Number Of Sunburns Research Articles

Sunlight exposure in association with risk of lymphoid malignancy: a meta-analysis of observational studies

Several observational studies have shown contradictory results regarding the association between sunlight exposure and the risk of malignant lymphoma. Thus, we aimed to systematically determine the association between sunlight exposure and lymphoid malignancy risk through a meta-analysis. A thorough search of four electronic databases (PubMed, Embase, Web of Science, and Scopus) was performed to identify eligible studies until 13 August 2020. A random-effects model was used to calculate risk estimates of sunlight exposure. The main outcome measure was the risk of lymphoid malignancy subtypes with odds ratios (ORs) and 95% confidence intervals (CIs) according to various forms of solar ultraviolet radiation. In total, 17 case-control studies and 9 cohort studies including 216,285 non-Hodgkin lymphoma (NHL) and 23,017 Hodgkin's lymphoma (HL) patients were included in the final analysis. Personal sunlight exposure was significantly associated with a decreased risk of HL (OR 0.77; 95% CI 0.68-0.87) and NHL (OR 0.81; 95% CI 0.71-0.92), including all subtypes except T-cell lymphoma. Ambient sunlight exposure at residence was associated with a reduced risk of HL (OR 0.88; 95% CI 0.81-0.95) and all NHL subtypes (OR 0.84; 95% CI 0.73-0.96), except for chronic lymphocytic leukemia/small lymphocytic lymphoma. As the number of sunburns and sunbaths increased, the risk of NHL tended to decrease. While there was an observed protective effect both from case-control and prospective studies, substantial heterogeneity was found in the current study. Thus, more evidence is required to confirm that promoting sunlight exposure can prevent the development of lymphoid neoplasia.

Recreational and residential sun exposure and risk of endometriosis: a prospective cohort study.

Is recreational and residential sun exposure associated with risk of endometriosis? Tanning bed use in early adulthood, sunscreen use and history of sunburns were associated with a greater risk of endometriosis; however, higher residential UV exposure was associated with a lower endometriosis risk. Previous research has reported an association between endometriosis and skin cancer, with evidence of shared risk factors between the two diseases. We investigated the potential associations between ultraviolet radiation and endometriosis risk. The Nurses' Health Study II is a prospective cohort of 116429 female US nurses aged 25-42 years at enrolment in 1989. Participants completed self-administered biennial questionnaires through June 2015. We investigated self-reported measures of recreational sun-exposure and geocoded residential UV exposure in childhood and adulthood in relation to risk of laparoscopically confirmed endometriosis among premenopausal white women. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% CIs. During follow-up, 4791 incident cases of laparoscopically confirmed endometriosis were reported among 1252 248 person-years. Tanning bed use during high school/college (≥6 times per year vs. never use: HR = 1.19, 95% CI = 1.01-1.40; Ptrend = 0.04) and at ages 25-35 (HR = 1.24, 95% CI = 1.12-1.39; Ptrend ≤ 0.0001), number of sunburns during adolescence (Ptrend = 0.03) and percentage of time using sunscreen in adulthood (Ptrend = 0.002) were positively associated with risk of endometriosis. In contrast, residential UV level at birth (highest vs. lowest quintile: HR = 0.81, 95% CI = 0.72-0.92; Ptrend = 0.0001), at age 15 (HR = 0.79, 95% CI = 0.70-0.88; Ptrend ≤ 0.0001) and at age 30 (HR = 0.90, 95% CI = 0.82-0.99; Ptrend = 0.21) were associated with a decreased risk of endometriosis. Self-reported endometriosis diagnosis may be prone to misclassification; however, we restricted our definition to laparoscopically confirmed endometriosis, which has been shown to have high validity compared to medical records. Our results suggest that tanning bed use in early adulthood increases endometriosis risk, potentially through a harmful effect of ultraviolet A wavelengths, and that residential UV exposure reduces risk, possibly via optimal vitamin D synthesis. These findings should be investigated further to enhance our understanding of endometriosis aetiology. This project was supported by NICHD grants HD48544 and HD52473, HD57210, NIH grant CA50385, CA176726. M.K. was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078) and is grateful to the Philippe Foundation and the Bettencourt-Schueller Foundation for their financial support. H.R.H. is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). The authors have nothing to disclose. N/A.

