Skin cancer risk factors

86% (90% in males and 82% in females) of malignant melanoma skin cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Skin cancer (malignant melanoma) is associated with a number of risk factors.[2,3]

Skin Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • Solar radiation
  • Ultraviolet-emitting tanning devices (malignant melanoma)
  • Cyclosporine (NMSC)
  • Coal tar pitch and distillation
  • Mineral and shale oils
  • Soot
  • Arsenic and inorganic arsenic compoundsa
  • X radiation, gamma radiation (BCC)
  • Azathioprine (SCC)
  • Methoxsalen plus UVA
  • Polychlorinated biphenyls (malignant melanoma)
  • Ultraviolet-emitting tanning devices (SCC)
  • HIV type I (NMSC)
  • Creosotes
  • Nitrogen mustard
  • Petroleum refining
  • Selenium supplements
 
  • Retinol supplements (SCC)

International Agency for Research on Cancer (IARC) and The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.

Classification for all skin cancer types (malignant melanoma and NMSC) unless otherwise specified. 

a Arsenic in drinking water classified by WCRF/AICR as a probable cause.

Use our interactive tool to explore risk factors for skin cancer.

More information about cancer risk factors evidence

References

  1. Parkin DM, Mesher D, Sasieni P. 13. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S66-9.
  2. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  3. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
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Exposure to solar UV radiation is classified by the International Agency for Research on Cancer (IARC) as a cause of skin cancer (melanoma and non-melanoma skin cancer [NMSC]).[1,2] An estimated 86% of malignant melanoma cases in the UK are linked to solar UV radiation.[3] An estimated 50-70% of squamous cell carcinoma (SCC) and 50-90% of basal cell carcinoma (BCC) in fair skinned people are caused by radiation.[4]

Malignant melanoma risk is more closely linked with intermittent exposure to high-intensity sunlight (e.g. sunbathing or holidaying in a place with strong sunlight), than to chronic sunlight exposure (e.g. being in an outdoor occupation), a meta-analysis has shown.[5]

References

  1. International Agency for Research on Cancer. Solar and ultraviolet radiation (Vol 55). Monographs on the evaluation of carcinogenic risks to humans. Lyon: IARCPress; 1992.
  2. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  3. Parkin DM, Mesher D, Sasieni P. 13. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S66-9.
  4. Lucas RM, McMichael AJ, Armstrong BK, et al. Estimating the global disease burden due to ultraviolet radiation exposure. International Journal of Epidemiology 2008;37:654-67
  5. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. European Journal of Cancer 2005;41:45-60.
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Malignant melanoma risk is 60% higher in people with the highest level of intermittent sun exposure, compared with those with the lowest, a meta-analysis showed; however this effect was limited to populations outside the UK, US, Canada or Australia.[1]

Malignant melanoma risk is more than doubled in people with a history of sunburn (often caused by intermittent exposure to high-intensity sunlight[1]), compared with people who have never been sunburned, meta-analyses have shown.[1,2] Malignant melanoma risk is increased by 2-3 times in women who had 26+ 'painful' or 'severe' sunburns in their lifetime, a pooled analysis showed.[3] Malignant melanoma risk is increased regardless of whether sunburn occurred in childhood or adulthood.[3,4]

Basal cell carcinoma (BCC) risk - and, to a lesser extent, squamous cell carcinoma (SCC) risk - is higher in people with a history of sunburn (especially in childhood) or intermittent exposure to the sunlight.[5-10]

26% of men and 33% of women in Britain actively try to get a tan, data from 1999 showed; rates were even higher in younger people.[11] Holidays abroad by UK residents have become increasingly popular in recent decades.[12] Climate changes may increase the strength of solar radiation and lead to more time spent in direct sunlight (due to warmer weather), with possible consequences for skin cancer incidence rates.[13] The impact of sunscreen use on skin cancer risk remains unclear, due largely to methodological limitations and other behaviours which may accompany (and perhaps counteract) sunscreen use.[14-19]

Sunbathing, tanning or burning should not be necessary to make sufficient vitamin D to obtain health benefits.

