Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign

Abstract

Introduction Sunbed use has been significantly associated with increased risk of melanoma and non‐melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once‐a‐year screening during which participants’ data, including sunbed use and phenotype, are collected via questionnaires. Objectives To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. Methods To ensure reliability of the data, we defined inclusion and exclusion criteria for countries’ eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. Results Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I–II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01–1.10)], atypical nevi [SOR = 1.04 (1.00–1.09)], lentigines [SOR = 1.16 (1.04–1.29)] and suspicion of melanoma [SOR = 1.13 (1.00–1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91–1.10)]. Conclusions Indoor tanning is significantly associated with well‐recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high‐risk phenotypes.

Changing Trends in Melanoma Incidence and Decreasing Melanoma Mortality in Hungary Between 2011 and 2019: A Nationwide Epidemiological Study

“…Primary prevention has been in the focus of the Hungarian Society of Dermatology for decades. Hungary joined the Euromelanoma skin cancer prevention and education alliance formally in 2009 and enter the international scientific collaborations (36)(37)(38). Before this time, the Hungarian Society of Dermatology successfully organized and offered skin cancer screenings countrywide with public awareness campaign with the aims to stress the importance of sun protection and early recognition of suspicious malignant lesions.…”

Expert Consensus on Sunscreen for the Primary Prevention of Skin Cancer: Results of the Skin Cancer Prevention Working Group Conference

“…age, gender, family history, genetics, skin phototype), modifiable risk factors, such as degree of UVR exposure, can be mitigated during a patient's lifetime to prevent further increase in their individual risk for skin cancer. 28,[30][31][32][33][34][35] UVR exposure-specifically to UVA radiation (320-400nm wavelength) and UVB (290-320 nm)-is a modifiable risk factor that has a material impact on skin cancer incidence. 30,35 Studies have demonstrated chronic intermittent UVR may preferentially influence the risk of developing melanoma while chronic sustained UVR may be more related to the development of NMSC.…”

Climatological aspects of the increase of the skin cancer (melanoma) incidence rate in Europe

“…In Poland, Norway and the UK, the trend is~41 to~48% per 10 years and in Belgium~69% for women, while for men it is 48-51% in Poland and Norway, and 69-77% in the UK and Belgium (Figure 1). A common opinion is that such growth should be connected with a positive trend in the ambient EUV (Malinovic-Milicevic et al, 2018), the increasing use of sunbeds (Suppa et al, 2019), changes in human behaviour, and styles of clothing since twentieth century (Chang et al, 2014).…”

“…There are other melanoma risk factors (e.g., suppressed immune system, a high number of moles, genetic mutation), which are not related to environmental factors (https://www.aad.org/public/diseases/skin-cancer/melanoma/genetic-testing-for-melanoma). It seems that recent changes in people's behaviour (e.g., use of sunbeds, more frequent holidays in southern sunny resorts, insufficient application of sun blockers, changes of clothing style) are a possible source of the increase in melanoma (Chang et al ., ; Suppa et al ., ).…”

“…org/public/diseases/skin-cancer/melanoma/genetic-testing-for-melanoma). It seems that recent changes in people's behaviour (e.g., use of sunbeds, more frequent holidays in southern sunny resorts, insufficient application of sun blockers, changes of clothing style) are a possible source of the increase in melanoma (Chang et al, 2014;Suppa et al, 2019).…”