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E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1
available a t www . scienc edirec t . com
journal homepage: www . ejconline . com
Sun exposure prior o !i"#nosis is "sso$i"e! %i& i'proe! suri" in'e"no'" p"iens* Resus +ro' " on#,er' +oo%,up su!- o+ ."i"n
p"iens
Se+"no Rosso"/
/ Fr"n$es$o Ser"
/ Nereo Se#n"n$/ Roero "nei
"
"CPO/ C"n$er Preenion Cenre/ Pie!'on C"n$er Re#isr-/ 3i" S"n Fr"n$es$o !" P"o" 1/ 1012 urin/ ."-
6oe$u"r "n! Nuriion" Epi!e'ioo#- Uni/ CSPO/ S$ieni+i$ .nsiue o+ us$"n-/ 3i" Cosi'o i 3e$$&io 2/ 501 Foren$e/ ."- $CPO/ C"n$er
Preenion Cenre/ C"n$er Epi!e'ioo#- Uni/ 3i" S"n Fr"n$es$o !" P"o" 1/ 1012 urin/ ."-
A R . C L E . N F O
Ari$e &isor-*
Re$eie! 21 Noe'er 2007
Re$eie! in reise! +or' 1 6"r$&
2008
A$$epe! 17 6"r$& 2008 A"i"e
onine 10 Apri 2008
e-%or!s*
Cu"neous 'e"no'"
Ris9 +"$ors
Re"ie suri"
3i"'in :
Sun exposure
A ; S R A C
$onro su!- in urin/ ."-? 0?8)? Ou!oor %or9 %"s no "sso$i"e! %i& "n in$re"se! ris9 o+ !e"&?
6ui"ri"e 'o!es in$u!in# "n"o'i$ sie/ 'e"no'" &i$9ness "n! &isoo#-/ s&o%e! &" iner'ien sun
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exposure &"! " en!en$- o e
inerse- "sso,$i"e! %i& &e ris9
o+ !e"& +ro' 'e"no'" %i& " R
o+ 0?=0 (5C. B 0?24>1?5) in &e
p"iens %i& 1 o 5 %ee9s "n! "
R o+ 0?54 (5C. B 0?2>1?2) in
p"iens %i& 'ore &"n =0 %ee9s
spen on &e e"$& !urin# &eir
i+ei'e?
&is su!-/ %i& si'i"r 'e&o!s "n! " on#er +oo%,up/ $on+ir's &e +in!in# &" sun exposure prior o
!i"#nosis o+ 'e"no'" is "sso$i"e! %i& i'proe! suri"?
2008 Eseier L!? A ri#&s resere!?
.nro!u$ion
6e"no'"/ "'on#s C"u$"si"n popu"ions/ &"s s&o%n o e one o+ &e
+"ses #ro%in# in$re"se in in$i!en$e in &e "s 50 -e"rs? Sin$e &e
seenies/ 'e"no'" in$i!en$e in USA (in %&ies) in$re"se! +ro' 8?7 per
100/000 in&"i"ns in 175 o 22? in 2001 %i& "n "nnu" per$en"#e
$&"n#e (APC) o+ "ou 5?8? .n Europe/ "n "nnu" in$re'en o+ 4>15
%"s o,sere!/2 %i& " !i++eren p"ern o+ in$re"se "'on#s Nor&,ern
$ounries/ %&ere &e in$re"se %"s 'ore !r"'"i$/ "n! "'on#s Sou&ern
$ounries/ %&ere &e in$re"se %"s 'ore 'o!es?4/5
.n Ausr"i"/ &e
$ounr- &" &"s su++ere! &e &i#&es o/ &e "nnu" per$en in$re"se %"s
"ou 4 +ro' &e ei#&ies o &e en! o+ 2000/ !espie &e prior in$i!en$e
r"e %"s "re"!- &e &i#&es in &e %or!?=/7
Forun"e-/ so'e re,
$en !"" s&o% " s"iis"ion o+ &e in$re"sin# ren! or een " s'"
!e$re"se in Nor& A'eri$" "n! in Ausr"i" in &e -oun#es $o&ors o+
ir&?1/=/7
On &e $onr"r-/ 'or"i- !i! no p"r"e &e in$re"se in in$i!en$e* in
USA/ &ere %ere 2? 'e"no'" !e"&s per 100/000 in 175 "n! ?0 in
200? .n Ausr"i"/ 'or"i- r"es pe"9e! in 185 "n! &en soppe!
