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PubMed1996

Sun-related behaviour in individuals with dysplastic naevus syndrome.

In Sweden, individuals with dysplastic naevus syndrome are regularly screened and informed about self-examination and sun-protection at special clinics. This study describes sun-related behaviour in this group. A total of 54/65 consecutive patients with dysplastic naevus syndrome (28 women and 26 men) completed diary recordings of sun-related behaviour during 1 month in 1994. A majority (81%) reported sunbathing with the intention to get a tan, mean number of occasions 9.2, range 1-24 occasions, during the month of recordings. Out of these, 61% reported sunburns, some of them repeatedly up to 7 times. Sunbathing occurred mainly in bathing suits during midday in sunny weather, with a mean duration of 2.5 h per occasion. Such a hazardous behaviour in the sun in a melanoma high risk group is alarming. New models for intervention to support a more sun protective life style in this group of patient have to be elaborated.

Adolescent↗

PubMed1999

Beach holiday sunburn: the sunscreen paradox and gender differences.

A survey about sunbathing practices was performed on a summer holiday weekend at a Galveston beach. The likelihood of sunburn increased with increasing duration of sun exposure, with 100% of subjects experiencing sunburn after exposure > or = 4.5 hours. Men exhibited a significantly higher frequency of sunburn, employed fewer sun-protective measures, and demonstrated less knowledge concerning sun safety information and skin cancer than women. This information suggests a need for greater educational efforts directed toward changing public attitudes about preventing sunburn, especially those of men, that currently lead to high-risk sunbathing behavior.

Adolescent↗

PubMed1991

Community-based cancer prevention--the Stockholm Cancer Prevention Program.

The Stockholm Cancer Prevention Program (SCPP) is among the first comprehensive community intervention programs in the world aimed at reducing cancer incidence and mortality. The program began in 1987 in an urban area with more than 1.6 million inhabitants. In its work, SCPP utilizes a community-based approach focusing on (1) reduction in tobacco consumption, (2) reduction in dietary fat consumption and increase in dietary fiber consumption, and (3) changing sunbathing behavior in order to reduce the incidence of malignant melanoma. The overall philosophy of the program is to initiate activities capable of affecting the life style of the Stockholm population in these directions. SCPP intends to influence behavior through individual face-to-face contact. The tool for this contact is collaboration with independent organizations which are already active in the target communities. Food supply to the general public will be influenced through food producers, wholesalers, retailers, and caterers. Tobacco use, food habits, and sunbathing habits will be influenced via occupational health services; public health services including primary care, schools and municipal social services; voluntary organizations; and mass media. A model for possible ways of evaluating the program has been designed.

Community Health Services↗

PubMed1988

The evaluation of possible melanoma risk groups of patients in a series of pigmented naevi. Clinical and histological intercorrelations.

The trends of the clinical/histological intercorrelations in two series of pigmented naevi have been compared. One series of naevi represents patients who are habitual sunbathers and/or who have travelled to Southern sunny climates. The other series includes naevi from easily sunburned patients. The sunburner-group is correlated to histological features such as mitoses, atypia and fibrosis of the tumour as well as to an irregular/atypical tumour type. Such trends are not found in the other target group. The sunburners have a poor ability to suntan, while the sunbather group includes good suntanners. This indicates the importance of the melanin UV-filter effect of the skin as a protection against the promotion of potential MM-precursors, such as irregular/atypical naevi.

Humans↗

PubMed1986

Relationship of cutaneous malignant melanoma to individual sunlight-exposure habits.