References

  1. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. European Journal of Cancer 2005;41:45-60.
  2. Elwood JM, Jopson J. Melanoma and sun exposure: an overview of published studies. Int J Cancer 1997;73:198-203.
  3. Olsen CM, Zens MS, Green AC, et al. Biologic markers of sun exposure and melanoma risk in women: Pooled case–control analysis. Int J Cancer 2011;129:713-23.
  4. Dennis LK, Vanbeek MJ, Beane Freeman LE, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol 2008;18:614-27.
  5. Pelucchi C, Di Landro A, Naldi L, et al. Risk factors for histological types and anatomic sites of cutaneous basal-cell carcinoma: an italian case-control study. J Invest Dermatol 2007;127:935-44.
  6. Zanetti R, Rosso S, Martinez C, et al. Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-centre case-case-control study. Br J Cancer 2006;94:743-51.
  7. Rosso S, Zanetti R, Martinez C, et al. 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 1996;73:1447-54.
  8. Corona R, Dogliotti E, D'Errico M, et al. Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life. Arch Dermatol 2001;137:1162-8.
  9. Steding-Jessen M, Birch-Johansen F, Jensen A, et al. Socioeconomic status and non-melanoma skin cancer: A nationwide cohort study of incidence and survival in Denmark. Cancer Epidemiology 2010;34:689-95.
  10. Veierød MB, Couto E, Lund E, et al. Host characteristics, sun exposure, indoor tanning and risk of squamous cell carcinoma of the skin. Int J Cancer. 2013 Dec 6.
  11. Office for National Statistics. ONS Omnibus Survey, Knowledge of the Solar UV Index. 2000.
  12. Office for National Statistics. Travel Trends. Available from:http://www.ons.gov.uk/ons/rel/ott/travel-trends/index.html. Accessed May 2014.
  13. Diffey B. Climate change, ozone depletion and the impact on ultraviolet exposure of human skin. Phys Med Biol 2004 Jan 7;49(1):R1-11.
  14. Chesnut C, Kim J. Is there truly no benefit with sunscreen use and Basal cell carcinoma? A critical review of the literature and the application of new sunscreen labeling rules to real-world sunscreen practices. J Skin Cancer 2012;2012:480985.
  15. Diffey BL. Sunscreens as a preventative measure in melanoma: an evidence-based approach or the precautionary principle? Br J Dermatol 2009;161:25-7.
  16. Weinstock MA. Do sunscreens increase or decrease melanoma risk: an epidemiologic evaluation. J Investig Dermatol Symp Proc 1999;4:97-100.
  17. Autier P, Boniol M, Dore JF. Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer 2007;121:1-5.
  18. Dennis LK, Beane Freeman LE, VanBeek MJ. Sunscreen use and the risk for melanoma: A quantitative review. Annals of Internal Medicine 2003;139:966-78.
  19. International Agency for Research on Cancer. IARC Handbook on Cancer Prevention Vol.5: Sunscreens. 2001.
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Malignant melanoma risk does not appear to be associated with chronic sunlight exposure, a meta-analysis showed; however occupational sun exposure still probably increases risk over no sun exposure at all.[1]

Adolescent and young adult melanoma risk, and possibly also childhood melanoma risk, is higher in geographical areas with higher ultraviolet (UV) levels, US data show.[2]

Basal cell carcinoma (BCC) risk is 43% higher in people who work outdoors, compared with those who do not, a meta-analysis showed.[3] squamous cell carcinoma (SCC) risk is 77% higher in outdoor workers compared with indoor workers, a meta-analysis showed.[4] These associations are stronger in countries nearer the equator.[3,4]

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Use of UV-emitting tanning devices (e.g. sunbeds) is classified by the International Agency for Research on Cancer (IARC) as a cause of melanoma; and as a probable cause of squamous cell carcinoma (SCC), based on limited evidence.[1,2] An estimated 100 malignant melanoma deaths each year in the UK are caused by sunbed use.[3,4]

Malignant melanoma risk is 16-25% higher in people who have ever used a sunbed (at any age), compared with sunbed never-users, meta-analyses have shown, though risk may vary by region.[3,5,6] Malignant melanoma risk is 59% higher in people who first used a sunbed before age 35, compared with sunbed never-users, a meta-analysis showed.[5]

SCC risk is at least 67% higher in people who have ever used a sunbed (at any age), compared with sunbed never-users, meta-analyses have shown.[3,7] Basal cell carcinoma (BCC) risk is up to 29% higher in people who have ever used a sunbed (at any age), compared with sunbed never-users, a meta-analysis showed.[3,7] BCC risk is 40% higher in people who first used a sunbed before age 25, a meta analysis showed.[7] Malignant melanoma and BCC risk are increased in people who have ever used a sunbed even if they have not been burned while doing so, case-control studies have shown.[8-10] Early-onset melanoma and BCC risk may be increased by sunbed use, cohort studies have shown.[11]

2% of adults in Britain trying to get a tan do so using a sunbed/tanning machine only, data from 1999 showed.[12] 5-6% of teenagers and young adults use or have used sunbeds, data from 2008 and 2009 showed.[13,14] Higher sunbed use rates in young females than young males may explain their higher melanoma incidence rates.[15,16] Sunbed use by under-18s is banned in Scotland, England and Wales, and Nothern Ireland.