risin#?8/
&is !is$rep"n$- %"s #ener"- "s$rie! o &e in$re"se o+
&inner 'e"no'"/ e"sier o re'oe " "n e"r- s"#e "n! &ere+ore %i& "
'ore +"our"e pro#nosis/ %&is &i$9er 'e"no'" in$re"se! " " o%er
r"e "n! %"s pro"- responsie +or &e $ons"n 'or"i-? . &"s "so
een su##ese! &" &e i'proe! sur,i" "sso$i"e! %i& in$re"se!
in$i!en$e/ "n! osere! "$ross seer" $ounries/ %"s !ue o " !i++eren
"n! 'ore eni#n -pe o+ 'e"no'"?10
r"!iion"-/ in$re"se! 'e"no'"
in$i!en$e
Correspon!in# "u&or* e?* D 0115==551 +"x* D 011=8=1? E,'"i "!!ress* se+"no?rosso$po?i (S? Rosso)?
05,804GH , see +ron '"er 2008 Eseier L!? A ri#&s resere!? !oi*10?101=GI?eI$"?2008?0?00
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127= E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1
%"s &ou#& o e "sso$i"e! %i& &e 'ore
%i!espre"! &"i o+ exposin# &e s9in o &e sun
!urin# eisure "$iiies %i&ou "n "!eu"e
proe$ion or o " per'"nen "n/ &e so,$"e!
Kiner'ien sun exposure?11
Re$en-/ "no&er &-po&esis %"s pu +or%"r!12
* &e
in,$re"se! nu'er o+/ '"in- &in/ 'e"no'"/ "n!
&e i',proe! suri" %ere o& re"e! o sun
exposure e$"use o+ " possie 'e"oi$ p"&%"-
in9in# sun exposure o i",'in : in!u$ion/ %&i$&
is suppose! o &"e "n inr",$eu"r "ni,oxi!"ie
"n! pro,"poposis e++e$? &is &-po&esis "rose +ro'
&e resus o+ &e +oo%,up o+ 'e"no'" p"iens in
Conne$i$u preious- inerie%e! in " $"se>
$onro su!-?1
&e "u&ors +oun! " posiie
"sso$i"ion e%een iner'i,en sun exposure
in!i$"ors "n! on#er suri"? An in!ire$
$on+ir'"ion o+ &ese +in!in#s %"s re$en- seen"n"-sin# &e +""i- o+ 'e"no'" in Ne% Sou&
2/ %i& " p"ri$ip"ion r"e o+ 85 %ere
inerie%e! ou o+ 05 ei#ie p"iens? &e ori#in"
su!- &"! " o" o+ 2=0 $"ses"n! 41= $on,ros?
A'on#s &ese $"ses/ 18= %ere %o'en "n! 74 'en*
su$& "n i'""n$e! sex r"io %"s !ue o &e +"$ &"
&e re$rui,'en o+ %o'en %"s proon#e! in or!er o
#e s"isi$" po%er +or su!-in# &e roe o+ or"
$onr"$epies in 'e"no'"?18
:"" $oe$ion "n! su!- "ri"es
A inerie%s %ere $"rrie! ou - r"ine!
inerie%ers usin# " uesionn"ire/ %&i$& in$u!e!
so$io,!e'o#r"p&i$ "ri"es ("#e " 'e"no'"
!i"#nosis/ sex/ ee o+ e!u$"ion "n! o$$u,p"ion)/
&os +"$ors (pi#'en"ion "n! s9in re"$ion o sun
exposure) "n! sun exposure &isor-? &e ee o+
e!u$"ion %"s use! "s " prox- o+ SES? .n &e
preious su!ies on &e e+,+e$ o+ so$i" !epri"ion
"n! suri" +ro' $"n$er/ &e ee o+ e!u$"ion in
."- proe! o e &e es in!i$or o+ SES?1
Pi#,
'en"ion %"s 'e"sure! - "ssessin# &"ir "n! e-e
$oour?
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"$ii-/ %e esi'"e! $u'u"ie sun exposure
su''in# up &e nu'er o+ %ee9s spen !urin#
i+ei'e/ "n! in$i!en exposure (%ee9sG-e"r) "s &e
r"io o+ $u'u"ie exposure o -e"rs o+ "$ii-? For
&e "n"-ses/ %e &en #roupe! &e ori#in" "ues in
per$enies o+ &e $u'u",ie !isriuions in
expose! $"ses? Ou!oor spors %ere $"ssi,+ie! "s
o%/ 'e!iu' "n! &i#& ris9 "n! suIe$ "ssi#ne! o
one o+ &ese $"e#ories? P"&oo#- repors "n!