Lifetime history of total body skin examinations in patients with disabilities: Examining for differences in skin cancer screening

Lifetime history of total body skin examinations in patients with disabilities: Examining for differences in skin cancer screening

Risk factors of fast growing melanomas in a French prospective cohort.

e21042 Background: Rate of growth (ROG) of the primary tumor is a known prognostic factor in melanoma (MM). Fast growing melanomas (FGMM) could account for an important part of the thick tumors which still exist despite earlier and earlier detection. Methods: All patients referred for a primary mm to two French Dermatology Department from the period 2012-2016 were prospectively enrolled in an observational case control study. ROG was calculated as the ratio of Breslow thickness to time to mm development according to patient, following a well-established process. FGMM were defined as those with a ROG > 0.5 mm/month and MMs with a ROG ≤05mm/month were used as controls. Differences in epidemiological, clinical and pathological features were evaluated with univariate and multivariate analysis. Results: 464 patients were enrolled. 149 mm (32.1%) were FGMM. Factors associated with FGMM in univariate analysis were age > 70 years (p = 0.006), tumor location (p = 0.032), histological subtype (p = 0.021), median thickness (p < 0.001), ulceration (p < 0.001), high mitotic rate ( > 1/mm2 )(p = 0.002), sentinel node involvement (p = 0.008), hair color at the age of 20 (p = 0.011), lower NSAIDS consumption (p = 0.012) and lower number of sunburns (p = 0.002). Age > 70 years (OR 1.88 95%CI 1.19-2.98, p = 0.007), ulceration (OR 3.70 95%CI 2.05-6.61) p < 0.001), sentinel node involvement (OR 1.93 95%CI 1.01-3.69 p = 0.046), regression (OR 0.37 95%CI 0.15-0.94) p = 0.037) and NSAIDS exposure (OR 0.29 95%CI 0.11-0.78, p = 0.014) remained associated with FGMM in multivariate analysis. OS and PFS were significantly lower in the FGMM group (HR 1.98 (95%CI 1.11-3.54, p = 0.02) and HR 1.79 (95%CI 1.17-2.73, p = 0.007), respectively). Conclusions: Fast growth characterizes a subset of primary mm which are intrinsically more aggressive and have different risk factors than other MM, namely more frequent in the elderly and with no association with skin type, nevus count or sun exposure. Association with ulceration could reflect a specific immune context. Negative association with NSAIDS exposure warrants more investigation, since it may have therapeutic implications.

Predictors of Beagley-Gibson skin cast grade in older adults.

The Beagley-Gibson (BG) grading system utilizes microtopographical skin changes to generate an individualized, objective estimate of cumulative, lifetime ultraviolet radiation (UVR) exposure. However, predictors of BG grade are ill-defined, particularly in older populations. The aim of this cross-sectional study was to describe the factors associated with skin damage as measured by the BG method in 835 community-dwelling older adults. Study participants aged 53-83 years had silicone casts taken from the dorsum of both hands and graded by the BG method. Lifetime sun exposure, skin phenotypic traits and smoking status were assessed by questionnaire. 25-hydroxyvitamin D and melanin density were measured using radioimmunoassay and spectrophotometry, respectively. Ordered logistic regression was used to compute a single odds ratio (OR) by taking BG grade as the outcome variable. Higher 25-hydroxyvitamin D was associated with increasing BG grade (OR = 1.39, P = 0.02) in adjusted analysis. Age (OR = 1.14, P < 0.001), occupational sun exposure (OR = 1.62, P < 0.001), ability to tan (OR = 1.40, P < 0.001), melanin density (OR=0.79, P = 0.001), lifetime leisure time sun exposure (OR = 1.21, P = 0.004), current smoking (OR = 1.82, P = 0.007), propensity to sunburn (OR = 1.18, P = 0.016), and waist-hip ratio (OR = 1.10, P = 0.02) were independent predictors of BG grade. Hair colour, number of sunburns, body mass index and gender were not independent predictors of BG grade. Beagley-Gibson skin cast grade is a biologically relevant marker of UVR exposure in older adults influenced by both intrinsic and extrinsic factors.