The relationships of different histologic types of cutaneous malignant melanoma to occupational and recreational sunlight exposure, habits of clothing, sunburn histories, and use of sunscreening agents were examined in a case-control study of 507 patients and 507 matched controls in Western Australia. Variations in relationships according to the primary site of melanoma were also examined. An increased incidence rate of superficial spreading melanoma was associated with low total outdoor exposure in early adulthood and frequent participation in boating and fishing. Superficial spreading melanoma of the trunk was also related to frequency of sunbathing at ages 15-24 years and of exposure of the trunk while working outdoors. In women the rate ratio for all types of melanoma occurring on the trunk was estimated at 13.0 (95% confidence interval, 2.0-83.9) in those who wore a bikini or bathed nude at ages 15-24 years compared with those wearing a conservative one-piece bathing suit. There was little evidence that sunbathing or wearing a bikini within 10 years of case diagnosis were risk factors for melanoma of the trunk. After control of confounding due to constitutional factors, only Hutchinson's melanotic freckle melanoma showed a relationship to severe sunburn. For nodular melanoma, sunburn appeared to be protective. Although many of the results supported the hypothesis that melanomas other than the Hutchinson's melanotic freckle type are related to occasional bursts of recreational sun exposure during a susceptible period in early adult life, little support for the hypothesis was obtained when recreational sun exposure was expressed as a proportion of total outdoor exposure, which had been considered a priori to be an index of intermittent sunlight exposure.

Adolescent↗

PubMed1994

[Is UV-A a cause of malignant melanoma?].

The first action spectrum for cutaneous malignant melanoma was published recently (2). This spectrum was obtained using the fish Xiphophorus. If the same action spectrum applies to humans, the following statements are true: Sunbathing products (agents to protect against the sun) that absorb UV-B radiation provide almost no protection against cutaneous malignant melanoma. UV-A-solaria are more dangerous than expected so far. If people are determined to use artificial sources of radiation for tanning, they should choose UV-B-solaria rather than UV-A-solaria. Fluorescent tubes and halogen lamps may have weak melanomagnetic effects. Ozone depletion has almost no effect on the incidence rates of CMM, since ozone absorbs very little UV-A radiation. Sunbathing products which contain UV-A-absorbing compounds or neutral filters (like titanium oxide) provide real protection against cutaneous malignant melanoma, at least if they are photochemically inert.

Animals↗

PubMed1997

To burn or not to burn: use of computer-enhanced stimuli to encourage application of sunscreens.

Skin cancer affects 515,000 Americans every year, causing more than 7,000 deaths. Prior studies attempted, with scant success, to increase general knowledge about protection of the skin and to encourage use of sunscreens. The failure was attributed to the allure of the suntan as a symbol of health and affluence and to the "optimistic bias" (belief in one's own invulnerability) displayed by sunbathers. The study detailed here sought to increase the use by subjects of sunscreen by showing computer-altered images of their own faces, aged and disfigured by lesions. That stimulus was designed to counter false impressions and illusions of sunbathers about the benefits of the sun by demonstrating, immediately and personally, negative effects of sun exposure. Data were collected from thirty adolescents in the form of six weekly logs of sunscreen use and time spent outdoors between 10 AM and 3 PM. Results showed that the computer-altered images motivated increased use of sunscreen in the short term: subjects in the experimental groups used sunscreen almost three times as frequently as those in the control group during the experimental period (P = 0.000). Images of aging and disfiguring by lesions produced a more intense and prolonged modification in behavior than images of aging only.

Adolescent↗

PubMed2005

The prevalence of common acquired melanocytic nevi and the relationship with skin type characteristics and sun exposure among children in Lithuania.

OBJECTIVE: To evaluate the prevalence of common acquired melanocytic nevi and its relationship with pigmentary characteristics and severe sunburns in children. DESIGN: Cross-sectional study. SETTING: Kaunas city, Lithuania (latitude of 55 degrees 55 minutes). PATIENTS: A random sample of 484 children aged 1 to 2 years, 4 to 5 years, and 9 to 10 years and adolescents aged 14 to 15 years. INTERVENTIONS: A questionnaire that provided information about the history of sunbathing and skin type. MAIN OUTCOME MEASURES: Atypical melanocytic nevi were defined according to the clinical criteria of the ABCDE rule. RESULTS: The median number of all common acquired melanocytic nevi was 12 in boys and 11 in girls; the median number of melanocytic nevi 2 mm or larger in boys and girls was 4. Twenty-seven percent of children experienced severe sunburns more than once. After adjustment for age and sex, it was found that children who had severe sunburns in summer and skin type I had a higher density of all melanocytic nevi and melanocytic nevi 2 mm or larger. The prevalence of atypical melanocytic nevi was 7% in all children and was age dependent (age 4-5 years, 1%; 9-10 years, 4%; 14-15 years, 16%). Three percent of children had congenital melanocytic nevi. CONCLUSIONS: The total number of common acquired melanocytic nevi in children increased with age. There was a positive association between severe sunburns, the tendency of the skin to burn, and the number of all melanocytic nevi and nevi 2 mm or larger.

