Skip to main content
SpringerLink
Log in

How sun exposure causes skin cancer: an epidemiological perspective

  • Chapter
Prevention of Skin Cancer

Part of the book series: Cancer Prevention — Cancer Causes ((CPCC,volume 3))

Abstract

It has been widely accepted since early in the 20th Century that sun exposure is a cause of BCC and SCC in humans [1]. That human melanoma is also caused by sun exposure was not suggested until the early 1950s, and is still not accepted by some, or the relationship is described as controversial or complex [2,3]. Nevertheless, an expert working group of the International Agency for Research on Cancer concluded, in 1992, “There is sufficient evidence in humans for the carcinogenicity of solar radiation. Solar radiation causes cutaneous malignant melanoma and non-melanocytic skin cancer” [4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Armstrong BK, Kricker A, English DR (1997) Sun exposure and skin cancer. Australas J Dermatol 38: s1–s6.

    Article  PubMed  Google Scholar 

  2. Cascinelli N, Marchesini R (1989) Increasing incidence of cutaneous melanoma, ultraviolet radiation and the clinician. Photochem Photobiol 50: 497–505.

    Article  PubMed  CAS  Google Scholar 

  3. de Gruijl FR (1993) UV-induced skin cancer: Man and mouse. In: de Gruijl FR, ed. The Dark Side of Sunlight. Utrecht: Utrecht University, pp. 111–127.

    Google Scholar 

  4. International Agency for Research on Cancer Expert Group (1992) Solar and Ultraviolet Radiation. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 55. Lyon, France: IARC Press, p. 227.

    Google Scholar 

  5. Holman CD, Armstrong BK (1984) Pigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma. J Natl Cancer Inst 72: 257–266.

    PubMed  CAS  Google Scholar 

  6. Kricker A, Armstrong BK, English DR, Heenan PJ (1991) Pigmentary and cutaneous risk factors for non-melanocytic skin cancer-a case-control study. Int J Cancer 48: 650–662.

    Article  PubMed  CAS  Google Scholar 

  7. English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Demographic characteristics, pigmentary and cutaneous risk factors for squamous cell carcinoma of the skin: a case-control study. Int J Cancer 76: 628–634.

    Article  PubMed  CAS  Google Scholar 

  8. Whiteman DC, Whiteman CA, Green AC (2001) Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control 12: 69–82.

    Article  PubMed  CAS  Google Scholar 

  9. Kricker A, Armstrong BK, English DR, Heenan PJ (1995) A dose-response curve for sun exposure and basal cell carcinoma. Int J Cancer 60: 482–488.

    Article  PubMed  CAS  Google Scholar 

  10. English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Case-control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer 77: 347–353.

    Article  PubMed  CAS  Google Scholar 

  11. Green A, MacLennan R, Youl P, Martin N (1993) Site distribution of cutaneous melanoma in Queensland. Int J Cancer 53: 232–236.

    Article  PubMed  CAS  Google Scholar 

  12. Buettner PG, Raasch BA (1998) Incidence rates of skin cancer in Townsville, Australia. Int J Cancer 78: 587–593.

    Article  PubMed  CAS  Google Scholar 

  13. Kricker A, Armstrong BK, Jones ME, Burton RC (1993) Health, solar UV radiation and environmental change. IARC Technical Reports, Vol 13. Lyon, France: IARC Press, pp. 20–44, 52–61.

    Google Scholar 

  14. Marrett LD, Nguyen HL, Armstrong BK (2001) Trends in the incidence of cutaneous malignant melanoma in New South Wales, 1983–1996. Int J Cancer 92: 457–462.

    Article  PubMed  CAS  Google Scholar 

  15. Karagas MR, Greenberg ER, Spencer SK, Stukel TA, Mott LA (1999) Increase in incidence rates of basal cell and squamous cell skin cancer in New Hampshire, USA. New Hampshire Skin Cancer Study Group. Int J Cancer 81: 555–559.

    Article  PubMed  CAS  Google Scholar 

  16. Armstrong BK, Kricker A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B 63: 8–18.

    Article  PubMed  CAS  Google Scholar 

  17. Holman CD, Armstrong BK (1984) Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: an analysis separating histogenetic types. J Natl Cancer Inst 73: 75–82.

    PubMed  CAS  Google Scholar 

  18. Elwood JM, Gallagher RP, Hill GB, Pearson JC (1985) Cutaneous melanoma in relation to intermittent and constant sun exposure-the Western Canada Melanoma Study. Int J Cancer 35: 427–433.