Sun Exposure and Protection Habits in Pediatric Patients with a History of Malignancy.

BackgroundSurvivors of childhood cancer are at high risk for developing non-melanoma skin cancer and therefore are firmly advised to avoid or minimize sun exposure and adopt skin protection measures. We aimed to compare sun exposure and protection habits in a cohort of pediatric patients with a history of malignancy to those of healthy controls.MethodsCase-control study of 143 pediatric patients with a history of malignancy (aged 11.2±4.6y, Male = 68, mean interval from diagnosis 4.4±3.8y) and 150 healthy controls (aged 10.4±4.8y, Male = 67). Sun exposure and protection habits were assessed using validated questionnaires.ResultsPatients and controls reported similar sun exposure time during weekdays (94±82minutes/day vs. 81±65minutes/day; p = 0.83), while during weekends patients spent significantly less time outside compared to controls (103±85minutes/day vs. 124±87minutes/day; p = 0.02). Time elapsed from diagnosis positively correlated with time spent outside both during weekdays (r = 0.194, p = 0.02) and weekends (r = 0.217, p = 0.01), and there was a step-up in sun exposure starting three years after diagnosis. There was no significant difference regarding composite sun protection score between patients and controls. Age was positively correlated with number of sunburns per year and sun exposure for the purpose of tanning, and was negatively correlated with the use of sun protection measures.ConclusionsAlthough childhood cancer survivors are firmly instructed to adopt sun protection habits, the adherence to these instructions is incomplete, and more attention should be paid to improve these habits throughout their lives. Since sunlight avoidance may results in vitamin D deficiency, dietary supplementation will likely be needed.

Adolescent dietary vitamin D and sun exposure in relation to benign breast disease.

Vitamin D may reduce cell proliferation and tumor growth in breast tissue, and exposure may be most important during adolescence when breast tissue is developing. In the Nurses' Health Study II, higher recalled adolescent vitamin D intake was associated with a lower risk of benign breast disease (BBD). Our study aimed to assess adolescent vitamin D exposure in relation to BBD in young women. Vitamin D was assessed in 6,593 adolescent girls (9-15years of age at baseline) in the prospective Growing Up Today Study cohort using the mean energy-adjusted intakes from food frequency questionnaires in 1996, 1997, and 1998. In 1999, 5,286 girls reported skin color, sunscreen use, tanning bed use, and number of sunburns in the past year, and we used state of residence to assess low versus high ultraviolet index. Biopsy-confirmed BBD was reported on questionnaires in 2005, 2007, and 2010 (n=122). Dietary vitamin D, tanning behaviors, and other sun exposure variables were not significantly associated with BBD in logistic regression models adjusted for age, family history of breast cancer or BBD, age at menarche, nulliparity, alcohol intake, body mass index, and physical activity. The relative risk for the top (>467IU/day) versus bottom (<243IU/day) quartile of vitamin D intake was 0.76 (95% CI 0.47, 1.23). Sun exposure was not significantly associated with BBD in this prospective cohort. However, a suggestive inverse association between dietary vitamin D and BBD was observed that merits further study.

Smartphone mobile application delivering personalized, real-time sun protection advice: a randomized clinical trial.