Adolescent↗

PubMed2003

Use of indoor tanning facilities by white adolescents in the United States.

CONTEXT: Indoor tanning is a risk factor for skin cancer, but the population-based prevalence of this behavior among adolescents is not clearly known. OBJECTIVES: To describe the prevalence of tanning booth use among white US adolescents and to assess its association with sociodemographic factors, health behaviors, and appearance. DESIGN, SETTING, AND PARTICIPANTS: A nationally representative sample of 6903 non-Hispanic white adolescents, aged 13 to 19 years, who participated in Wave II (between April 1, 1996, and August 31, 1996) of the National Longitudinal Study of Adolescent Health. MAIN OUTCOME MEASURE: Frequency of lifetime use of indoor artificial tanning facilities. RESULTS: With the data weighted to national levels, 36.8% of the white female adolescents and 11.2% of the white male adolescents have used a tanning booth at least once in their life, while 28.1% and 6.9% of the female and male adolescents, respectively, reported tanning booth use 3 or more times. The percentage of female adolescents using tanning booths 3 or more times increased with age, from 11.2% of the 13- to 14-year-olds to 47.0% of 18- to 19-year-olds and also increased with greater tanning ability, from 12.6% of the poor tanners to 38.1% of those with a strong tan response. After multivariate adjustment, those residing in the Midwest (adjusted odds ratio [aOR], 2.38; 95% confidence interval [CI], 1.53-3.68) or South (aOR, 2.91; 95% CI, 1.89-4.53), attending a rural high school (aOR, 1.80; 95% CI, 1.09-2.98), and reporting the use of 2 or 3 substances (aOR, 3.06; 95% CI, 2.44-3.82) were more likely to use indoor tanning facilities, as were dieters (aOR, 1.26; 95% CI, 1.01-1.57) regardless of their body mass index. Decreased odds of indoor tanning were observed among those with a college-educated mother (aOR, 0.68; 95% CI, 0.51-0.90) and greater cognitive ability (per 10-point score increase; aOR, 0.89; 95% CI, 0.82-0.96) while routine participation in physical activity significantly lowered the odds of indoor tanning only among female adolescents. CONCLUSIONS: Indoor tanning is prevalent, particularly among female adolescents, and aligns with other risk behaviors, appearance-related factors, and intentional sunbathing. The risks of artificial tanning need increased emphasis among adolescents, especially in the Midwest and South where extremes in the availability of natural light appear to send intentional tanners indoors.

Adolescent↗

PubMed1997

Case-control study of malignant melanoma among employees of the Lawrence Livermore National Laboratory.

During 1972 to 1977, the Lawrence Livermore National Laboratory (LLNL) experienced increased diagnosis of malignant melanoma among employees. In 1984, a report on the results of a case-control study of 39 cases concluded that occupational factors, including exposures to ionizing radiation and to chemicals, caused the excess incidence. The study reported here, based on results from 69 case-control pairs, re-examines the role of the occupational factors implicated by the earlier study in melanoma causation. Results from this study suggest that constitutional factors, including skin reactivity to sunlight, sunbathing frequency, and number of moles, explain most of the excess melanoma. Exposures to occupational factors, including ionizing radiation and chemicals, were found to be no different in cases than in controls.

Algorithms↗

PubMed2000

An international evaluation of the cancer-preventive potential of sunscreens.