$ini$" re$or!s o+ " &e 2=0 p"iens proi!e! &e
nee!e! in+or'"ion on esion &i$9ness/ C"r9s
s"#in#/ &isoo#- -pe "n! sie o+ 'e"no'" (&e"!"n! ne$9/ run9/ upper i' "n! o%er i')?
A&ou#& presen in &e ori#in" p"&oo#- repors/
in+or'"ion on u$er"ion/ on so"r e"sosis "n! on
o&er $&"r"$erisi$s o+ &e esion "n! &e
surroun!in# issue %"s no re$or!e!? .n &e "n"-ses/
%e use! in+or'"ion on esions &i$9ness sin$e i
%"s 'ore $o'pee (18 'issin#) &"n C"r9s
s"#in# (20 'issin#) "n! #roupe! is +irs %o
$"e#ories (0?75 '' "n! 0?75>1?50 '') sin$e %e
&"! no '"n- &in esions (14) o Ius,i+- &eir use
"s &e re+eren$e $"e#or-?
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E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1
1277
i" o+ " #roup in &e #ener" popu"ion $o'p"r"e - "#e "n! sex/ "n!
"ssu'e! o e pr"$i$"- +ree +ro' $"n$er? o $"$u"e &e expe$e!
nu'er o+ !e"&s/ %e use! 1,-e"r "#e $"ss i+e "es sr"i+ie! - sex?
&e i+e "es o+ &e ur,in proin$e %ere proi!e! - &e ."i"n
N"ion" .nsiue o+ S"isi$s (.SA) +or &e perio!s 18=>10/ 11>
15/ 1=> 2000 "n! 2001>2005? For &e -e"rs 184>185 %&en &e
re$rui,'en "n! +oo%,up o+ 'e"no'" p"iens s"re!/ %e use! &e i+e
"es o+ &e $oses ""i"e perio! (185>10)? o inesi#"e &e!i++ereni" ris9 in re"ie suri" "'on#s &e +"$ors su!ie!/ %e use!
#ener"ise! ine"r 'o!es %i& " Poisson error/ "n! " o# o++se o+ person>
-e"rs " ris9?20
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" &e e#innin# o+ +oo%,up
!e"&s ()
!e"&s ()"
A#e " !i"#nosis (-e"rs)
Less &"n =5
175
=1 (45)
1= (17)
Re+eren$e
=5 "n! oer
7=
=7 (5)
4 (=0)
2?7
(1?4 5?1)
Sex
6en
7
45 (=2)
1= (22)
Re+eren$e
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0?44
(0?25 0?78)
E!u$"ion
Up o &i#& s$&oo
225
118 (52)
4= (20)
Re+eren$e
Fur&er &"n &i#& s$&oo
2=
10 (8)
(1)
0?5
(0?20 1?78)
An"o'i$ sie o+ 'e"no'"
e"! "n! ne$9
=0
40 (=7)
20 (4)
Re+eren$e
Upper i's
=
17 (47)
10 (2=)
0?75
(0?27 2?1)
Lo%er i's
100
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4 (4)
14 (14)
0?55
(0?1 1?=)
run9
5
2= (4)
= (12)
1?5
(0?5 ?7)
6e"no'" &i$9ness
1?50 ''
2
0 ()
1 (21)
Re+eren$e
1?50 ?00) ''
51
24 (47)
(18)
4?5
(0?82 22?2)
?00 ''
5
45 (7=)
11 (1)
12?8
(2?5 =4?=)
No ""i"e
4
2 (5)
10 (21)
=?5
(1?1 8?0)
isoo#i$ -pe o+ 'e"no'"
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Super+i$i" spre"!in#
11
52 (40)
24 (18)
Re+eren$e
No!u"r
24
1= (=7)
2?1 (8?8)
2?0
(0?82 4?7)
A$r"
1
10 (77)
2?2 (17)
2?
(0?=2 8?4)
Leni#o
2=
1= (=2)
1 (50)
0?42
(0?04 4?4)
No ""i"e
57
4 (=0)
7? (14)
1?
(0?52 ?1)
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Nu'er o+ !e"&s expe$e! in &e s"'e #roup o+ $"ses i+ &e- &"! experien$e! &e s"'e 'or"i- "s &e #ener" popu"ion on-?
