Abstract
A systematic revision of the literature was conducted in order to undertake a comprehensive
meta-analysis of all published observational studies on melanoma. An extensive analysis
of the inconsistencies and variability in the estimates was performed to provide some
clues about its Epidemiology. Following a systematic literature search, relative risks
(RRs) for sun exposure were extracted from 57 studies published before September 2002.
Intermittent sun exposure and sunburn history were shown to play considerable roles
as risk factors for melanoma, whereas a high occupational sun exposure seemed to be
inversely associated to melanoma. The country of study and adjustment of the estimates
adjuste for phenotype and photo-type were significantly associated with the variability
of the intermittent sun exposure estimates (P = 0.024, 0.003 and 0.030, respectively). For chronic sun exposure, inclusion of controls
with dermatological diseases and latitude resulted in significantly different data
(P = 0.05 and 0.031, respectively). Latitude was also shown to be important (P = 0.031) for a history of sunburn; studies conducted at higher latitudes presented higher
risks for a history of sunburns. Role of country, inclusion of controls with dermatological
diseases and other study features seemed to suggest that “well conducted” studies
supported the intermittent sun exposure hypothesis: a positive association for intermittent
sun exposure and an inverse association with a high continuous pattern of sun exposure
Keywords
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References
Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and a typical naevi. Eur J Cancer 2005, 41, this issue
Consensus Development Panel. National Institutes of Health summary of the consensus development conference on sunlight, Ultraviolet radiation, and the skin. Bethesda, Maryland, May 8–10, 1989. J Am Acad Dermatol 1991, 24, 608–612
International Agency for Research on Cancer. IARC Monograph on the evaluation of carcinogenic risks to humans; ultraviolet radiation. Lyon; 1992
- Sun exposure and malignant melanoma among susceptible individuals.Environ Health Perspect. 1989; 81: 139-151
- Melanoma and sunburn.Cancer Cause Control. 1994; 5: 564-572
- An addition to the controversy on sunlight exposure and melanoma risk: a meta-analytical approach.J Clin Epidemiol. 1995; 48: 1331-1342
- Risk factors for cutaneous melanoma in Queensland.Rec Res Cancer Res. 1986; 102: 76-97
- Moles and site-specific risk of nonfamilial cutaneous malignant melanoma in women.J Natl Cancer Inst. 1989; 81: 948-952
- Reproducibility of reported measurements of sun exposure in a case-control study.Cancer Epidemiol Biomar Prev. 1998; 7: 857-863
- Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun.J Dermatol Surg Oncol. 1988; 14: 835-849
- Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies.Cancer Cause Control. 2001; 12: 69-82
- Melanoma and sunburn.Cancer Cause Control. 1994; 5: 564-572
- An addition to the controversy on sunlight exposure and melanoma risk: a meta-analytical approach.Clin Epidemiol. 1995; 48: 1331-1342
- Melanoma and sun exposure: an overview of published studies.Int J Cancer. 1997; 73: 198-203
International Agency for Research on Cancer. IARC monograph on the evaluation of carcinogenic risks to humans; ultraviolet radiation. Lyon; 1992
- IARC monographs on the evaluation of carcinogenic risks to humans-solar and ultraviolet radiation.IARC, Lyon, France1992
- Melanoma and sun exposure.Semin Oncol. 1996; 23: 650-666
- Sun exposure and the epidemiology of malignant melanoma.in: Gallagher R.P. Elwood J.M. Epidemiological aspects of cutaneous malignant melanoma. Kluwer academic, Dordrecht1994: 16-66
- IARC monographs on the evaluation of carcinogenic risks to humans-Solar and ultraviolet radiation.IARC, Lyon, France1992
- Risk factors for childhood melanoma in Queensland, Australia.Int J Cancer. 1997; 70: 26-31