The IARC convened a working group of experts in Lyon, France, on 10-18 April, 2000, to evaluate the cancer-preventive activity of sunscreens and to compile the fifth volume of the IARC Handbooks of Cancer Prevention. The working group concluded that the topical use of sunscreens reduces the risk of sunburn in humans and that sunscreens probably prevent squamous-cell carcinoma of the skin when used mainly during unintentional sun exposure. No conclusion can be drawn about the cancer-preventive activity of topical use of sunscreens against basal-cell carcinoma and cutaneous melanoma. Use of sunscreens can extend the duration of intentional sun exposure, such as sunbathing. Such an extension may increase the risk for cutaneous melanoma. The working group warned against relying solely on sunscreens for protection from UV radiation.

Basal Cell Carcinoma↗

PubMed2004

PTCH polymorphism is associated with the rate of increase in basal cell carcinoma numbers during follow-up: preliminary data on the influence of an exon 12-exon 23 haplotype.

After first presentation with a basal cell carcinoma (BCC), patients demonstrate interindividual diversity in the rate of development of further BCCs (number/year of follow-up). The mechanism for this variation is unknown. In this study, we evaluated whether PTCH variants mediate this phenomenon. We used negative binomial regression analysis to identify associations between BCC numbers/year and host characteristics, parameters of exposure to ultraviolet radiation (UVR), and PTCH exon 12(1686) C/T, intron 15(2560+9) G/C, and exon 23(3944) C/T genotypes and haplotypes in 279 BCC cases who presented with an initial tumor on the head/neck. PTCH genotypes were not significantly associated with BCCs/year, although cases with two copies of the C1686-C3944 haplotype developed significantly fewer BCCs/year than those without this haplotype (rate ratio = 0.44; 95% CI = 0.27-0.71). Cases with one copy of T1686-T3944 developed more BCCs/year (rate ratio = 2.46; 95% CI = 1.27-3.97) than those without the haplotype. We found no significant associations between BCCs/year and the other PTCH haplotypes studied. We reexamined the association of C1686-C3944 with BCCs/year in a model that included UVR exposure parameters (sunburning in childhood, sunbathing score, intermittency of exposure between 40 and 60 years of age, exposure in hours/year) and skin type, gender, and age at first presentation. The association between C1686-C3944 and BCCs/year remained significant (rate ratio = 0.44; 95% CI = 0.26-0.73 for two copies of the haplotype). The data show that allelic variation in PTCH contributes to the rate of development of BCC.

Adult↗

PubMed2003

Changing epidemiology of malignant cutaneous melanoma in Europe 1953-1997: rising trends in incidence and mortality but recent stabilizations in western Europe and decreases in Scandinavia.

We analyzed time trends in incidence of and mortality from malignant cutaneous melanoma in European populations since 1953. Data were extracted from the EUROCIM database of incidence data from 165 cancer registries. Mortality data were derived from the WHO database. During the 1990s, incidence rates were by far highest in northern and western Europe, whereas mortality was higher in males in eastern and southern Europe. Melanoma rates have been rising steadily, albeit with substantial geographic variation. In northern Europe, a deceleration in these trends occurred recently in persons aged under 70. Joinpoint analyses indicated that changes in these trends took place in the early 1980s. In western Europe, mortality rates have also recently leveled off [estimated annual percentage change (EAPC) from -13.6% (n.s.) to 3.3%], whereas in eastern and southern Europe both incidence and mortality rates are still increasing [incidence EAPCs 2.3-8.9%, mortality EAPCs -1.8% (n.s.) to 7.2%]. Models including the effects of age, period and birth cohort were required to adequately describe the rising incidence trends in most European populations, with a few exceptions. Time trends in mortality were adequately summarized on fitting either an age-cohort model (with the leveling off of rates starting in birth cohorts between 1930 and 1940) or an age-period-cohort model. The most plausible explanations for the deceleration or decline in the incidence and mortality trends in recent years in northern (and to a lesser extent western) Europe are earlier detection and more frequent excision of pigmented lesions and a growing public awareness of the dangers of excessive sunbathing.

