The Burden of Skin Cancer in the Military Health System, 2017-2022.

This retrospective observational study investigates skin cancer prevalence and care patterns within the Military Health System (MHS) from 2017 to 2022. Utilizing the MHS Management Analysis and Reporting Tool (most commonly called M2), we analyzed more than 5 million patient encounters and documented skin cancer prevalence in the MHS beneficiary population utilizing available demographic data. Notable findings included an increased prevalence of skin cancer in the military population compared with the civilian population, a substantial decline in direct care (DC) visits at military treatment facilities compared with civilian purchased care (PC) visits, and a decreased total number of visits during COVID-19 restrictions.

Apremilast Uses and Relevance to the Military.

Apremilast is a small-molecule biologic approved by the US Food and Drug Administration (FDA) for use in plaque psoriasis, psoriatic arthritis, and Behçet disease. Although apremilast is seemingly a less favorable choice for treating psoriasis in the era of injectable biologics, the drug is an important option for patients in the military. In this article, we review on-label indications and off-label uses for apremilast; highlight the importance of apremilast for managing psoriasis in the military population; and propose other patient populations in whom the use of apremilast is favorable. We also present a case report that highlights and embodies the benefit of apremilast for military service members.

Sun Exposure Prevention Practices Within U.S. Naval Aviation.

INTRODUCTION: Occupational exposure to ultraviolet radiation is a critical concern for those serving in the U.S. Military. Work and mission requirements predispose members to significant sun exposure, while sun-protective behavior often comes second to mission accomplishment. Prior research implicated institutional practices and constraints as preventing the routine use of sun protection modalities, but no large-scale studies have assessed service members' perceptions regarding sun protection modalities available to them in their work environment or their daily sun protection practices. METHODS: The study employed a cross-sectional survey distributed to active duty (AD) U.S. Navy service members assigned to 1 of 19 aircraft squadrons based in Southern California and deployed on missions across the Pacific theater of operations. The intent was to evaluate rates of sunburn, sun-protective practices, and perceptions regarding sun exposure and prevention practices in their workplace. The study and survey tool received approval from the Naval Medical Center San Diego Institutional Review Board. Statistical analysis of survey answers was performed to assess for trends in response rates overall and response rates within sociodemographic groups. Pearson's chi-squared tests were utilized to assess for significance where appropriate. P-values <.05 were used to determine statistically significant trends in response rates. RESULTS: One thousand surveys were distributed, of which 896 surveys were completed. The response rate was 89.6%. Eight hundred and eighty-eight surveys were included in the analysis. The surveyed population was consistent with the demographics of the U.S. Navy as a whole. 55.1% of survey respondents reported sunburn within the past year, higher than the rate reported in a previously surveyed civilian population. Reports of sunburn within the past year were not significantly different in regard to gender (P = .88), age (P = .53), and years of AD (P = .48). Increasing rank did show a significant correlation with reports of sunburn (P = .0) (Table S1). 62.2% of those surveyed reported frequent/routine use of some form of sun protection. This was lower than the rate reported in a previously surveyed civilian population. A large majority of service members surveyed (75.9%) reported using sunscreen with a sun protection factor >15.29.1% of survey respondents reported working in direct sunlight always/almost always. This was lower than the rates reported in a previously surveyed U.S. Air Force population of aviation maintainers. Low rates of respondents reported frequent reminders to use sun protection (18.9%), and fewer reported the routine or frequent use of sunscreen while at work (12.3%). A higher percentage reported regular use of sunscreen during outdoor leisure activities (36.5%), suggesting a barrier to use in the workplace. CONCLUSIONS: U.S. Military personnel report higher rates of sunburn and lower rates of routine use of sun protection practices compared to a previously surveyed civilian population. The overall rates of sun protection use while in the work setting are low both overall and compared to reports of routine use during outdoor leisure activities. Reported rates of reminders to use sunscreen are low, suggesting that increased education regarding the risk of excessive sun exposure and tools for effective sun protection are still needed.