"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or "#e/ sex/ e!u$"ion "n! +oo%,up perio!?
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8/17/2019 Sun Exposure Prior to Diagnosis is Associated With Improved
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S9in -pe
.3
8
4
(5)
18 (22)
Re+eren$e
...
=7
0
(45)
11 (17)
0?75
(0?= 1?5)
..
75
4
(45)
1= (22)
0?57
(0?28 1?2)
.
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1
11
(58)
2? (12)
1?4
(0?5= ?=)
E-e $oour
;"$9Gro%n
1=
5=
(41)
21 (15)
Re+eren$e
;ue
52
1
(=0)
12 (24)
1?7
(0?80 ?5)
Qreen
1
(58)
=?4 (1)
1?8
(0?77 4?4)
Qre-
2
22
(7=)
?8 (4)
1?
(0?7= 4?)
"ir $oour
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;"$9Gro%n
178
88
(4)
8 (22)
Re+eren$e
;on!Gre!
=8
40
(5)
11 (1=)
1?5
(0?8 2?=)
Suns$reen use
No
14
8
(=2)
1 (2)
Re+eren$e
es
117
45
(8)
18 (1=)
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0?75
(0?41 1?4)
Sunurns in $&i!&oo!
Neer
180
(52)
8 (21)
Re+eren$e
So'ei'esGo+en
=7
(4)
12 (17)
0?=
(0?51 1?8)
Seere sunurns i+eon#
Neer
175
1
(52)
(22)
Re+eren$e
So'ei'esGo+en
72
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=
(50)
10 (14)
1?4
(0?7 2?5)
Ou!oor spors
No
17=
4
(5)
7 (21)
Re+eren$e
es
74
(45)
11 (15)
0?=4
(0?2 1?)
Ou!oor &oies
Neer
1
104
(52)
8 (1)
Re+eren$e
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So'ei'esGo+en
52
24
(4=)
12 (22)
0?=0
(0?27 1?)
Ou!oor %or9
No
14
8
(4=)
(17)
Re+eren$e
es
57
(=8)
1= (28)
1?
(0?=5 2?5)
Nu'er o+ %ee9s on &e e"$& in " i+ei'e
0
70
52
(74)
18? (2=)
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Re+eren$e
?
1>5
=7
27
(40)
?5 (14)
0?41
(0?18 0?0)
=0
114
4
(4)
22 (1)
0?
(0?1 0?7)
Nu'er o+ !e"&s expe$e! in &e s"'e #roup o+ $"ses i+ &e- &"! experien$e! &e s"'e 'or"i- "s &e #ener" popu"ion
on-?
"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or "#e/ sex/ e!u$"ion "n! +oo%,up perio!?
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E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1
127
in$re"se!/ "&ou#& no s"isi$"- si#ni+i$"n/ ris9 o+ !e"& +ro'
'e"no'" (R B 1? 5C. B 0?=5>2?5)?
.ner'ien sun exposure/ 'e"sure! - nu'er o+ %ee9s spen oer "
i+ei'e on &e e"$& ( "e 2)/ %"s inerse- "sso,$i"e! %i& &e ris9 o+
!e"&* p"iens %i& 1 o 5 %ee9s spen on &e e"$& !urin# &eir i+ei'e
&"! " si#ni+i$"n- !e,$re"se! ris9 o+ !-in# +ro' 'e"no'" (R B 0?41
5C. B 0?18>0?0) $o'p"re! o &ose %&o !i! no isi &e e"$& +or
&oi!"-s? A si'i"r/ u sron#er e++e$ %"s osere! +or &e p",iens %i&
'ore &"n =0 %ee9s spen on &e e"$& in &eir i+e,i'e (R B 0?
5C. B 0?1>0?7)/ %i& " si#ni+i$"n ine"r ren! (p,"ue B 0?015)? &e
$u,o++ " =0 %ee9s %"s !erie! +ro' &e u"rie o+ &e !isriuion o+
i'e spen " e"$&/ #roupin# o#e&er &e %o &i#&es u"ries +or
in$re"sin# &e nu'er o+ osere! eens?
Li+eon# exposure re+e$s " $o'posie p"ern o+ expo,sure?