- Melanoma in adolescents: a case-control study of risk factors in Queensland, Australia.Int J Cancer. 2002; 98: 92-98
- Risk of cutaneous melanoma in dysplastic nevus syndrome types A and B.N Engl J Med. 1986; 315: 1615-1616
- Malignant melanoma risk factors by anatomic site: a case-control study and polychotomous logistic regression analysis.Int J Cancer. 1996; 67: 636-643
- Quantitative methods in the review of epidemiologic literature.Epidemiol Rev. 1987; 9: 1-30
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- A sensitivity analysis for publication bias in systematic reviews.Stat Meth Med Res. 2001; 10: 251-265
- Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1099
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- An inquiry into the epidemiology of melanoma.Am J Epidemiol. 1985; 122: 606-619
- Average midrange ultraviolet radiation flux and time outdoors predict melanoma risk.Cancer Res. 2002; 62: 3992-3996
- The Danish case-control study of cutaneous malignant melanoma. II. Importance of UV-light exposure.Int J Cancer. 1988; 42: 319-324
- Occupation and the risk of malignant melanoma.Cancer. 1994; 75: 637-644
- Personal risk-factor chart for cutaneous melanoma.Lancet. 1989; 2: 487-490
- Risk factors for childhood melanoma in Queensland, Australia.Int J Cancer. 1997; 70: 26-31
- Socio-economic status in door and outdoor work and malignant melanoma.Int J Cancer. 1984; 34: 57-62
- Melanoma and other tumours of the skin among office other indoor and outdoor workes in Sweden 1961–79.Br J Cancer. 1986; 53: 507-512
- Proportional melanoma incidence and occupation among white males in Los Angeles County (California, United States).Cancer Cause Control. 1995; 6: 451-459
- Malignant melanoma: social status and outdoor work.Br J Cancer. 1980; 41: 757-763
- The relationship of malignant melanoma, basak and squamous skin cancers to indoor and outdoor work.Br J Cancer. 1981; 44: 886-891
- Residential and occupational exposure to sunlight and mortality from non-Hodgkin’s lymphoma: composite (threefold) case-control study.BMJ. 1997; 314: 1451-1455
- Nonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age.Pediatrics. 1989; 84: 199-204
- Pigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma.J Natl Cancer Inst. 1984; 72: 257-266
- Influence of sun exposures during childhood and during adulthood on melanoma risk. EPIMEL and EORTC Melanoma Cooperative Group. European Organisation for Research and Treatment of Cancer.Int J Cancer. 1998; 77: 533-537
- Sunburn and malignant melanoma.Br J Cancer. 1985; 51: 393-397
- A sensitivity analysis for publication bias in systematic reviews.Stat Meth Med Res. 2001; 10: 251-265
- Melanoma and sun exposure: an overview of published studies.Int J Cancer. 1997; 73: 198-203
- Melanoma and sun exposure.Semin Oncol. 1996; 23: 650-666
- An inquiry into the epidemiology of melanoma.Am J Epidemiol. 1985; 122: 606-619
- Risk factors for cutaneous melanoma in Queensland.Rec Res Cancer Res. 1986; 102: 76-97
- Sunburn, suntan and the risk of cutaneous malignant melanoma – The Western Canada Melanoma Study.Br J Cancer. 1985; 51: 543-549
- Sun exposure and the epidemiology of malignant melanoma.in: Gallagher R.P. Elwood J.M. Epidemiological aspects of cutaneous malignant melanoma. Kluwer academic, Dordrecht1994: 16-66
- Simultaneous assessment of risk factors for malignant melanoma and non-melanoma skin lesions, with emphasis on sun exposure and related variables.Int J Epidemiol. 1990; 19: 811-819
- Melanoma risk in relation to height, weight, and exercise (United States).Cancer Cause Control. 2001; 12: 599-606
- Malignant melanoma. A controlled study of possibly associated factors.Arch Dermatol. 1969; 99: 43-48
- A case-control study of malignant melanoma of the trunk among white males in upstate New York.Cancer Detect Prev. 1993; 17: 601-608
- Cutaneous melanoma in women. I. Exposure to sunlight, ability to tan, and other risk factors related to ultraviolet light.Am J Epidemiol. 1995; 141: 923-933
- Relationship of cutaneous malignant melanoma to individual sunlight-exposure habits.J Natl Cancer Inst. 1986; 76: 403-414
- Case-control study of malignant melanoma in Washington State. I. Constitutional factors and sun exposure.Am J Epidemiol. 1994; 139: 857-868
- Sunburn, suntan and the risk of cutaneous malignant melanoma – The Western Canada Melanoma Study.Br J Cancer. 1985; 51: 543-549
- The pathogenesis of melanoma induced by ultraviolet radiation.N Engl J Med. 1999; 340: 1341-1348
- Number of melanocytic nevi as a major risk factor for malignant melanoma.J Am Acad Dermatol. 1987; 17: 459-468
- Relationship of cutaneous malignant melanoma to individual sunlight-exposure habits.J Natl Cancer Inst. 1986; 76: 403-414
- The Danish case-control study of cutaneous malignant melanoma. I. Importance of host factors.Int J Cancer. 1988; 42: 200-206
- A consideration of ambient solar ultraviolet radiation in the interpretation of studies of the aetiology of melanoma.Melanoma Res. 1993; 3: 113-122
- Pigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma.J Natl Cancer Inst. 1984; 72: 257-266
- Some environmental and bodily characteristics of melanoma patients. A case-control study.Int J Cancer. 1979; 23: 482-486
- Malignant melanoma: social status and outdoor work.Br J Cancer. 1980; 41: 757-763
- Severe sunburn and subsequent risk of primary cutaneous malignant melanoma in Scotland.Br J Cancer. 1982; 46: 955-960
- Sun exposure habits in patients with cutaneous melanoma: a case control study.J Dermatol Surg Oncol. 1983; 9: 981-986
- Socio-economic status in door and outdoor work and malignant melanoma.Int J Cancer. 1984; 34: 57-62
- Pigmentation and reaction to sun as risk factor for cutaneous melanoma: Western Canada Melanoma Study.Br Med J. 1984; 288: 99-102
- Sunburn and malignant melanoma.Br J Cancer. 1985; 51: 393-397
- Malignant melanoma in relation to moles, pigmentation and exposure to fluorescent and other lighting sources.Br J Cancer. 1986; 53: 65-74
- Melanoma and other tumours of the skin among office other indoor and outdoor workes in Sweden 1961–79.Br J Cancer. 1986; 53: 507-512
- Aetiological factors in cutaneous malignant melanomas seen at a UK skin clinic.J Epidemiol Comm Health. 1987; 41: 306-311
- Risk factors for cutaneous malignant melanoma in a northern italian population.Int J Cancer. 1987; 39: 150-154
- Number of melanocytic nevi as a major risk factor for malignant melanoma.J Am Acad Dermatol. 1987; 17: 459-468
- The Danish case-control study of cutaneous malignant melanoma. I. Importance of host factors.Int J Cancer. 1988; 42: 200-206
- Markers and relative risk in a German population for developing malignant melanoma.Int J Dermatol. 1989; 28: 517-523
- Personal risk-factor chart for cutaneous melanoma.Lancet. 1989; 2: 487-490
- Moles and site-specific risk of nonfamilial cutaneous malignant melanoma in women.J Natl Cancer Inst. 1989; 81: 948-952
- Malignant melanoma: aetiological importance of individual pigmentation and sun exposure.Br J Dermatol. 1990; 122: 43-51
- Simultaneous assessment of risk factors for malignant melanoma and non-melanoma skin lesions, with emphasis on sun exposure and related variables.Int J Epidemiol. 1990; 19: 811-819
- Malignant melanoma in England: risks associated with naevi, freckles, social class, hair colour, and sunburn.Int J Epidemiol. 1990; 19: 801-810
- Count of benign melanocytic nevi as a major indicator of risk for nonfamilial nodular and superficial spreading melanoma.Cancer. 1990; 66: 387-395
- Malignant melanoma in southern Germany: different predictive value of risk factors for melanoma subtypes.Dermatologica. 1991; 183: 109-113
- Risk factors for skin melanoma in Moscow.Int J Cancer. 1992; 52: 159-161
- A case control study of malignant melanoma.Irish Med J. 1993; 86: 57-59
- Effect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals.Environ Health Perspect. 1993; 101: 252-255
