medical students use social media sites for educational purposes [10,15,16]. In a study by Chapagain et al., sunscreen use was reported in 75.67% of medical students in years 1-4. Regular use was detected in 15.41% of the students, only facial application in 63.43%, and repeated application in 31.71%. Sunscreen use was more common among female students compared to males. Sunscreens with an SPF value of 30 were mainly used. Females used additional sun protection methods more fre- quently than males. Moreover, it was stated that 89.34% of the students knew the harmful effects of sun exposure with- out protection [12]. Rodríguez-Gambetta et al. reported reg- ular sunscreen use during summer in 38.1% of the first-year medical students. High sunscreen use was associated with fe- male sex, attendance of sun protection workshops, and being reminded by others to wear sunscreen. Moreover, using long trousers as a photoprotection method was more frequent in females than in males [13]. In a study from Australia, nearly two-thirds of medical students reported having experienced sunburn, and 29% revealed they applied the recommended amount of sunscreen, which was two tablespoons. As only 20% reapplied sunscreen every two hours, most were not following recommendations for the proper use of sunscreen. However, the frequency of applying sunscreen in the sum- mer and sun protection behaviors such as wearing a hat and avoiding the sun at peak times increased with age [17]. Fur- thermore, in another study, getting sunburned was associated with increased sunscreen use and decreased sun exposure during peak hours [18]. It has been suggested that these re- sults might be obtained as a result of the inadequate lectures on sun protection given in medical faculties; therefore, future doctors may have insufficient information to inform their patients on sun protection [19]. Although society’s aware- ness about sun protection has recently increased through so- cial projects and campaigns, continuous education on skin cancer and sun protection measures is crucial. Therefore, it has been stated that medical students could also take part in the creation of educational programs for the public [3]. An expanded curriculum on skin cancer and the effects of the sun on health can improve medical students’ knowledge and behavior regarding sun protection [20]. Original Article | Dermatol Pract Concept. 2025;15(2): 4996 11 review. N Am J Med Sci. 2016;8(7):268-78. DOI: 10.4103/1947- 2714.187131. PMID: 27583234. 16. Findyartini A, Greviana N, Hanum C, et al. “How is social media used for learning?”: relationships between social media use by medical students with their self-regulated learning skills. BMC Med Educ. 2024;24(1):235. DOI: 10.1186/s12909-024-05222- 7. PMID: 38443909. 17. Scott AJ, Harris V, Lee A, et al. Assessment of sun-protective attitudes and behaviours of Australian medical students. J Eur Acad Dermatol Venereol. 2017;31(11):e497-8. DOI: 10.1111 /jdv.14298. PMID: 28449221. 18. Ermertcan AT, Oztürkcan S, Dinç G, et al. Sunscreen use and sun protection practices in students and personnel of Celal Bayar University. Photodermatol Photoimmunol Photomed. 2005;21(4):191-7. DOI: 10.1111/j.1600-0781.2005.00158.x. PMID: 15998367. 19. Isvy A, Beauchet A, Saiag P, et al. Medical students and sun pre- vention: knowledge and behaviours in France. J Eur Acad Derma- tol Venereol. 2013;27(2):e247-251. DOI: 10.1111/j.1468-3083 .2012.04621.x. PMID: 22827632. 20. Gooderham MJ, Guenther L. Impact of a sun awareness curric- ulum on medical students’ knowledge, attitudes, and behaviour. J Cutan Med Surg. 1999;3(4):182-7. DOI: 10.1177/12034754 9900300404. PMID: 10366391. 10. Pearlman RL, Patel V, Davis RE, et al. Effects of health beliefs, social support, and self-efficacy on sun protection behaviors among medical students: testing of an extended health belief model. Arch Dermatol Res. 2021;313(6):445-52. DOI: 10.1007 /s00403-020-02123-9. PMID: 32780198. 11. Shanshal SA, Khaleel SM, Hammoodi SH. Sun exposure and usage of sun protection: knowledge, perception and prac- tice among university students. Malays J Med Sci. 2024;31(2): 208-21. DOI: 10.21315/mjms2024.31.2.19. PMID: 38694582. 12. Chapagain K, Rauniar GP. Sunscreen use among medical un- dergraduate students in a medical college: a descriptive cross- sectional study. JNMA J Nepal Med Assoc. 2022;60(245):35-9. DOI: 10.31729/jnma.6417. PMID: 35199681. 13. Rodríguez-Gambetta P, Moscoso-Porras MG, Taype-Rondan A. Factors associated with regular sunscreen use by medical students of a Peruvian university. J Prev Med Hyg. 2016;57(3):E172-7. PMID: 27980382. 14. Nahar VK, Wilkerson AH, Ghafari G, et al. Skin cancer knowl- edge, attitudes, beliefs, and prevention practices among medical students: a systematic search and literature review. Int J Womens Dermatol. 2018;4(3):139-49. DOI: 10.1016/j.ijwd.2017.10.002. PMID: 30175215. 15. Guraya SY. The usage of social networking sites by medical stu- dents for educational purposes: a meta-analysis and systematic