Sunbed use may be particularly dangerous for children; for people with skin phototypes I or II, many moles (naevi), a history of frequent childhood sunburn, pre-malignant/malignant skin lesions, or sun-damaged skin; and for people wearing cosmetics or taking medications which may enhance their UV-sensitivity.[17,18] In addition to increased skin cancer risk, sunbed users may also be at increased risk of eye damage, photodermatosis, photosensivity and premature skin ageing.[17]

References

  1. International Agency for Research on Cancer. Solar and ultraviolet radiation (Vol 55). Monographs on the evaluation of carcinogenic risks to humans. Lyon: IARCPress; 1992.
  2. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  3. Boniol M, Autier P, Boyle P, et al. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012;345:e4757 doi: 10.1136/bmj.e4757.
  4. Diffey BL. A quantitative estimate of melanoma mortality from ultraviolet A sunbed use in the U.K. Br J Dermatol 2003;149:578-81.
  5. Boniol M, Autier P, Boyle P, et al. Correction to Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012;345:e8503.
  6. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: Systematic review and meta-analysis. J Am Acad Dermatol 2014;70(5):847-857.
  7. Wehner MR, Shive ML, Chren MM, et al. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012;345:e5909. doi: 10.1136/bmj.e5909.
  8. Ferrucci LM, Cartmel B, Molinaro AM, et al. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol. 2011.
  9. Lazovich D, Vogel RI, Berwick M, et al. Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population. Cancer Epidemiol Biomarkers Prev 2010;19:1557-68.
  10. Vogel RI, Ahmed RL, Nelson HH, et al. Exposure to indoor tanning without burning and melanoma risk by sunburn history. J Natl Cancer Inst 2014 Jul;106(7).
  11. Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011;128:2425-35.
  12. Office for National Statistics. ONS Omnibus Survey, Knowledge of the Solar UV Index. 2000.
  13. Thomson CS, Woolnough S, Wickenden M, et al. Sunbed use in children aged 11-17 in England: face to face quota sampling surveys in the National Prevalence Study and Six Cities Study. BMJ 2010;340.
  14. Boyle R, O’Hagan AH, Donnelly D, et al. Trends in reported sun bed use, sunburn, and sun care knowledge and attitudes in a U.K. region: results of a survey of the Northern Ireland population. Br J Dermatol 2010;163:1269-75.
  15. Cokkinides V, Weinstock M, Lazovich D, et al. Indoor tanning use among adolescents in the US, 1998 to 2004. Cancer 2009;115:190-8.
  16. Coelho SG, Hearing VJ. PUVA tanning is involved in the increased incidence of skin cancers in fair-skinned young women. Pigment Cell Melanoma Res 2010;23:57-63.
  17. International Commission on Non-Ionizing Radiation Protection. Health issues of ultraviolet tanning appliances used for cosmetic purposes. Health Phys 2003;84:119-27.
  18. World Health Organization. Artificial tanning sunbeds: risk and guidance. 2003.
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Malignant melanoma risk is more than doubled in people with skin phototype I compared with people with skin phototype IV, a meta-analysis showed.[1] Malignant melanoma risk is around doubled for all skin phototype II, and 35% higher for skin phototype III compared with skin phototype IV, a meta-analysis showed.[1]

Skin Phototypes

Skin Phototype Typical Features Tanning Ability
Type I Tends to have freckles, red or fair hair, and blue or green eyes. Often burns, rarely tans.
Type II Tends to have light hair, and blue or brown eyes. Usually burns, sometimes tans.
Type III Tends to have brown hair and eyes. Sometimes burns, usually tans.
Type IV Tends to have dark brown eyes and hair. Rarely burns, often tans.
Type V Naturally black-brown skin. Often has dark brown eyes and hair.  
Type VI Naturally black-brown skin. Usually has black-brown eyes and hair.  

Based on: Fitzpatrick T. Soleil et peau. J Med Esthet 1975;2:33-4.