- Recreational exposure to sunlight and lack of information as risk factors for cutaneous malignant melanoma. Results of an European Organization for Research and Treatment of Cancer (EORTC) case- control study in Belgium, France and Germany. The EORTC Malignant Melanoma Cooperative Group.Melanoma Res. 1994; 4: 79-85
- Occupation and the risk of malignant melanoma.Cancer. 1994; 75: 637-644
- At what age do sunburn episodes play a crucial role for the development of malignant melanoma.Eur J Cancer. 1994; 30A ([published erratum appears in Eur J Cancer A 1995, 31(2), 287]): 1647-1654
- Proportional melanoma incidence and occupation among white males in Los Angeles County (California United States).Cancer Cause Control. 1995; 6: 451-459
- Cutaneous melanoma in women II. Phenotypic characteristics and other host-related factors.Am J Epidemiol. 1995; 141: 934-942
- Malignant melanoma risk factors by anatomic site: a case-control study and polychotomous logistic regression analysis.Int J Cancer. 1996; 67: 636-643
- Melanoma and occupation:results of a case-control study.Occup Environ Med. 1996; 53: 168-173
- Sun exposure, pigmentary traits, and risk of cutaneous malignant melanoma: a case-control study in a Mediterranean population.Cancer Cause Control. 1996; 7: 275-283
- Identification of melanoma risk factors in the Polish population.Dermatol Surg. 1997; 23: 1039-1042
- Residential and occupational exposure to sunlight and mortality from non-Hodgkin’s lymphoma: composite (threefold) case- control study.BMJ. 1997; 314: 1451-1455
- Case-control study of malignant melanoma among employees of the Lawrence Livermore National Laboratory.Am J Ind Med. 1997; 32: 377-391
- The measurement of constitutive and facultative skin pigmentation and estimation of sun exposure in Caucasians with basal cell carcinoma and cutaneous malignant melanoma.Br J Dermatol. 1998; 139: 610-617
- Phenotypic markers, sunlight-related factors and sunscreen use in patients with cutaneous melanoma: an Austrian case-control study.Melanoma Res. 1998; 8: 370-378
- Cutaneous melanoma and sunburns in childhood in a southern European population.Eur J Cancer. 1992; 28A: 1172-1176
- Parallel risk assessment of melanoma and basal cell carcinoma: skin characteristics and sun exposure.Melanoma Res. 1998; 8: 573-583
- Cutaneous melanoma histologically associated with a nevus and melanoma de novo have a different profile of risk: results from a case-control study.J Am Acad Dermatol. 1999; 40: 549-557
- A case-control study of malignant melanoma in Israeli kibbutzim.Isr Med Assoc J. 1999; 1: 154-157
- Association of cutaneous malignant melanoma with intermittent exposure to ultraviolet radiation: results of a case-control study in Ontaria, Canada.Int J Epidemiol. 1999; 28: 418-427
- Is there a relationship between influenza vaccinations and risk of melanoma? A population-based case-control study.Eur J Epidemiol. 2000; 16: 777-782
- Pigmentary traits, modalities of sun reaction, history of sunburns, and melanocytic nevi as risk factors for cutaneous malignant melanoma in the Italian population: results of a collaborative case-control study.Cancer. 2000; 88: 2703-2710
- Occupational sunlight exposure and cancer incidence among Swedish construction workers.Epidemiology. 2001; 12: 552-557
- Outdoor activities in childhood: a protective factor for cutaneous melanoma? Results of a case-control study in 271 matched pairs.Br J Dermatol. 2001; 145: 602-609
- Combined risk factors for melanoma in a Mediterranean population.Br J Cancer. 2001; 85: 1304-1310
- Risk factors for cutaneous melanoma: a case-control study in Argentina.Int J Dermatol. 2001; 40: 108-114
- Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma.Br J Dermatol. 2001; 144: 471-475
- Sunburn, sunscreens, and phenotypes: some risk factors for cutaneous melanoma in southern Brazil.Int J Dermatol. 2002; 41: 557-562
Article info
Publication history
Accepted:
October 14,
2004
Received in revised form:
September 20,
2004
Received:
June 30,
2004
Identification
Copyright
© 2004 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
