A 3-Year Follow-up of Sun Behavior in Patients With Cutaneous Malignant Melanoma

Abstract

IMPORTANCE UV radiation (UVR) exposure is the primary environmental risk factor for developing cutaneous malignant melanoma (CMM). OBJECTIVE To measure changes in sun behavior from the first until the third summer after the diagnosis of CMM using matched controls as a reference. DESIGN, SETTING, AND PARTICIPANTS Three-year follow-up, observational, case-control study performed from May 7 to September 22, 2009, April 17 to September 15, 2010, and May 6 to July 31, 2011, at a university hospital in Denmark of 21 patients with CMM and 21 controls matched to patients by sex, age, occupation, and constitutive skin type participated in the study. Exposure to UVR was assessed the first and second summers (n=20) and the first and third summers (n=22) after diagnosis. Data from 40 participants were analyzed. MAIN OUTCOMES AND MEASURES Exposure to UVR was assessed by personal electronic UVR dosimeters that measured time-related UVR in standard erythema dose (SED) and corresponding sun diaries (mean, 74 days per participant each participation year). RESULTS Patients' daily UVR dose and UVR dose in connection with various behaviors increased during follow-up (quantified as an increase in daily UVR dose each year; all days: mean, 0.3 SED; 95% CI, 0.05-0.5 SED; days with body exposure: mean, 0.6 SED; 95% CI, 0.07-1.2 SED; holidays: mean, 1.2 SED; 95% CI, 0.3-2.1 SED; days abroad: 1.9 SED; 95% CI, 0.4-3.4 SED; and holidays with body exposure: mean, 2.3 SED; 95% CI, 1.1-3.4 SED). After the second year of follow-up, patients' UVR dose was higher than that of controls, who maintained a stable UVR dose. No difference was found between groups in the number of days with body exposure or the number of days using sunscreen in the second and third years of follow-up. CONCLUSIONS AND RELEVANCE Our findings suggest that patients with CMM do not maintain a cautious sun behavior in connection with an increase in UVR exposure, especially on days with body exposure, when abroad, and on holidays.

25‐Hydroxyvitamin D2/D3 levels and factors associated with systemic inflammation and melanoma survival in the Leeds Melanoma Cohort

“…Another weakness is that although more than half of the cases were recruited within 6 months of diagnosis for some cases there is potentially a delay in vitamin D sampling for anything up to 2 years postdiagnosis. Recently diagnosed patients may well alter their UVR exposure to such an extent in this time frame that the sampled serum level is not reflective of the original level at diagnosis . We therefore re‐ran analyses of vitamin D in subsets of the data where the blood had been sampled no more than 1 year postdiagnosis and saw no material difference in the results (data not shown) suggesting that the delays in blood sampling did not materially affect our results.…”

Sun Exposure and Protection Behaviors among Long-term Melanoma Survivors and Population Controls

“…A small prospective study of melanoma survivors and controls found that UVR exposure was initially lower among survivors compared to controls but then converged over the three-year study. [23, 24]…”

“…Few studies have included a control group[23, 24, 26, 35]; the largest to date compared 156 melanoma survivors to 11408 respondents without cancer who participated in 2005 and 2007 National Cancer Institute Health Information National Trends Surveys (HINTS). [26] Notably, the results were similar to our study, though HINTS respondents reported slightly lower frequencies of sunscreen use.…”

Black light visualized solar lentigines on the shoulders and upper back are associated with objectively measured UVR exposure and cutaneous malignant melanoma

“…CMM patients are likely to have changed their UVR exposure behaviour, at least immediately after diagnosis. 13,24 Additionally, CMM patients may be affected by recall bias regarding UVR exposure behaviour before CMM diagnosis, although there is some disagreement on this matter, especially regarding sunbathing and sunburns. [26][27][28] Hence, solar lentigines in patients with CMM cannot be expected to associate with current or past UVR exposure.…”