    Article  PubMed  CAS  Google Scholar 

  19. Gallagher RP, Hill GB, Bajdik CD et al. (1995) Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma. Arch Dermatol 131: 157–163.

    Article  PubMed  CAS  Google Scholar 

  20. Gallagher RP, Hill GB, Bajdik CD et al. (1995) Sunlight exposure, pigmentation factors, and risk of nonmelanocytic skin cancer. II. Squamous cell carcinoma. Arch Dermatol 131: 164–169.

    Article  PubMed  CAS  Google Scholar 

  21. Bataille V, Sasieni P, Grulich A et al. (1998) Solar keratoses: a risk factor for melanoma but negative association with melanocytic naevi. Int J Cancer 78: 8–12.

    Article  PubMed  CAS  Google Scholar 

  22. Gallagher RP, Rivers JK, Lee TK, Bajdik CD, McLean DI, Coldman AJ (2000) Broad-spectrum sunscreen use and the development of new nevi in white children: A randomized controlled trial. JAMA 283: 2955–2960.

    Article  PubMed  CAS  Google Scholar 

  23. Brash DE, Rudolph JA, Simon JA et al. (1991) A Role for Sunlight in Skin Cancer–UV-Induced p53 Mutations in Squamous Cell Carcinoma. Proc Natl Acad Sci USA 88: 10124–10128.

    Article  PubMed  CAS  Google Scholar 

  24. Wikonkal NM, Brash DE (1999) Ultraviolet radiation induced signature mutations in photocarcinogenesis. J Invest Dermatol Symp Proc 4: 6–10.

    Article  CAS  Google Scholar 

  25. Ponten F, Berg C, Ahmadian A et al. (1997) Molecular pathology in basal cell cancer with p53 as a genetic marker. Oncogene 15: 1059–1067.

    Article  PubMed  CAS  Google Scholar 

  26. Ouhtit A, Nakazawa H, Armstrong BK et al. (1998) UV-radiation-specific p53 mutation frequency in normal skin as a predictor of risk of basal cell carcinoma. J Natl Cancer Inst 90: 523–531.

    Article  PubMed  CAS  Google Scholar 

  27. Pollock PM, Pearson JV, Hayward NK (1996) Compilation of somatic mutations of the CDKN2 gene in human cancers: non-random distribution of base substitutions. Genes, Chromosomes & Cancer 15: 77–88.

    Article  CAS  Google Scholar 

  28. Robinson JK, Rademaker AW (1992) Relative importance of prior basal cell carcinomas, continuing sun exposure, and circulating T lymphocytes on the development of basal cell carcinoma. J Invest Dermatol 99: 227–231.

    Article  PubMed  CAS  Google Scholar 

  29. Thompson SC, Jolley D, Marks R (1993) Reduction of solar keratoses by regular sunscreen use. N Engl J Med 329: 1147–1151.

    Article  PubMed  CAS  Google Scholar 

  30. Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH (1995) High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol 131: 170–175.

    Article  PubMed  CAS  Google Scholar 

  31. Green A, Williams G, Neale R et al. (1999) Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet 354: 723–729.

    Article  PubMed  CAS  Google Scholar 

  32. Fears TR, Scotto J, Schneiderman MA (1977) Mathematical models of age and ultraviolet effects on the incidence of skin cancer among whites in the United States. Am J Epidemiol 105: 420–427.

    PubMed  CAS  Google Scholar 

  33. Elwood JM (1992) Melanoma and sun exposure: contrasts between intermittent and chronic exposure. World J Surg. 16: 157–165.

    Article  PubMed  CAS  Google Scholar 

  34. Armstrong BK (1988) Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun? J Dermatol Surg Oncol 14: 835–849.

    PubMed  CAS  Google Scholar 

  35. Gilchrest BA, Eller MS, Geller AC, Yaar M (1999) The pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med. 340: 1341–1348.

    Article  PubMed  CAS  Google Scholar 

  36. Strickland PT, Vitasa BC, West SK, Rosenthal FS, Emmet EA, Taylor HR (1989) Quantitative carcinogenesis in man: solar ultraviolet B dose dependence of skin cancer in Maryland watermen. J Natl Cancer Inst 81: 1910–1913.

    Article  PubMed  CAS  Google Scholar 

  37. Rosso S, Zanetti R, Martinez C et al. (1996) The multicentre south European study ‘Helios’. II: Different sun exposure patterns in the aetiology of basal cell and squamous cell carcinomas of the skin. Br J Cancer 73: 1447–1454.