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(2?0 =?8)
$onro su!-? &e
"e > Join e++e$ o+ sun exposure on &e e"$& !urin# $&i!&oo! "n! "!u&oo! on ris9 o+ !e"& +or 'e"no'" in " popu"ion,"se! su!- o+ urin
resi!ens/ ."-
Nu'er o+ %ee9s on &e e"$& !urin# "!u&oo!
Nu'er o+ %ee9s on &e e"$& !urin# $&i!&oo!
0
1>5
=0
0
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Osere!Gexpe$e!" !e"&s
52G18
G0?1
2G0?8
"@"r! r"io
"n! 5 C.
Re+eren$e
1?87 (0?4 7?2)
0?75 (0?10 5?7)
1>5
Osere!Gexpe$e!" !e"&s
2G8?8
G1?1
1G0?2
"@"r! r"io
"n! 5 C.
0?40 (0?17 0?4)
0?14 (0?02 0?=)
0?1 (0?01 5?1)
=0
Osere!Gexpe$e!" !e"&s
25G1
8G?4
11G?8
"@"r! r"io
"n! 5 C.
0?42 (0?18 0?8)
0?= (0?10 1?)
0?=8 (0?25 1?)
Nu'er o+ !e"&s expe$e! in &e s"'e #roup o+ $"ses i+ &e- &"! experien$e! &e s"'e 'or"i- "s &e #ener" popu"ion on-
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"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or "#e/ sex/ e!u$"ion "n! +oo%,up perio!?
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1280 E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1
"e 5 > Join e++e$ o+ iner'ien sun exposure/
'e"no'" &i$9ness/ sex "n! e!u$"ion on ris9 o+
!e"& +or 'e"no'" in " popu"ion,"se! su!- o+
urin resi!ens/ ."-
.ner'ien sun exposure
Neer
So'ei'esGo+en
6e"no'" &i$9ness"
?00 ''
Re+eren$e
0?4=
(0?18 1?2)
?00 ''
?4 (1?4 8?0)
1?8 (0?71 4?7)
Sex
6en
Re+eren$e
0?2
(0?14 0?7=)
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"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or
"#e/ e!u$"ion/ 'e"no'" &i$9ness "n! +oo%,up perio!?
"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or
"#e/ sex/ 'e"no'" &i$9ness "n! +oo%,up perio!?
$"se>$onro su!-/ $on!u$e! !urin# &e ei#&ies in "
6e!ier,r"ne"n popu"ion (urin/ ."-) +oun! "
sron# "sso$i"ion o+ s9in sensiii- o sun (OR 5?0
in 'en "n! 2?2 in %o'en) "n! sun exposure !urin#
re$re"ion" "$iiies (OR 4?1 in 'en "n! 2?7 in
%o'en) %i& 'e"no'" ris9?1=
Fur&er'ore/ in &e
ori#in" $"se>$onro su!-/ %e +oun! "n in$re"se!
ris9 o+ 'e"no'" +or &e &isor- o+ sunurns in
$&i!&oo! (OR 5?)/ e"in# "n in!epen!en e++e$ +or
re$re"ion" sun exposure !urin# o& "!u "n!
$&i!&oo!?17
&e resus o+ suri" "n"-sis
$on+ir'e! &e preious +in!in#s1
o+ " proe$ie
e++e$ o+ iner'ien sun exposure prior o &e
!eeop'en o+ 'e"no'" "#"ins 'or"i-? &e
"sso$i"ion %"s "so pres,en %i& "n in!ire$
'e"sure o+ iner'ien sun exposure su$& "s
$u'u"ie "'oun o+ i'e spen !urin# eisure "$i,
iies (&oi!"-s on &e e"$&)? .n seer" su!ies "$ross
&e %or! &is sun exposure &"i %"s "so +reuen-
"sso$i"e! %i& "n in$re"se! ris9 o+ !eeopin#
'e"no'" "n! " 'e","n"-sis21
esi'"e! " ris9 o+
1?= (5C.* 1?4 2?0)?
A&ou#& " repro!u$iii- su!-22
s&o%e! &" sun
expo,sure &isor- $ou! rei"- e esi'"e! &rou#&
" uesion,n"ire "!'inisere! - proper- r"ine!
inerie%ers/ " $er"in "'oun o+ un!erreporin#/
pro"- !ue o pui$ "%"reness "ou ris9 +"$ors
"s s&o%n in " $"se>$onro su!- on sune! use "n!
'e"no'"2
'"- e si presen? o%eer/ in ."-
!urin# &e ei#&ies/ %&en &e inerie%s %ere $on,
!u$e! "n! in+or'"ion on ris9 +"$ors %"s $oe$e!/
&ere %ere no -e e!u$"ion" $"'p"i#ns on 'e!i"
"ou 'e",no'" preenion/ nor p"ri$u"r pressure
+or usin# U3 e++e$,ie s9in proe$ion or "oi!in#
sun exposure? o%eer/ een i+ !i++ereni"
'is$"ssi+i$"ion $"n e ess i'por"n sin$e &ere %e"re !e"in# on- %i& 'e"no'" $"ses/ &e i'in# o+
inerie%s i'is our in+or'"ion " &e i'e o+
!i"#nosis "n! e+ore* sun exposure e&"iours $"n
&"e $&"n#e! sin$e &en "n! in+uen$e!/ in so'e
%"-/ p"iens suri"?
&e "sso$i"ion e%een suri" "n! iner'ien
sun exposure %"s no exp"ine! - $on+oun!in# %i&
so$i" $"ss/
represene! &ere - " &i#& e!u$"ion ee/ %&i$&
%"s "so in,erse- "sso$i"e! %i& ris9 o+ !-in# o+
'e"no'"? .n "!!iion/ &e re"ie suri"
"ppro"$& "so oo9 ino "$$oun &e !i+,+eren$es in
'or"i- +or " $"uses - "#e "n! sex/ $onsi!erin#
&e %i!e "#e r"n#e o+ in$i!en $"ses in$u!e! in &is
su!-? Een "+er "!Ius'en +or "n"o'i$ sie/
'e"no'" &i$9ness "n! -pe o+ 'e"no'"/
iner'ien sun exposure $on+ir'e! " en!en$- o e
inerse- "sso$i"e! %i& &e ris9 o+ !e"&?
&e i'proe! suri" "'on#s suIe$s %i& "n
iner'i,en sun exposure $"n "so e !ue o &eir
in$re"se! s9in sur,ei"n$e/ "&ou#& &e preious
su!ies1/14
s&o%e! &" &is %"s in!epen!en-
"sso$i"e! %i& suri"? .n &e presen su!-/ &ere
%ere no 'e"sure o+ s9in surei"n$e "n! &us %e
%ere un"e o !ire$- e"u"e is i'p"$ on
suri"? o%eer/ seer" su!ies &"e "re"!-
s&o%e! &" s9in sur,ei"n$e %"s sus"ni"-
"sso$i"e! %i& &i#& so$i" $"ss "n!Gor &i#&
e!u$"ion?24/25
As " '"er o+ +"$/ in our su!- &e
proe$ie e++e$ o+ iner'ien sun exposure %"s
si presen "so "'on#s ess e!u$"e! peope? .n
"!!iion/ &e proe$ie e++e$ o+ sun exposure on ris9
o+ !e"& +ro' 'e",no'" %"s si'i"r %&eneer &e
p"iens &"! " &in or &i$9 esion?
O+ $ourse &is su!-/ "n! si'i"r su!ies/ $"nno
exp"in &e ioo#i$" p"usiii- o+ &e e++e$ o+ sun
exposure on p",ien suri"? o%eer/ i %"s
i'por"n o +in! " $on+ir'",ion o+ &e su!- -
;er%i$9 "n! $oe"#ues in " !i++eren popu"ion/%i& !i++eren/ "&ou#& si'i"r/ !"" $oe$ion
'e&o!s/ " on#er +oo%,up ('e!i"n i'e 17 -e"rs)/
"n! " o% per$en"#e o+ 'isse! o +oo%,up $"ses
(?5)? An! i %"s "so uie ineresin# &" our
esi'"es o+ " proe$ie e++e$/ 'e"sure! in er's o+
&"@"r! r"ios/ %ere r"&er si'i,"r o &ose
preious- +oun!* " R o+ 0?= (5C. 0?>1?0) +or
&i#& ersus o% iner'ien sun exposure? On &e
o&er &"n!/ ;er%i$9 "n! $oe"#ues +oun! "n
i'proe'en o+ sur,i" "so in &e presen$e o+
so"r e"sosis/ &" $"n e ie%e! "s " surro#"e +or
$&roni$ sun exposure/ %&is in &e presen su!-/
%&ere so"r e"sosis %"s no re$or!e! +ro' &e
p"&oo#- repors/ "n in!i$"or o+ $&roni$ sun
exposure su$& "s exposure !urin# o$$up"ion/ !i!no s&o% "n- e++e$? A possie exp"n"ion o+ &e
ioo#i$" 'e$&"nis' e-on! &e proe$ie e++e$ o+
sun exposure on 'e"no'" 'or"i- %"s propose!
o ie in &e "ni,proi+er"ie/ pro,"popoi$ "n! pro,
!i++ereni"ion e++e$s o+ i"'in :/2=
%&i$& in,
$re"ses "+er sun exposure? E$oo#i$" su!ies pu in
re"ion suni#& "n! $"n$er suri"27
"n! 'or"i-/
u &ere is ei,!en$e "so +ro' o&er su!ies &"
person" &"is o+ &i#& sun exposure '"- i'proe
ou$o'e "so +or re"s/ $oon "n! pros"e $"n$er
(+or " reie% o+ &e su!ies on suni#& "n! $"n$er
see "so ri$9er "n! Ar'sron#)?28
o%eer/ &e
&-po&esis o+ " posiie roe p"-e! - i"'in : is/
in so'e %"-/ in $onr"!i$ion %i& our resu o+ "nin$re"se! ris9 o+ !e"&/ "&ou#& no s"isi$"-
si#ni+i$"n/ +or $&roni$ expo,sure/ 'e"sure! %i&
8/17/2019 Sun Exposure Prior to Diagnosis is Associated With Improved
25/27
$u'u"ie i'e o+ sun exposure !urin# ou!oor
%or9? Aso in &is $"se &e "'oun o+ s-n&esis o+ 25,
&-!rox- i"'in : s&ou! e in$re"se! "s %e "s
!urin# iner'ien sun exposure?
.n #ener"/ "s E#"n12
re'"r9e! Kno one . . . is
su##esin# &" sun"&in# is &e roue o . . . " eer
$"n$er ou$o'e. . ./ &o%,eer/ i re'"ins ineresin#
o expore &e &-po&esis o+ " pos,sie roe o+
i"'in : in 'e"no'" suri" or &e presen$e o+
8/17/2019 Sun Exposure Prior to Diagnosis is Associated With Improved
26/27
E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1
1281
" #enei$ pre!isposiion $onsisen %i& &e %o p"&%"-s +or 'e"no'"?2
Con+i$ o+ ineres s"e'en
None !e$"re!?
A$9no%e!#e'ens
&e ori#in" $"se>$onro su!-/ +ro' %&i$& &is "n"-sis se's/ %"s
p"ri"- suppore! - &e ."i"n Asso$i"ion +or C"n$er Rese"r$& "n! &e
."i"n Le"#ue A#"ins C"n$er?
17* risin# ren!s in
in$i!en$e "n! 'or"i- u re$en s"ii@"ions in 2=?
Seeri Q/ Qies QQ/ Roerson C/ ;o-e P/ Auier P? 6or"i- +ro' $u"neous
'e"no'"* ei!en$e +or $onr"sin# ren!s e%een popu"ions? ;r J C"n$er
200082*1887>1?
Cro$ei E/ C"po$"$$i" R/ C"se" C/ e "? Popu"ion,"se! in$i!en$e "n!
'or"i- $"n$er ren!s (18=>17) +ro' &e ne%or9 o+ ."i"n $"n$erre#isries? Eur J C"n$er Pre 20041*287>5?
Coor- 6/ ;""!e P/ Ai9en J/ S'i&ers 6/ 6$Leo! QR/ Rin# .? ren!s +or in
siu "n! in"sie 'e"no'" in Mueens"n!/ Ausr"i"/ 182>2002? C"n$er
C"use Conro 200=17*21>7?
6"rre L:/ N#u-en L/ Ar'sron# ;? ren!s in &e in$i!en$e o+ $u"neous
'"i#n"n 'e"no'" in Ne% Sou& =2?
;""!e P/ Coor- 6? ren!s in 'e"no'" 'or"i- in Ausr"i"* 150>2002 "n!
&eir i'pi$"ions +or 'e"no'" $onro? Aus N J Pui$ e"&
20052*8>=?
Qies QQ/ Ar'sron# ;/ ;uron RC/ S"pes 6P/ &urs+ie! 3J? "s
'or"i- +ro' 'e"no'" soppe! risin# in Ausr"i"T An"-sis o+ ren!s
e%een 11 "n! 14? ;6J 1=12*1121>5?
;uron RC/ Ar'sron# ;? Curren 'e"no'" epi!e'i$* " non'e"s"si@in#
+or' o+ 'e"no'"T ?