References

  1. Olsen CM, Carroll HJ, Whiteman DC. Estimating the attributable fraction for melanoma: a meta-analysis of pigmentary characteristics and freckling. Int J Cancer 2010;127:2430-45.
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Malignant melanoma risk is 57% higher in people with blue/blue-grey eyes, compared with dark-eyed people, a meta-analysis showed.[1] Malignant melanoma risk is 51% higher in people with green/grey/hazel eyes, compared with dark-eyed people.[1]

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) risk is higher in people with blue/green-blue/green-grey eyes, compared with dark-eyed people, a cohort study showed.[2]

References

  1. Olsen CM, Carroll HJ, Whiteman DC. Estimating the attributable fraction for melanoma: a meta-analysis of pigmentary characteristics and freckling. Int J Cancer 2010;127:2430-45.
  2. Gerstenblith MR, Rajaraman P, Khaykin E, et al. Basal cell carcinoma and anthropometric factors in the U.S. radiologic technologists cohort study. Int J Cancer 2012;131:E149-E55.
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Malignant melanoma risk is up to tripled in people with red/red-blonde hair, compared with dark-haired people, meta-analyses have shown.[1,2] Malignant melanoma risk is doubled in blondes, and 46% higher in people with light brown hair, compared with dark-haired people, a meta-analysis showed.[1]

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) risk is higher in people with red and light-coloured hair, compared with dark-haired people, a meta-analysis and cohort studies have shown.[3-5]

References

  1. Olsen CM, Carroll HJ, Whiteman DC. Estimating the attributable fraction for melanoma: a meta-analysis of pigmentary characteristics and freckling. Int J Cancer 2010;127:2430-45.
  2. Williams PF, Olsen CM, Hayward NK, et al. Melanocortin 1 receptor and risk of cutaneous melanoma: a meta-analysis and estimates of population burden. Int J Cancer 2011;129:1730-40.
  3. Gerstenblith MR, Shi J, Landi MT. Genome-wide association studies of pigmentation and skin cancer: a review and meta-analysis. Pigment Cell Melanoma Res 2010;23:587-606.
  4. Kiiski V, de Vries E, Flohil SC, et al. Risk factors for single and multiple basal cell carcinomas. Arch Dermatol 2010;146:848-55.
  5. Rosso S, Zanetti R, Martinez C, et al. The multicentre south European study 'Helios'. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin. Br J Cancer 1996;73:1440-6.
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Malignant melanoma risk is around doubled in people with freckles, compared with people without freckles, a meta-analysis showed.[1] This is independent of their number of moles.[2]

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Malignant melanoma risk is around 4-10 times higher in people with any unusually shaped or large moles (also called atypical naevi; these are usually larger than common naevi, with a more variegated appearance; poorly-defined border, and some areas slightly raised), meta-analyses show.[1,2] Malignant melanoma risk is nearly 7 times higher in people with a large number (100+) of common moles, compared with people with very few (0-15 moles), a meta-analysis showed.[1] Malignant melanoma risk increases by around 2% for every additional common mole, a meta-analysis showed.[2]

Most moles are genetically determined, appearing during childhood or adolescence.[3-5] Sun exposure can increase the number of moles, with chronic sun exposure more influential than number of sunburn episodes.[3]

References

  1. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. European Journal of Cancer 2005;41:28-44.
  2. Olsen CM, Carroll HJ, Whiteman DC. Estimating the attributable fraction for cancer: A meta-analysis of nevi and melanoma. Cancer Prev Res (Phila) 2010;3:233-45.
  3. Bauer J, Garbe C. Acquired Melanocytic Nevi as Risk Factor for Melanoma Development. A Comprehensive Review of Epidemiological Data. Pigment Cell Res 2003;16:297-306.
  4. Dulon M, Weichenthal M, Blettner M, et al. Sun exposure and number of nevi in 5- to 6-year-old European children. Journal of Clinical Epidemiology 2002;55:1075-81.
  5. Wachsmuth RC, Gaut RM, Barrett JH, et al. Heritability and gene-environment interactions for melanocytic nevus density examined in a U.K. adolescent twin study. J Invest Dermatol. 2001;117:348-52.
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Malignant melanoma risk is around doubled in people with a family history of the same disease, versus people without such a family history, meta-analyses and a cohort study have shown.[1-3] Risk is highest if the affected relative is aged under 30, or more than one first-degree relative is affected, a cohort study showed.[3] Inherited risk accounts for around 10% of malignant melanoma cases.[4,5]

Squamous cell carcinoma (SCC) risk is increased in people with a family history of the same disease, a cohort study has shown.[6] Basal cell carcinoma (BCC) risk is increased in people with a family history of malignant melanoma, a cohort study has shown.[7]