Adult↗

PubMed1988

The Danish case-control study of cutaneous malignant melanoma. II. Importance of UV-light exposure.

A population-based case-control study of 474 patients with cutaneous malignant melanoma and 926 population controls, conducted in East Denmark over a 3-year period, included an evaluation of the relationship of UV-light exposure to cutaneous melanoma risk. Patients with lentigo maligna melanoma were not included. Significantly increased risk was associated with severe sunburn before age 15 (RR = 2.7 for 5 + vs. never), sunbathing (RR = 1.6), boating (RR = 1.4) and vacations spent in the sun (RR = 1.4 for very sunny vs. never). A significant decrease in risk was associated with occupational exposure during the summer in males (RR = 0.7), and no association with cutaneous microtopography was seen. These findings were independent of the effects of constitutional risk factors (naevi, freckles and light hair colour). No association was found between the risk of cutaneous melanoma and exposure to artificial UV-light (fluorescent light, sun lamps, or sun beds). No significant difference was found between superficial spreading melanoma and nodular melanoma with regard to any of the sun exposure variables. Our data indicate that exposure to intermittent intense sunlight is an important risk factor for cutaneous malignant melanoma, while long-term continuous exposure does not appear to be risk factor.

Adult↗

PubMed1980

Case report: malignant melanoma arising during drug therapy for vitiligo.

A 30-year-old white male developed cutaneous patches of depigmentation which were treated with Trioxsalen ingested before daily sunbathing. A darkly pigmented lesion which appeared three weeks later on his back was widely excised and classified as a low-grade malignancy. Although the treatment of vitiligo with plants containing photodynamically active compounds dates back as far as 1400 BC, the modern period of research began only in the 1930's leading to the development of oral psoralens, a coumarin derivative. In early tests, patients showed increased sunlight tolerance and repigmentation of vitiliginous areas. Although some patients have developed uveitis and vitiligo while being treated for melanoma, previous published reports deny any cutaneous malignancy arising during drug therapy of vitiligo. The associations between vitiligo and melanoma are discussed. The possible causative role of Trioxsalen in etiology of the case presented is discussed.

Adult↗

PubMed2001

Assessment of knowledge of melanoma risk factors, prevention, and detection principles in Texas teenagers.

INTRODUCTION: The incidence of melanoma has increased in the past 10 years more rapidly than any other cancer. Exposure to intense solar radiation in youth significantly increases the lifetime risk of developing melanoma. We postulate that teenagers have little awareness of melanoma prevention or detection principles. The purpose of this study was to assess the knowledge of teenagers about melanoma and to identify which age groups are most receptive to altering their sun exposure behaviors. METHODS: Two hundred and ten examinations testing general knowledge of sun exposure and melanoma were completed and returned by junior high and high school students ages 12 to 18 in Dallas and Houston, Texas. All students completing and returning the examination were provided with the correct answers to the test and a detailed explanation of each of the test items as part of an educational exercise. A second questionnaire was then administered to determine the effect of the educational exercise on future sun exposure practices. Students were divided into two age groups (12 to 15 and >or=16 years old) for comparison of scores on the knowledge examination and responses to behavioral items. Comparison of response rates between age groups was performed using chi(2) analysis. RESULTS: The return rate was 100%, with 109 students age 12-15 years, and 101 students >or=16 years. Seventy-six percent of all respondents sunbathed outdoors, and 18% had used a tanning bed in the past 6 months. Thirty-three percent of students admitted to at least three blistering sunburns in the past. The average score on the knowledge assessment examination was 65% correct for students >or=16 years old and 54% correct for those 12-15 years old. Students 12 to 15 years old were significantly more likely to indicate they planned to change future behaviors regarding performance of skin self-examinations and limiting sun exposure as compared to the older students. CONCLUSION: A significant number of teenagers have already enhanced their risk for future melanoma by suffering severe sunburns. Students younger than 16 years of age were significantly more likely to indicate they planned to change future behaviors after receiving information about melanoma. The data from this pilot study support education aimed at younger age groups to most effectively achieve risk reduction and prevent future melanomas.