Ar'sron# ;/ ri$9er A? o% 'u$& 'e"no'" is $"use! - sun exposureT
6e"no'" Res 1*5>401?
E#"n 6/ Sos'"n JA/ ;o ?
;onio 6/ Ar'sron# ;/ :ore JF? 3"ri"ion in in$i!en$e "n! +""i- o+
'e"no'" - se"son o+ !i"#nosis in Ne% Sou&
8/17/2019 Sun Exposure Prior to Diagnosis is Associated With Improved
27/27
&o'"s NE/ ;er%i$9 6/ Cor!eiro,Sone 6? Cou! ;RAF 'u"ions in
'e"no$-i$ esions "rise +ro' :NA !"'"#e in!u$e! - ur"ioe r"!i"ionT J
.nes :er'"o 200=12=*115>7?
"nei R/ Rosso S/ F"##i"no F/ Ro++ino R/ Coonn" S/ 6"rin" Q? A $"se,
$onro su!- on $u"neous '"i#n"n 'e"no'" in &e proin$e o+ urin/ ."-?
Re Epi!e' e S"ne Pu 188=*0>17?
"nei R/ Fr"n$es$&i S/ Rosso S/ Coonn" S/ ;i!oi E? Cu"neous 'e"no'"
"n! sunurns in $&i!&oo! in " sou&ern Europe"n popu"ion? Eur J C"n$er
1228A*1172>=?
"nei R/ Fr"n$es$&i S/ Rosso S/ ;i!oi E/ Coonn" S? Cu"neous '"i#n"n
'e"no'" in +e'"es* &e roe o+ &or'on" "n! repro!u$ie +"$ors? .n J
Epi!e'io 101*522>=?
Rosso S/ F"##i"no F/ "nei R/ Cos" Q? So$i" $"ss "n! $"n$er suri" in
urin/ ."-? J Epi!e'io Co''un e"& 1751*0>4?
:i$9'"n P=4?
Q"n!ini S/ Ser" F/ C""ru@@" 6S/ e "? 6e","n"-sis o+ ris9 +"$ors +or
$u"neous 'e"no'"* ..? Sun exposure? Eur J C"n$er 200541*45>=0?
Rosso S/ 6in"rro R/ S$&r"u S/ u'ino R/ Fr"n$es$&i S/ "nei R?
Repro!u$iii- o+ s9in $&"r"$erisi$ 'e"sure'ens "n! repore! sun exposure
&isor-? .n J Epi!e'io 20021*4>4=?
!e 3ries E/ ;onio 6/ Seeri Q/ e "? Pui$ "%"reness "ou ris9 +"$ors $ou!
pose proe's +or $"se,$onro su!ies* &e ex"'pe o+ sune! use "n!
$u"neous 'e"no'"? Eur J C"n$er 200541*2150>4?
A@@"reo L6/ J"$osen P;? F"$ors in+uen$in# p"ri$ip"ion in $u"neous
s$reenin# "'on# in!ii!u"s %i& " +"'i- &isor- o+ 'e"no'"? J A' A$"!
:er'"o 20075=*8>40=?
C"ri P/ :e Qior#i 3/ P"i :/ e "? Se+,!ee$e! $u"neous 'e"no'"s in
."i"n p"iens? Cin Exp :er'"o 20042*5>=?
Or!one@,6or"n P/ L"rri" 6J/ Pen!"s,Fr"n$o N/ Auier" O/ Qon@"es,
S"n$&o J6/ 6uno@ A? 3i"'in : "n! $"n$er* "n up!"e o+ in iro "n! in io
!""? Fron ;ios$i 200510*272>4?
Li' S/ Ro-$&ou!&uri R/ Peo J/ S$&%"r@ Q/ ;""!e P/ 6Ver ? C"n$er
suri" is !epen!en on se"son o+ !i"#nosis "n! suni#& exposure? .n J
C"n$er 200=11*150>=?
ri$9er A/ Ar'sron# ;? :oes suni#& &"e " ene+i$i" in+uen$e on $er"in
$"n$ersT Pro# ;iop&-s 6o ;io 200=2*12>?
Pur!ue 6P/ Fro' L/ Ar'sron# ;/ e "? Eioo#i$ "n! o&er +"$ors
pre!i$in# neus,"sso$i"e! $u"neous '"i#n"n 'e"no'"? C"n$er Epi!e'io
;io'"r9ers Pre 200514*2015>22?
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