References

  1. Olsen CM, Carroll HJ, Whiteman DC. Familial melanoma: a meta-analysis and estimates of attributable fraction. Cancer Epidemiol Biomarkers Prev 2010;19:65-73.
  2. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer 2005;41:2040-59.
  3. Fallah M, Pukkala E, Sundquist K, et al. Familial melanoma by histology and age: Joint data from five Nordic countries. Eur J Cancer. 2014 Apr;50(6):1176-83.
  4. Law MH, Macgregor S, Hayward NK. Melanoma genetics: recent findings take us beyond well-traveled pathways. J Invest Dermatol 2012;132:1763-74.
  5. Hansen CB, Wadge LM, Lowstuter K, et al. Clinical germline genetic testing for melanoma. Lancet Oncol 2004;5:314-9.
  6. Hemminki K, Zhang H, Czene K. Time trends and familial risks in squamous cell carcinoma of the skin. Arch Dermatol 2003;139:885-9.
  7. Qureshi AA, Zhang M, Han J. Heterogeneity in host risk factors for incident melanoma and non-melanoma skin cancer in a cohort of US women. J Epidemiol 2011;21:197-203.
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Malignant melanoma risk is higher in Europeans with CDKN2A mutation, characteristic of familial atypical multiple mole melanoma (FAMMM); around 6 in 10 develop malignant melanoma by age 80.[1,2]

Malignant melanoma and NMSC risk may be increased in Li Fraumeni syndrome.[3]

References

  1. Bonadies DC, Bale AE. Hereditary melanoma. Current Problems in Cancer 2011;35:162-72.
  2. Bishop DT, Demenais F, Goldstein AM, et al. Geographical variation in the penetrance of CDKN2A mutations for melanoma. J Natl Cancer Inst 2002;94:894-903.
  3. Schneider K GJ. Li-Fraumeni Syndrome. In: Pagon RA BT, Dolan CR, et al., editors, ed. GeneReviews™ [Internet]. Seattle (WA): University of Washington; 1999 Jan 19 [Updated 2010 Feb 9].
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Malignant melanoma risk is 8-15 fold higher in people with a previous malignant melanoma, multiple cohort studies have shown,[1-4] the effect is stronger for women.[1,2] Malignant melanoma risk is 30-fold higher in people with a previous malignant melanoma and a parent with malignant melanoma.[5] Malignant melanoma risk may be around 3 times higher in people with a previous non-melanoma skin cancer (NMSC), a case-control study showed.[6]

Malignant melanoma risk is up to doubled among people with a previous diagnosis of various other cancers, including female breast cancer;[7,8] non-Hodgkin lymphoma;[9,10] renal cell carcinoma;[11] certain childhood cancers;[12,13] prostate cancer;[7,14,15] thyroid cancer;[7] and leukaemia.[7] Often these associations are bi-directional,[2] supporting shared genetic or environmental factors.

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) risk is ten times higher in people with previous SCC.[16-18] BCC risk is ten times higher in people with previous BCC. SCC risk is inflated to a lesser extent in BCC survivors.[16-18] NMSC risk is three times higher in people with previous malignant melanoma.[19]

References

  1. Balamurugan A, Rees JR, Kosary C, et al. Subsequent primary cancers among men and women with in situ and invasive melanoma of the skin. J Am Acad Dermatol 2011;65:S69-77.
  2. Bradford PT, Freedman DM, Goldstein AM, et al. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol 2010;146:265-72.
  3. van der Leest RJ, Liu L, Coebergh JW, et al. Risk of second primary in situ and invasive melanoma in a Dutch population-based cohort: 1989-2008. Br J Dermatol 2012;167(6):1321-30.
  4. Jung GW, Dover DC, Salopek TG. Risk of second primary malignancies following a diagnosis of cutaneous malignant melanoma or nonmelanoma skin cancer in Alberta, Canada from 1979 to 2009. Br J Dermatol. 2014 Jan;170(1):136-43.
  5. Zhang H, Bermejo JL, Sundquist J, et al. Modification of second cancer risk after malignant melanoma by parental history of cancer. Br J Cancer 2008;99:536-8.
  6. Rees JR, Zens MS, Gui J, et al. Non melanoma skin cancer and subsequent cancer risk. PLoS One 2014 Jun;9(6):e99674.
  7. Yang GB, Barnholtz-Sloan JS, Chen Y, et al. Risk and Survival of Cutaneous Melanoma Diagnosed Subsequent to a Previous Cancer. Archives of Dermatology 2011;147:1395-402.
  8. Goggins W, Gao W, Tsao H. Association between female breast cancer and cutaneous melanoma. Int J Cancer 2004;111:792-4.
  9. Pirani M, Marcheselli R, Marcheselli L, et al. Risk for second malignancies in non-Hodgkin’s lymphoma survivors: a meta-analysis. Annals of Oncology 2011;22:1845-58.
  10. Morton LM, Curtis RE, Linet MS, et al. Second Malignancy Risks After Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia: Differences by Lymphoma Subtype. Journal of Clinical Oncology 2010;28:4935-44.
  11. Liu H, Hemminki K, Sundquist J. Renal Cell Carcinoma as First and Second Primary Cancer: Etiological Clues From the Swedish Family-Cancer Database. The Journal of Urology 2011;185:2045-9.
  12. Braam KI, Overbeek A, Kaspers GJL, et al. Malignant melanoma as second malignant neoplasm in long-term childhood cancer survivors: A systematic review. Pediatric Blood Cancer 2012;58:665-74.
  13. Pappo AS, Armstrong GT, Liu W, et al. Melanoma as a subsequent neoplasm in adult survivors of childhood cancer: a report from the childhood cancer survivor study. Pediatr Blood Cancer 2013;60(3):461-6.
  14. Braisch U, Meyer M, Radespiel-Troger M. Risk of subsequent primary cancer among prostate cancer patients in Bavaria, Germany. Eur J Cancer Prev 2012.
  15. Li WQ, Qureshi AA, Ma J, et al. Personal History of Prostate Cancer and Increased Risk of Incident Melanoma in the United States. J Clin Oncol November 4, 2013 JCO.2013.51.1915.
  16. Marcil I, Stern RS. Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer. A critical review of the literature and meta-analysis. Archives of Dermatology 2000;136:1524-30.
  17. Levi F, Randimbison L, Maspoli M, et al. High incidence of second basal cell skin cancers. Int J Cancer 2006;119:1505-7.
  18. Hemminki K, Jiang Y, Steineck G. Skin cancer and non-Hodgkin's lymphoma as second malignancies. markers of impaired immune function? Eur J Cancer 2003;39:223-9.
  19. Crocetti E, Guzzinati S, Paci E, et al. The risk of developing a second, different, cancer among 14 560 survivors of malignant cutaneous melanoma: a study by AIRTUM (the Italian Network of Cancer Registries). Melanoma Res 2008;18:230-4.
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Malignant melanoma risk among men may be up to doubled in those with Parkinson’s disease versus those without, a meta-analysis showed;[1] subsequent cohort studies indicate the risk increase may be much smaller than this.[2-4] Malignant melanoma risk among women is not associated with Parkinson’s disease, a meta-analysis and cohort study have shown;[1,4] other cohort studies indicate a risk increase similar to that in males.[2,3]

Non-melanoma skin cancer (NMSC) risk may be associated with Parkinson's disease, but evidence remains mixed.[1,2,4]

References

  1. Liu R, Gao X, Lu Y, et al. Meta-analysis of the relationship between Parkinson disease and melanoma. Neurology 2011;76:2002-9.
  2. Rugbjerg K, Friis S, Lassen CF, et al. Malignant melanoma, breast cancer and other cancers in patients with Parkinson's disease. Int J Cancer 2012;131(8):1904-11.
  3. Wirdefeldt K, Weibull CE, Chen H, et al. Parkinson's Disease and Cancer: A Register-based Family Study. Am J Epidemiol. 2013 Oct 18.
  4. Ong EL, Goldacre R, Goldacre M. Differential risks of cancer types in people with Parkinson's disease: a national record-linkage study. Eur J Cancer 2014;50(14):2456-62.
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The immunosuppressants azathioprine and cyclosporine, and the eczema treatment methoxsalen+UVA, are classified by the International Agency for Research on Cancer (IARC) as causes of squamous cell carcinoma (SCC), non-melanoma skin cancer (NMSC), and all skin cancer types, respectively.[1] The immunosuppressant nitrogen mustard is classified by IARC as a probable cause of skin cancer, based on limited evidence.[1] Increased skin cancer risk in some medical conditions may be linked with use of these treatments.

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
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Malignant melanoma risk is 2.4 times higher in organ transplant recipients compared with the general population, a meta-analysis and cohort studies have shown.[1]

Non-melanoma skin cancer (NMSC) risk is 29-33 times higher in organ transplant recipients, a meta-analysis and cohort study have shown.[1-3]

References

  1. Dahlke E, Murray CA, Kitchen J, Chan AW. Systematic review of melanoma incidence and prognosis in solid organ transplant recipients. Transplant Res 2014;3:10.
  2. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet;370:59-67.
  3. Moloney FJ, Comber H, O'Lorcain P, et al. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol 2006;154:498-504.
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Malignant melanoma risk is 80% higher in people with Crohn's disease, a meta-analysis showed.[1] Malignant melanoma risk is 23% higher in people with ulcerative colitis, a meta-analysis showed.[1]

