Gatekeepers or barriers? Exploring traditional medicine practitioners' understanding of breast cancer in Ghana.

Skin cancer continues to be the leading cancer diagnosis in the United States [,]. Basal cell carcinoma (BCC) is the most common form of skin cancer, followed by squamous cell carcinoma (SCC), while invasive melanoma is the deadliest form of skin cancer [,]. Each year, there are approximately 3.6 million cases of BCC diagnosed in the United States, and an estimated 1.8 million cases of SCC []. Within the past decade, from 2016 to 2026, the incidence of invasive melanoma has increased by 46.6% [,,]. In 2026 alone, it is estimated that 234,680 melanoma cases will be diagnosed in the United States, of which 112,000 will be invasive [,]. These projections represent a 10.6% increase in cases and a 1% increase in mortality compared with 2025 [,]. UV radiation (UVR) from the sun is widely recognized as the primary risk factor for the development of skin cancer [,]. Sunburns, which result from prolonged and intense UVR exposure without sun protection, are reported to be directly associated with an increased risk of both nonmelanoma (BCC and SCC) and melanoma skin cancer []. Severe sunburns are among the strongest predictors of melanoma, with evidence showing that even 1 sunburn every 2 years can triple the risk [,]. Outdoor workers receive up to 8 times more UVR exposure than indoor workers and have a 60% greater risk of developing skin cancer []. Construction and landscaping are among the occupations with the highest proportion of outdoor work time []. Despite this, prior interventions targeting these outdoor sectors in the United States remain scarce [-].