    Article  PubMed  CAS  Google Scholar 

  38. Scotto J, Fears TR, Fraumeni JF (1983) Incidence of Nonmelanoma Skin Cancer in the United States. Washington: US Department of Health and Human Services.

    Google Scholar 

  39. Muir C, Waterhouse J, Mack T, Powell J, Whelan S (1987) Cancer Incidence in Five Continents Volume V. Lyon: International Agency for Research on Cancer.

    Google Scholar 

  40. Mack TM, Floderus B (199 1) Malignant melanoma risk by nativity, place of residence at diagnosis, and age at migration. Cancer Causes Control 2: 401–411.

    Google Scholar 

  41. English DR, Armstrong BK (1994) Melanocytic nevi in children. I. Anatomic sites and demographic and host factors. Am J Epidemiol 139: 390–401.

    PubMed  CAS  Google Scholar 

  42. Kricker A, Armstrong BK, English DR, Heenan PJ (1995) Does intermittent sun exposure cause basal cell carcinoma? A case-control study in Western Australia. Int J Cancer 60: 489–494.

    Article  PubMed  CAS  Google Scholar 

  43. Zanetti R, Rosso S, Martinez C et al. (1996) The multicentre south European study ‘Helios’. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin. Br J Cancer 73: 1440–1446.

    Article  PubMed  CAS  Google Scholar 

  44. Corona R, Dogliotti E, D’Errico M et al. (2001) Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life. Arch Dermatol 137: 1162–1168.

    PubMed  CAS  Google Scholar 

  45. Autier P, Dore JF, Lejeune F et al. (1996) Sun protection in childhood or early adolescence and reduction of melanoma risk in adults: an EORTC case-control study in Germany, Belgium and France. J Epidemiol Biostat 1: 51–57.

    Google Scholar 

  46. Houghton A, Munster EW, Viola MV (1978) Increased incidence of malignant melanoma after peaks of sunspot activity. Lancet 1: 759–760.

    Article  PubMed  CAS  Google Scholar 

  47. Swerdlow AJ (1979) Incidence of malignant melanoma of the skin in England and Wales and its relationship to sunshine. BMJ 2: 1324–1327.

    Article  PubMed  CAS  Google Scholar 

  48. Schwartz SM, Armstrong BK, Weiss NS (1987) Seasonal variation in the incidence of cutaneous malignant melanoma: an analysis by body site and histologic type. Am J Epidemiol 126: 104–111.

    PubMed  CAS  Google Scholar 

  49. Fleming MG, Swan LS, Heenan PJ (1991) Seasonal variation in the proliferation fraction of Australian common nevi. Am J Dermatopathol 13: 463–466.

    Article  PubMed  CAS  Google Scholar 

  50. Holman CD, Mulroney CD, Armstrong BK (1980) Epidemiology of pre-invasive and invasive malignant melanoma in Western Australia. Int J Cancer 25: 317–323.

    Article  PubMed  CAS  Google Scholar 

  51. Beral V, Robinson N (1981) The relationship of malignant melanoma, basal and squamous skin cancers to indoor and outdoor work. Br J Cancer 44: 886–891.

    Article  PubMed  CAS  Google Scholar 

  52. Vagero D, Ringback G, Kiviranta H (1986) Melanoma and other tumors of the skin among office, other indoor and outdoor workers in Sweden 1961–1979. Br J Cancer 53: 507–512.

    Article  PubMed  CAS  Google Scholar 

  53. Autier P, Dore JF (1998) Influence of sun exposures during childhood and during adulthood on melanoma risk. Int J Cancer 77: 533–537.

    Article  PubMed  CAS  Google Scholar 

  54. McKinlay AF, Diffey BL (1987) A reference action spectrum for ultraviolet induced erythema in human skin. CIE Journal 6: 17–22.

    Google Scholar 

  55. Freeman SE, Hacham H, Gange RW, Maytum DJ, Sutherland JC, Sutherland BM (1989) Wavelength dependence of pyrimidine dimer formation in DNA of human skin irradiated in situ with ultraviolet light. Proc Natl Acad Sci USA 86: 5605–5609.

    Article  PubMed  CAS  Google Scholar 

  56. de Gruijl FR, Sterenborg HJCM, Forbes PD, Davies RE, Cole C, Kelfkens G (1993) Wavelength dependence of skin cancer induction by ultraviolet irradiation of albino hairless mice. Cancer Research 52: 1–8.

