Sunburn and malignant melanoma

Abstract

Summary We investigated the relationship between cutaneous malignant melanoma and multiple sunburns in the Queensland population. Interview data were gathered from 236 case-control pairs concerning their lifetime experience of severe sunburns, their occupational and recreational sun exposure, and their skin type. Excluding the lentigo maligna melanoma subtype, an association between multiple sunburns and melanoma was evident. After controlling for other major risk factors there was a significant dose-response relationship (P < 0.05): the estimated relative risk associated with 2-5 sunburns in life was 1.5, and with 6 or more was 2.4. This observation extends the hitherto circumstantial evidence of a causal relationship between exposure to solar ultraviolet radiation and melanoma, and suggests that precautionary measures could prevent the development of this disease in a proportion of cases in fair-skinned populations.In spite of the widely held view that exposure to sunlight is related to melanoma, there is a lack of direct supporting evidence (Editorial, Lancet 1981). This may be related in part to problems in quantifying the harmful solar radiation that penetrates the epidermis during sun exposure. There are no established criteria for measuring harmful sun exposure at the target-cell (melanocyte) level on which to base comparisons between populations or individuals. Ideally such criteria would allow quantitation of actual ultraviolet (UV) dose, as the specific carcinogenic wavelengths in sunlight are thought to lie in the UV range (Setlow, 1974), and especially in the UV-B band (280-320 nm) (Granstein & Sober, 1982 In a case-control study in Queensland, Australia, we have examined the relation of UV exposure to cutaneous melanoma by comparing the sunburn experiences accumulated over a lifetime in incident cases, with those of the general population. Materials and methods SubjectsCases were residents of Queensland, who were reported as having a first primary cutaneous melanoma between 1 July, 1979 and 30 June, 1980. The histological diagnoses were provided by pathology laboratories throughout the state. From the year's total of 871 cases, 243 eligible cases were selected at random, 236 (97%) of whom were successfully contacted and interviewed. Controls were randomly selected from the total population by means of electoral rolls (enrolment is compulsory). They were matched to individual cases by age within 5 years, sex and place of residence. The 236 controls represented 92% of the eligible persons contacted (a further 13 were not at the address listed and could not be contacted). ProtocolAll subjects were interviewed by one of us (A.G.) using a standard questionnaire. Respondents were asked to recall all episodes of severe sunburn where pain had persisted longer than 48 h, with or without blistering. The number of sunburn experiences (to a maximum of 9) was recorded for the age groups 0-9, 10-19, 20-29 years, and 30 years and over. Virtually all burns reported occurred before age 40 (there were only 8 sunburns...

The multicentre south European study 'Helios'. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin

“…However, the association was not significant after controlling for skin characteristics. Allowance for these variables is open to criticism as sunburns, as previously noted, occur only if exposure exceeds skin protection (Green et al, 1985;Kricker et al, 1995a).…”

Mutations in ras genes in cells cultured from mouse skin tumors induced by ultraviolet irradiation.

“…Solar UV light is important in the development of melanoma (1) and nonmelanoma skin cancers (2) in sun-exposed areas of human skin. Cyclobutane pyrimidine dimer and pyrimidine(6-4)pyrimidone photoproducts, which have cytotoxic and mutagenic effects, are the major types of DNA damage induced by far UV (3).…”

Cutaneous malignant melanoma and ultraviolet radiation: A review

“…CMM risk is associated with childhood sunburn [30][31][32], but the association may only reflect an individual's pigmentary characteristics relating to poor sun tolerance. An evaluation of the risk associated with outdoor work before college found a significantly elevated odds ratio for those who had worked outdoors compared with those who had not [33].…”

“…In the studies reviewed [28,30,31,40], higher risk of CMM was associated with fairer skin, and red and blond hair in childhood (as compared to dark hair). Blue eyes were an independent risk factor in only one of four epidemiologic studies.…”