Mobile smartphones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications (apps), they can access remote databases, track time and location, and integrate user input to provide tailored health information. A smartphone mobile app providing personalized, real-time sun protection advice was evaluated in a randomized clinical trial. The trial was conducted in 2012 and had a randomized pretest-posttest controlled design with a 10-week follow-up. Data were collected from a nationwide population-based survey panel. A sample of 604 non-Hispanic and Hispanic adults from the Knowledge Panel 18 years or older who owned an Android smartphone were enrolled. The mobile app provided advice on sun protection (ie, protection practices and risk of sunburn) and alerts (to apply or reapply sunscreen and get out of the sun), hourly UV Index, and vitamin D production based on the forecast UV Index, the phone's time and location, and user input. Percentage of days using sun protection and time spent outdoors (days and minutes) in the midday sun and number of sunburns in the past 3 months were collected. Individuals in the treatment group reported more shade use (mean days staying in the shade, 41.0% vs 33.7%; P = .03) but less sunscreen use (mean days, 28.6% vs 34.5%; P = .048) than controls. There was no significant difference in number of sunburns in the past 3 months (mean, 0.60 in the treatment group vs 0.62 for controls; P = .87). Those who used the mobile app reported spending less time in the sun (mean days keeping time in the sun to a minimum, 60.4% for app users vs 49.3% for nonusers; P = .04) and using all protection behaviors combined more (mean days, 39.4% vs 33.8%; P = .04). The mobile app improved some sun protection. Use of the mobile app was lower than expected but associated with increased sun protection. Providing personalized advice when and where people are in the sun may help reduce sun exposure.

Evaluation of immediate and 12-week effects of a smartphone sun-safety mobile application: a randomized clinical trial.

Mobile applications on smartphones can communicate a large amount of personalized, real-time health information, including advice on skin cancer prevention, but their effectiveness may be affected by whether recipients can be convinced to use them. To evaluate a smartphone mobile application (Solar Cell) delivering real-time advice about sun protection for a second time in a randomized clinical trial. A previous trial conducted in 2012 used a randomized pretest-posttest design. For the present trial, we collected data from a volunteer sample of 202 adults 18 years or older who owned a smartphone. Participants were recruited nationwide through online promotions. Screening procedures and a 3-week run-in period were added to increase the use of the mobile application. We conducted follow-ups at 3 and 8 weeks after randomization to examine the immediate and the longer-term effects of the intervention. Use of the mobile application. The application gave feedback on sun protection (ie, sun-safety practices and the risk for sunburn) and alerted users to apply or to reapply sunscreen and to get out of the sun. The application also displayed the hourly UV Index and vitamin D production based on the forecast UV Index, time, and location. Percentage of days with the use of sun protection, time spent outdoors in the midday sun (days and hours), and the number of sunburns in the last 3 months. Participants in the intervention group used wide-brimmed hats more at 7 weeks than control participants (23.8% vs 17.4%; F = 4.07; P = .045). Women who used the mobile application reported using all sun protection combined more than men (46.4% vs 43.3%; F = 1.49; P = .04), whereas men and older individuals reported less use of sunscreen (32.7% vs 35.5%; F = 5.36; P = .02) and hats (15.6% vs 17.9%; F = 4.72; P = .03). The mobile application initially appeared to confer weak improvement of sun protection. Use of the mobile application was greater than in a previous trial and was associated with greater sun protection, especially among women. Strategies to increase the use of the mobile application are needed if the application is to be deployed effectively to the general adult population.

Actinic damage on the back is significantly determined by MC1R variants and previous sun exposure compared with other body sites in a multivariate analysis

Only recently, site-dependent associations of actinic damage with melanoma were identified in our study population. To elucidate the diverse aetiologies for actinic damage at different body sites. We performed multivariate logistic regression analyses to identify independent risk factors for actinic damage on the face, hands and the back in 2112 participants of central European origin. For actinic damage on the face, age was the only risk factor that remained consistently significant in a multivariate analysis, whereas actinic damage on the back was predominantly associated with number of sunburns, freckles in childhood, holiday weeks and male sex. Moreover, we identified a particular significance of MC1R variants and dorsal actinic skin damage. The particular effect of MC1R variants and sun exposure during recreational time on dorsal actinic damage indicates that actinic damage on the back is more informative regarding susceptibility to sunlight and past sun exposure associated with melanoma risk.