Malignant melanoma risk among people with inflammatory bowel disease (IBD; including Crohn’s and colitis) is not associated with treatment type, a meta-analysis showed.[1]

Non-melanoma skin cancer (NMSC) risk among people with IBD may be higher in those treated with thiopurines versus those not, but evidence is unclear, a meta-analysis showed.[2]

References

  1. Singh S, Nagpal SJ, Murad MH, et al. Inflammatory Bowel Disease Is Associated With an Increased Risk of Melanoma: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2013 doi: 10.1016/j.cgh.2013.04.033.
  2. Ariyaratnam J, Subramanian V. Association between thiopurine use and nonmelanoma skin cancers in patients with inflammatory bowel disease: a meta-analysis. Am J Gastroenterol 2014;109(2):163-9.
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Non-melanoma skin cancer (NMSC) risk among people with rheumatoid arthritis is probably not associated with tumour necrosis factor inhibitors (anti-TNF-α) treatment, but evidence is unclear, meta-analyses have shown.[1-3]

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NMSC risk is increased in people with atopic dermatitis (the most common form of eczema), cohort studies show.[1,2]

NMSC risk may be very slightly decreased in people with contact allergy.[3]

NMSC risk may be 7 times higher in people with severe psoriasis, compared with the general population, a cohort study showed.[4]

Malignant melanoma risk may be 11 times higher in people with severe psoriasis, a cohort study showed.[4]

References

  1. Arana A, Wentworth CE, Fernández-Vidaurre C, et al. Incidence of cancer in the general population and in patients with or without atopic dermatitis in the U.K. Br J Dermatol 2010;163:1036-43.
  2. Jensen AO, Svaerke C, Kormendine Farkas D, et al. Atopic dermatitis and risk of skin cancer: a Danish nationwide cohort study (1977-2006). Am J Clin Dermatol 2012;13:29-36.
  3. Engkilde K, Thyssen JP, Menne T, et al. Association between cancer and contact allergy: a linkage study. BMJ Open 2011;1:e000084.
  4. Lee MS, Lin RY, Chang YT, et al. The risk of developing non-melanoma skin cancer, lymphoma and melanoma in patients with psoriasis in Taiwan: a 10-year, population-based cohort study. Int J Dermatol 2012;51(12):1454-60.
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HIV infection is classified by the International Agency for Research on Cancer (IARC) as a probable cause of non-melanoma skin cancer (NMSC), based on limited evidence.[1] Malignant melanoma risk is 50% higher in people with HIV or AIDS, a meta-analysis showed.[2] NMSC risk is higher in people with HIV or AIDS, a meta-analysis showed.[3]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  2. Olsen CM, Knight LL, Green AC. Risk of melanoma in people with HIV/AIDS in the pre- and post-HAART eras: a systematic review and meta-analysis of cohort studies. PLoS One 2014;9(4):e95096.
  3. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet;370:59-67.
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Malignant melanoma risk is 17% (females) and 13% (males) higher per 5cm height increment, a pooled analysis of Nordic data showed.[1]

Non-melanoma skin cancer (NMSC) risk is 12% (females) and 10% (males) higher per 5cm height increment, a pooled-analysis of Nordic data showed.[1]

References

  1. Wiren S, Haggstrom C, Ulmer H, et al. Pooled cohort study on height and risk of cancer and cancer death. Cancer Causes Control. 2013 Oct 31.
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Malignant melanoma risk is 31% higher in overweight (body mass index (BMI) 25-29.9) and obese (BMI 30+) men, compared with men whose BMI is lower than 25, a meta-analysis showed.[1] Risk may plateau in overweight men,[1] but evidence is unclear.[2] Malignant melanoma risk may not be associated with BMI in women,[1-3] however, this may reflect mutual confounding between body size and sun exposure (e.g. larger women self-limit their public sun exposure).[1]

Basal cell carcinoma (BCC) risk is 26-43% higher, and squamous cell carcinoma (SCC) risk is 20-41% higher, in women with BMI lower than 25, compared with larger women, US cohort studies have shown.[4,5] Again this may reflect self-limited public sun exposure in larger women.[5,6]

Early onset malignant melanoma risk is more than doubled in people weighing 4.5-6kg at birth, compared with those weighing 3-3.5kg at birth, a cohort study showed.[7]