Adolescent↗

PubMedDate not supplied

Sunbed use in Swedish urban adolescents related to behavioral characteristics.

BACKGROUND: Sunbed use among Swedish adolescents has not been extensively studied, nor has the social learning process associated with it. The purpose of this study was to explore Swedish adolescents' sunbed use in relation to sex, age, smoking, perceived physical attractiveness, attitudes to artificial and natural UV exposure, psychosomatic symptoms, and risk knowledge. METHODS: In the spring of 1993, 60 school classes comprising 1,502 students ages 14-19 were randomly selected to answer a questionnaire concerning sunbed use and sunbathing habits, smoking, perceived physical attractiveness, psychosomatic symptoms, and need for information about and knowledge of the risks of UV exposure. RESULTS: Of 1,252 respondents, 57% had used sunbeds (females 70%, males 44%) > or = four times during the previous year. A marked increase (P < 0.001) in both sunbed use and smoking was detected between the 8th and the 9th grade (at ages 14-15). Sunbed use was also significantly correlated with sex, age, excessive tanning in natural sunlight, and low perceived physical attractiveness. The need for information on risks of high UV exposure was greatest among the best informed students and among students with high UV exposure (sunbed use, excessive tanning in natural sunlight). CONCLUSIONS: It seems doubtful whether further information on UV risks would result in altered behavior among highly exposed students, who seem receptive to information and have good knowledge. For a better understanding of the mechanisms underlying the association between sunbed use, smoking, and self-esteem, more in-depth, qualitative studies are required.

Adolescent↗

PubMedDate not supplied

Summer sun exposure: knowledge, attitudes, and behaviors of Midwest adolescents.

BACKGROUND: Extensive print, radio, and television coverage about the dangers of sun exposure and benefits of sun protection occurred over the past decade. Illinois teen knowledge and attitudes about sun exposure/protection, sun-exposure/protection behavior, and information sources were determined by a summer telephone survey. METHODS: Telephone interviews with 658 teenagers between ages 11 and 19 included African-American, Asian, Hispanic, Native American, and white teenagers. RESULTS: Teens knew that too much sun was harmful as it caused skin cancer and sunburn. Sunburn was mentioned more often by those with skin types that burned easily and tanned poorly (I,II) (P < 0.001), was better known to girls than to boys (P < 0.001), and was recognized more by those with higher socioeconomic status (P < 0.001) but was not associated with age. Widely held sun exposure attitudes were socializing with friends and feeling better when outdoors. On weekdays, boys averaged 5.3 hr (SD, 1.65 hr) outside compared with 3.9 hr (SD, 0.75 hr) for girls (P < 0.001). Teenage boys were more likely to obtain occupational sun exposure, and girls sunbathed. Subjects with skin types I and II reported an average of 3.3 sunburns in the past year. During unprotected sun exposure, extensive numbers of teens with moderate-risk skin type experienced at least 1 sunburn per year. Indoor tanning use was more prevalent among older girls and those with skin types I and II. Sunscreen use was associated with water recreational activities (swimming, water sports, and going to the beach) by girls slightly more than by boys (P < 0.001). Hat-wearing was more common among boys than among girls. CONCLUSIONS: Teen knowledge that excessive sun exposure causes skin cancer and sunburns and that wearing sunscreens and hats were sun-protective methods did not enable sun protection that prevented burning. This is particularly troublesome because severe sunburns in youth are associated with an increased risk of melanoma. Existing teen sunscreen use could be broadened by educating teens to use adequate quantities of sunscreen prior to daily sun exposure to prevent painful burns. Messages to teens that emphasize the short-term consequence of painful sunburns because of inadequate protection during outdoor occupational and non-water-related recreational exposure would increase the relevance of the message and may enable behavioral change. Parents and physicians need to be included in messages that are directed to teens and to become part of their education. Parents could ensure an adequate sunscreen supply for daily use by the family, encourage teens not to deliberately tan, and serve as role models for the use of protective clothing.

Adolescent↗