Understanding ultraviolet radiation dorsal foot injury at the beach

Background: Efforts made to protect the dorsal aspect of the foot are currently unknown. We sought to determine whether beachgoers protect the dorsal aspect of their feet as frequently as other anatomic sites. Methods: A convenience sample of Galveston, Texas, beachgoers completed anonymous surveys to assess whether the dorsal foot was at risk for ultraviolet radiation (UV-R) injury. Additional information collected included demographics and general knowledge about skin cancer to determine if these variables were significantly correlated with dorsal foot protection from UV-R injury. Results: Of 216 respondents, only 103 used a topical UV-R barrier on their dorsal feet, while 183 applied sunscreen to the body and 133 applied sunscreen to the legs. Eighty-seven of 113 nonusers explained, ‘‘I did not think about it.’’ The average number of applications of sunscreen per person to the dorsal feet was less than other anatomical body sites (1.19 body applications, 0.86 leg applications, and 0.58 dorsal feet applications per person; P <.001). 58.0% of females applied sunscreen to the dorsal feet compared with only 36.5% of males (P =.001). Self-identifying Fitzpatrick skin type 5 or 6 individuals did not apply sunscreen to the dorsal foot as regularly as individuals with types 1 to 4 (84.6% versus 47.6%; P =.0001). Conclusions: Current skin cancer epidemiology pairs the feet and the legs together as ‘‘lower extremity.’’ For epidemiologic purposes, however, feet and legs should be considered distinct areas in UV-R research because they may use different photo-protection strategies.