Genome-wide association studies identify several new loci associated with pigmentation traits and skin cancer risk in European Americans

Aiming to identify novel genetic loci for pigmentation and skin cancer, we conducted a series of genome-wide association studies on hair color, eye color, number of sunburns, tanning ability and number of non-melanoma skin cancers (NMSCs) among 10 183 European Americans in the discovery stage and 4504 European Americans in the replication stage (for eye color, 3871 males in the discovery stage and 2496 males in the replication stage). We targeted novel chromosome regions besides the known ones for replication. As a result, we identified a new region downstream of the EDNRB gene on 13q22 associated with hair color and the strongest association was the single-nucleotide polymorphism (SNP) rs975739 (P = 2.4 × 10(-14); P = 5.4 × 10(-9) in the discovery set and P = 1.2 × 10(-6) in the replication set). Using blue, intermediate (including green) and brown eye colors as co-dominant outcomes, we identified the SNP rs3002288 in VASH2 on 1q32.3 associated with brown eye (P = 7.0 × 10(-8); P = 5.3 × 10(-5) in the discovery set and P = 0.02 in the replication set). Additionally, we identified a significant interaction between the SNPs rs7173419 and rs12913832 in the OCA2 gene region on brown eye color (P-value for interaction = 3.8 × 10(-3)). As for the number of NMSCs, we identified two independent SNPs on chr6 and one SNP on chromosome 14: rs12203592 in IRF4 (P = 7.2 × 10(-14); P = 1.8 × 10(-8) in the discovery set and P = 6.7 × 10(-7) in the replication set), rs12202284 between IRF4 and EXOC2 (P = 5.0 × 10(-8); P = 6.6 × 10(-7) in the discovery set and P = 3.0 × 10(-3) in the replication set) and rs8015138 upstream of GNG2 (P = 6.6 × 10(-8); P = 5.3 × 10(-7) in the discovery set and P = 0.01 in the replication set).

Abstract 1645: Genome-wide association studies identify several new loci for human pigmentation traits

Abstract Genome-wide association studies (GWASs) have been widely conducted and numerous new loci have been associated with various outcomes. Multiple GWASs have been completed in the Nurses’ Health Study and the Health Professionals Follow-up Study, and we have accrued more than 15,000 individuals with genome-wide genotype data. More recently, with the data released from the 1000 Genomes Project, we have imputed about 10 million SNPs based on the genotyped SNPs and haplotypes from the 1000 Genomes Project. Based on the knowledge that light human pigmentation is a host risk factor for skin cancer development, we conducted the GWASs on pigmentary traits in multiple GWAS datasets in the two cohorts using the newly imputed data. We systematically evaluated the traits of natural hair color (ordinal coding from blonde, light brown, dark brown to black, excluding red hair color), eye colors (blue, green and brown eye colors as co-dominant outcomes), tanning ability (ordinal coding from practically no tan, moderate tan to deep tan) and the number of sunburns (continuous variable). We adjusted for the four largest principal components of genetic variation in the regression model for each component dataset, and performed a meta-analysis to combine the results of all these datasets. No systematic deviation from the expected distribution was detected for any of these pigmentation GWASs. Using a multistage study design, we identified a new region on chromosome 13q22 associated with natural hair color that reached the GWAS significance level. The most significant SNP in this region reached a p-value of 2.4 ×10−14 (p = 5.4×10−9 in the discovery stage and p = 1.2×10−6 in the replication stage). We also newly identified and replicated the association of a SNP on 1q32.3 with brown eye color (p = 7.0×10−8 in the combined set), a SNP on 5p15 with green eye color (p = 9.1×10−7 in the combined set), and a SNP on 11q25 with the number of sunburns (p = 5.6×10−6 in the combined set). Of note, the SNP associated with the number of sunburns was also associated with the expression of a local gene based on the transcript expression profiling data of 87 HapMap CEU cell lines (NCBI GEO database, accession GSE7792). These novel pigmentation SNPs identified by our GWASs are strong candidates to evaluate skin cancer risk. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1645. doi:1538-7445.AM2012-1645

Pre-Diagnostic Plasma 25-Hydroxyvitamin D Levels and Risk of Non-Melanoma Skin Cancer in Women