    Google Scholar 

  57. Setlow RB, Grist E, Thompson K, Woodhead AD (1993) Wavelengths effective in induction of malignant melanoma. Proc Natl Acad Sci USA 90: 6666–6670.

    Article  PubMed  CAS  Google Scholar 

  58. Ley RD (2001) Dose response for ultraviolet radiation A-induced focal melanocytic hyperplasia and nonmelanoma skin tumors in Monodelphis domestica. Photochem Photobiol 73: 20–23.

    Article  PubMed  CAS  Google Scholar 

  59. Moan J, Dahlback A, Setlow RB (1999) Epidemiological support for an hypothesis for melanoma induction indicating a role for UVA radiation. Photochem Photobiol. 70: 243–247.

    Article  PubMed  CAS  Google Scholar 

  60. Miller SA, Hamilton SL, Wester UG, Cyr WH (1998) An analysis of UVA emissions from sunlamps and the potential importance for melanoma. Photochem Photobiol 68: 63–70.

    Article  PubMed  CAS  Google Scholar 

  61. Armstrong BK, Kricker A (1993) How much melanoma is caused by sun exposure? Melanoma Res 3: 395–401.

    Article  PubMed  CAS  Google Scholar 

  62. Rose G (1992) The strategy of preventive medicine. Oxford: Oxford University Press.

    Google Scholar 

  63. Jones G, Blizzard C, Riley MD, Parameswaran V, Greenaway TM, Dwyer T (1999) Vitamin D levels in prepubertal children in Southern Tasmania: prevalence and determinants. Eur J Clin Nutr 53: 824–829.

    Article  PubMed  CAS  Google Scholar 

  64. Grover SR, Morley R (2001) Vitamin D deficiency in veiled or dark-skinned pregnant women. Med J Aust 175: 251–252.

    PubMed  CAS  Google Scholar 

  65. Pasco JA, Henry MJ, Nicholson GC, Sanders KM, Kolowicz MA (2001) Vitamin D status of women in the Geelong Osteoporosis Study: association with diet and casual exposure to sunlight. Med J Aust 175: 401–405.

    PubMed  CAS  Google Scholar 

  66. Elwood JM, Jopson J (1997) Melanoma and sun exposure: an overview of published studies. Int J Cancer 73: 198–203.

    Article  PubMed  CAS  Google Scholar 

  67. Dubin N, Moseson M, Pasternack BS (1989) Sun exposure and malignant melanoma among susceptible individuals. Environ Health Perspect 81: 139–151.

    Article  PubMed  CAS  Google Scholar 

  68. White E, Kirkpatrick CS, Lee JA (1994) Case-control study of malignant melanoma in Washington State. I. Constitutional factors and sun exposure. Am J Epidemiol 139: 857–868.

    PubMed  CAS  Google Scholar 

  69. Weinstock MA, Colditz GA, Willett WC et al. (1991) Melanoma and the sun: the effect of swimsuits and a “healthy” tan on the risk of nonfamilial malignant melanoma in women. Am J Epidemiol 134: 462–470.

    PubMed  CAS  Google Scholar 

  70. Nelemans PJ, Groenendal H, Kiemeney LA et al. (1993) Effect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals. Environ Health Perspect 101: 252–255.

    Article  PubMed  CAS  Google Scholar 

  71. Cress RD, Holly EA, Ahn DK (1995) Cutaneous melanoma in women. V. Characteristics of those who tan and those who burn when exposed to summer sun. Epidemiology 6: 538–543.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Public Health, The University of Sydney, New South Wales, Australia

    Bruce K. Armstrong M.B., B.S., D.Phil.

Authors
  1. Bruce K. Armstrong M.B., B.S., D.Phil.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Melbourne, Victoria, Australia

    David Hill Ph.D.

  2. National Cancer Control Initiative, Melbourne, Victoria, Australia

    J. Mark Elwood M.D., D.Sc.

  3. Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria, Australia

    Dallas R. English Ph.D.

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Armstrong, B.K. (2004). How sun exposure causes skin cancer: an epidemiological perspective. In: Hill, D., Elwood, J.M., English, D.R. (eds) Prevention of Skin Cancer. Cancer Prevention — Cancer Causes, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-0511-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-94-017-0511-0_6

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-90-481-6346-5

  • Online ISBN: 978-94-017-0511-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation