Abstract
BackgroundPrevious studies have reported an association between sun exposure and improved cutaneous melanoma (CM) survival. We analysed the association of UV exposure with prognostic factors and outcome in a large melanoma cohort.MethodsA questionnaire was given to 289 (42%) CM patients at diagnosis (Group 1) and to 402 CM patients (58%) during follow-up (Group 2). Analyses were carried out to investigate the associations between sun exposure and melanoma prognostic factors and survival.ResultsHolidays in the sun two years before CM diagnosis were significantly associated with lower Breslow thickness (p=0.003), after multiple adjustment. Number of weeks of sunny holidays was also significantly and inversely associated with thickness in a dose-dependent manner (p=0.007). However when stratifying by gender this association was found only among women (p=0.0004) the risk of CM recurrence in both sexes was significantly lower in patients (n=271) who had holidays in the sun after diagnosis, after multiple adjustment including education: HR=0.30 (95%CI:0.10-0.87; p=0.03) conclusions: Holidays in the sun were associated with thinner melanomas in women and reduced rates of relapse in both sexes. However, these results do not prove a direct causal effect of sun exposure on survival since other confounding factors, such as vitamin D serum levels and socio-economic status, may play a role. Other factors in sun seeking individuals may also possibly affect these results.
Highlights
The incidence of cutaneous melanoma (CM) has steadily increased over the last 30 years in most fair-skinned populations even if the great majority of the increase has been linked to the increase in diagnoses of thin lesions with excellent prognosis[1]
This American study of 528 melanoma cases showed that markers of sun exposure were inversely associated with death from melanoma[4].In this study, we investigated if different indicators of UV exposure, collected before and after CM diagnosis, are associated with Breslow thickness and recurrence in Italy
A history of holidays in the sun for 2 years before CM diagnosis was significantly associated with lower Breslow thickness with a significant dose response in Italy
Summary
The incidence of CM has steadily increased over the last 30 years in most fair-skinned populations even if the great majority of the increase has been linked to the increase in diagnoses of thin lesions with excellent prognosis[1]. Long noted is the relationship between sun exposure and nonmelanoma skin cancer (NMSC) and superficial spreading melanoma (SSM), which are often not aggressive[3] This last hypothesis arose from the results of a study evaluating the association of sun exposure indicators with melanoma mortality. When stratifying by gender this association was found only among women (p=0.0004) the risk of CM recurrence in both sexes was significantly lower in patients (n=271) who had holidays in the sun after diagnosis, after multiple adjustment including education: HR=0.30 (95%CI:0.10-0.87; p=0.03) conclusions: Holidays in the sun were associated with thinner melanomas in women and reduced rates of relapse in both sexes These results do not prove a direct causal effect of sun exposure on survival since other confounding factors, such as vitamin D serum levels and socio-economic status, may play a role. Other factors in sun seeking individuals may possibly affect these results
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