BackgroundRecent reports have shown that vitamin D status was inversely associated with the risk of various cancers. However, few studies examined the association between vitamin D levels and risk of skin cancer.MethodsWe prospectively evaluated the association between baseline plasma 25(OH)D levels and the risk of incident squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) among 4,641 women from the Nurses’ Health Study (NHS) and the NHS II with 510 incident BCC cases and 75 incident SCC cases. We used multivariate logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsPlasma 25(OH)D levels were positively associated with risk of BCC after adjusting for age at blood draw, season of blood draw, lab batch, hair color, burning tendency, the number of sunburns, and ultra-violet B flux of residence at blood collection. Women in the highest quartile of 25(OH)D had more than 2-fold increased risk of BCC compared with women in the lowest quartile (OR = 2.07, 95% CI = 1.52–2.80, P for trend <0.0001). We also found a significantly positive association between plasma 25(OH)D levels and SCC risk after adjusting for the same covariates (OR, highest vs. lowest quartile = 3.77, 95% CI = 1.70–8.36, P for trend = 0.0002).ConclusionIn this prospective study of women, plasma vitamin D levels were positively associated with non-melanoma skin cancer risk. Considering that most circulating vitamin D is due to sun exposure, the positive association between plasma vitamin D and non-melanoma skin cancer is confounded by sun exposure. Our data suggest that one-time measurement of plasma vitamin D levels may reasonably reflect long-term sun exposure and predict the risk of non-melanoma skin cancer.

Geographical Variation in Residence and Risk of Multiple Nonmelanoma Skin Cancers in US Women and Men

Residence in high ultraviolet (UV) locations is associated with increased risk for incident nonmelanoma skin cancer (NMSC). However, the effect of geographic location on multiple NMSC development has not been well studied. We evaluated the association between state of residence at birth, age 15 and 30 and risk of multiple NMSCs among 80275 women and men. After adjusting for age, gender, hair color, number of sunburns, tanning ability, family history of melanoma and nevus count, the cumulative relative risks (RRs) of developing ≥1 NMSC for those consistently residing in medium- and high-UV index states were 1.20 (95% CI 1.14-1.27) and 1.42 (95% CI 1.32-1.53) respectively. We found that compared to individuals with one lifetime NMSC, the multivariate cumulative RRs of developing ≥2 NMSCs for those who stayed in medium- and high-UV index states at all three timepoints were 1.09 (95% CI 1.00-1.19) and 1.15 (95% CI 1.02-1.30) respectively. These results cannot account for migration during the interval period and seasonal changes in residence; further, as BCC is the predominant NMSC, the results may be BCC-driven. In conclusion, we found that consistent residence in medium- or high-UVR locations was significantly associated an incremental risk of ≥2 NMSCs later in life.

Sun Protecting and Sun Exposing Behaviors: Testing Their Relationship Simultaneously with Indicators of Ultraviolet Exposure Among Adolescents

The aim of this study was to build on existing understanding of adolescent sun-related behavior by combining sun protecting and sun exposing behaviors and testing their relationship simultaneously with indicators of ultraviolet (UV) exposure. Data were collected for 692 adolescents aged between 12 and 18 years. General linear modeling was undertaken to test the relationship of sun-related behaviors with indicators of UV exposure. Overall, the combined sun protection and sun exposing behaviors accounted for 13.8% of the variance in the number of sunburns, 28.1% of the variance in current tan and 57.5% of the variance in desired tan, respectively. Results indicated that having a strong desire for a tan was significantly associated with spending time tanning, delaying the use of sun protection, wearing brief clothing and using no sun protection; whereas the number of sunburns was significantly associated with sunscreen use, avoiding peak hours and delaying sun protection. Current tan was significantly associated with wearing sunglasses, shade use and time spent tanning. In examining sun-related behaviors among adolescents, consideration needs to be given to both sun exposing and sun protecting behaviors. This research has important implications for conceptualizing outcomes in programs designed to reduce UV exposure.

FC30 An epidemiologic study of prevalent risk factors of basal cell carcinoma in the Greek population

Introduction The risk for BCC development results from the interplay of both constitutional and environmental factors, with ultraviolet radiation (UVR) being the primary established risk factor in the development of BCC [1,2]. The epidemiologic risk factors of BCC in Mediterranean populations remain unclear. Aim To investigate the risk associations of BCC in the Greek population. Methods We conducted a hospital-based case-control study. We studied 199 patients with histologically confirmed BCC and 200 cancer-free controls. The following data were collected by the use of a standardized questionnaire: pigmentary traits (tanning ability, ease of sunburning), patterns of sun exposure (continuous versus intermittent), timing of sun exposure, history of severe sunburns, use of sunscreens, exposure to artificial sources of UVR, personal or family history of skin cancer, and lifestyle-related factors (smoking). A clinical examination was performed with respect to pigmentary traits (skin/hair/eye color), number of melanocytic nevi, actinic keratoses, lentigines, and the presence of elastosis. Results In our multivariate analysis of BCC, several factors were found to be significantly associated with BCC (P<0.05), including female sex, light skin color, number of years of occupational sun exposure, number of sunburns during adulthood, no use of sunscreen, and presence of nevi and lentigines. A trend for a ‘dose-response’ effect was noted for patients who had 5 years or more, of occupational sun exposure. No association was found with skin type, exposure to non-solar UVR exposure, and lifestyle-related factors (smoking, alcohol consumption). Statistically significant risk factors for early BCC (age at diagnosis <50 years) included female sex, number of weeks per year spent at the beach before the age of 20, and the number of sunburns during childhood. Conclusion BCC risk was associated with light skin color, occupational sun exposure, and the presence of nevi and lentigines. The association of early onset BCC with recreational sun exposure and sunburns during childhood and adolescence suggests that intense intermittent sun exposure during the early years of life may be a key risk factor for development of BCC at an early age.

Cigarette smoking and malignant melanoma: A case-control study

Several previous studies have reported inverse associations between cigarette smoking and melanoma. Often these studies have not adjusted for ultraviolet (UV) exposure history, skin type, or number of blistering sunburns, which could confound the observed associations between cigarette smoking and melanoma. We sought to assess whether this reported inverse association persists after adjusting for UV exposure, skin type, and number of blistering sunburns. We conducted a population-based case-control study (82 patients with melanoma, 164 control subjects). Two control subjects were matched to each patient by age, sex, race, and skin type. Conditional logistic regression models were fit to assess the association between cigarette smoking history and melanoma, with additional adjustments for UV exposure and sunburns. Compared with never smoking, both former (odds ratio 0.43, 95% confidence interval 0.18-1.04) and current (odds ratio 0.65, 95% confidence interval 0.19-2.24) smoking were inversely associated with melanoma, but the associations were not statistically significant. The number of cutaneous nevi was not assessed in this study. In addition, the relatively small number of patients limits the statistical precision of the observed associations. After matching for age, sex, race, and skin type, and further adjusting for UV exposure and number of sunburns, cigarette smoking was not statistically significantly associated with melanoma risk, but the results were consistent with previous observations of an inverse association.

Sun and Solarium Exposure and Melanoma Risk: Effects of Age, Pigmentary Characteristics, and Nevi

Few prospective studies have analyzed solar and artificial (solarium) UV exposure and melanoma risk. We investigated these associations in a Norwegian-Swedish cohort study and addressed effect modification by age, pigmentary characteristics, and nevi. The cohort included women ages 30 to 50 years at enrollment from 1991 to 1992. Host factors and exposure to sun and solariums in life decades were collected by questionnaire at enrollment. Relative risks (RR) with 95% confidence intervals (CI) were estimated by Poisson regression. Among 106,366 women with complete follow-up through 2005, 412 melanoma cases were diagnosed. Hair color and large, asymmetric nevi on the legs were strongly associated with melanoma risk (P(trend) < 0.001), and the RR for > or =2 nevi increased from brown/black to blond/yellow to red-haired women (RRs, 1.72, 3.30, and 4.95, respectively; P(interaction) = 0.18). Melanoma risk increased significantly with the number of sunburns and bathing vacations in the first three age decades (P(trend) < or = 0.04) and solarium use at ages 30 to 39 and 40 to 49 years [RRs for solarium use > or =1 time/mo 1.49 (95% CI, 1.11-2.00) and 1.61 (95% CI 1.10-2.35), respectively; P(trend) < or = 0.02]. Risk of melanoma associated with sunburns, bathing vacations, and solarium use increased with accumulating exposure across additional decades of life. Melanoma risk seems to continue to increase with accumulating intermittent sun exposure and solarium use in early adulthood. Apparently, super-multiplicative joint effects of nevi and hair color identify people with red hair and multiple nevi as a very high risk group and suggest important gene-gene interactions involving MC1R in melanoma etiology.

Associations between Silicone Skin Cast Score, Cumulative Sun Exposure, and Other Factors in the Ausimmune Study: A Multicenter Australian Study

Past sun exposure is linked to a wide range of disease outcomes but is difficult to measure accurately. Silicone skin casts measure skin damage, but some studies show that age rather than sun exposure is the most important determinant of cast score. We examined skin damage scores from silicone casts of the back of the hand in a large adult sample (n = 534) with a broad range of past cumulative UV radiation (UVR) doses. Participants were ages 18 to 61 years and resided in one of four locations down the eastern Australian seaboard, spanning 27-43 degrees S. Data were collected by questionnaire and during a nurse-led interview and examination. Silicone casts were graded from 1 to 6, where higher score represents greater damage. Higher skin damage score was associated with lighter skin pigmentation [adjusted odds ratio (AOR), 4.51; 95% confidence interval (95% CI), 2.33-8.75], fairer natural hair color, particularly red hair (AOR, 11.31; 95% CI, 4.08-31.36), and blue/gray eyes (AOR, 1.72; 95% CI, 1.14-2.59). Higher cumulative UVR dose, particularly before age 18 years, was associated with higher skin damage score (AOR, 2.06; 95% CI, 1.15-2.67 per 1,000 KJ/m(2)), as was number of sunburns, even after adjustment for cumulative UVR dose (AOR, 2.86; 95% CI, 1.50-5.43 for >10 sunburns ever compared with no sunburns ever). Silicone casts of the dorsum of the hand provide a measure of cumulative UVR dose and number of sunburns over the lifetime, which persists after adjustment for chronological age. They can be used as an objective measure of cumulative past sun exposure in epidemiologic studies, but other determinants of skin damage, such as skin pigmentation, should be concurrently evaluated.

Prevalence of acquired melanocytic naevi in Brazilian schoolchildren

The prevalence of acquired melanocytic naevi (AMN) is one of the most important known risk factors for malignant melanoma (MM) in homogeneous white populations. However, there are few studies on AMN in heterogeneous populations. Insight into the causes of AMN in heterogeneous populations in a country with intense ultraviolet radiation should lead to successful strategies in the prevention of MM. To evaluate the frequency and anatomical distribution of AMN and to observe the influence of environmental and constitutional variables. A cross-sectional study on the prevalence of AMN was performed on 1279 Brazilian schoolchildren, aged 2-8 years, according to an international protocol. Both girls and boys had the same number of AMN. The number of AMN was higher on sun-exposed body sites, such as shoulders, thorax/upper abdomen, face/ears and back. A high number of AMN was associated with lighter skin type, greater sun exposure, age, number of sunburns and presence of freckles. In genetically predisposed people, the body-site distribution of AMN in a heterogeneous population (mixed ethnic backgrounds) is similar to that in a homogeneous population and has the same tendency toward potential proliferation of melanocytes in the presence of ultraviolet radiation. Strategies to reduce the incidence of MM should start at an early age. We believe that these findings will have a direct effect on concepts for preventive strategies. Studies in different populations may serve as a starting point for research into the mechanism underlying increasing rates of AMN.