References

  1. Sergentanis TN, Antoniadis AG, Gogas HJ, et al. Obesity and risk of malignant melanoma: a meta-analysis of cohort and case-control studies. Eur J Cancer 2013;49(3):642-57.
  2. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371:569-78.
  3. Olsen CM, Green AC, Zens MS, et al. Anthropometric factors and risk of melanoma in women: A pooled analysis. Int J Cancer 2008;122:1100-8.
  4. Gerstenblith MR, Rajaraman P, Khaykin E, et al. Basal cell carcinoma and anthropometric factors in the U.S. radiologic technologists cohort study. Int J Cancer 2012;131:E149-E55.
  5. Pothiawala S, Qureshi A, Li Y, et al. Obesity and the incidence of skin cancer in US Caucasians. Cancer Causes and Control 2012;23:717-26.
  6. Pothiawala S, Qureshi AA, Li Y, et al. Obesity and the incidence of skin cancer in US Caucasians. Cancer Causes Control 2012;23(5):717-26.
  7. Yang TO, Reeves GK, Green J, et al. Birth weight and adult cancer incidence: large prospective study and meta-analysis.. Ann Oncol 2014;25(9):1836-43.
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X radiation and gamma radiation are classified by the International Agency for Research on Cancer (IARC) as causes of non-melanoma skin cancer (NMSC).[1]

Radiotherapy for a previous cancer is estimated to have caused 17.9% of second primary malignant melanoma cases in women and 2.8% of second primary malignant melanoma cases in men in 2010.[2] Malignant melanoma or NMSC risk is 14% higher in people who receive at least one computed tomography (CT) scan of the brain before age 20, with no significant effect of CT scans to other anatomical sites, a cohort study showed.[3]

Basal cell carcinoma (BCC) risk is higher in atomic bomb survivors compared with the general population, a cohort study showed, with a greater risk increase in those exposed at a younger age.[4]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  2. Parkin DM, Darby SC. 12. Cancers in 2010 attributable to ionising radiation exposure in the UK. Br J Cancer 2011;105 Suppl 2:S57-65.
  3. Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013;346 doi: 10.1136/bmj.f2360.
  4. Sugiyama H, Misumi M, Kishikawa M, et al. Skin cancer incidence among atomic bomb survivors from 1958 to 1996. Radiat Res 2014;181(5):531-9.
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Coal tar pitch, soot, mineral oils and shale oils, arsenic and inorganic arsenic compounds are classified by the International Agency for Research on Cancer (IARC) as causes of skin cancer, and polychlorinated biphenyls are classified as a cause of malignant melanoma.[1] Creosotes and petroleum refining are classified by IARC as probable causes of skin cancer, based on limited evidence.[1]

An estimated 7% (males) and 1% (females) of non-melanoma skin cancers (NMSCs) in Britain are due to occupational exposures (including solar radiation).[2]

References

  1. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  2. Young C, Rushton L. Occupational cancer in Britain: Skin cancer. Br J Cancer 2012;107 Suppl 1:S71-5.
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Malignant melanoma risk is 2.2 times higher among airline pilots and cabin crew compared with the general population, a meta-analysis showed.[1] Ultraviolet (UV) exposure both occupational (UV levels are higher at altitude than on the ground) and non-occupational may explain this association.[1,2]

References

  1. Sanlorenzo M, Wehner MR, Linos E, et al. The Risk of Melanoma in Airline Pilots and Cabin Crew: A Meta-analysis.. JAMA Dermatol 2015;151(1):51-8.
  2. Dos Santos Silva I, De Stavola B, Pizzi C, et al. Cancer incidence in professional flight crew and air traffic control officers: Disentangling the effect of occupational versus lifestyle exposures. Int J Cancer 2012.
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Retinol (vitamin A from animal sources) supplements are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as possibly protective against squamous cell carcinoma (SCC), based on limited evidence.[1]

Melanoma risk is not associated with retinol intake, a meta-analysis of cohort studies showed, however case-control studies indicate lower risk with higher retinol intake.[2]

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Zhang YP, Chu RX, Liu H. Vitamin A intake and risk of melanoma: a meta-analysis.. PLoS One 2014 Jul;9(7):e102527.
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The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) make no judgment on the association between skin cancer risk and potatoes; non-starchy vegetables; fruits; fish; eggs; milk; total fat; cholesterol; coffee; tea; alcohol; protein; vitamin A; retinol (foods); folate; vitamin C; vitamin D; vitamin E; multivitamins; selenium; carotenoids; beta-carotene (melanoma); alphacarotene; lycopene; physical activity; body fatness; and energy intake due to limited evidence.[1]

WCRF/AICR classify beta-carotene as unlikely to have a substantial effect on non-melanoma skin cancer (NMSC) risk.[1]

Skin cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Oral contraceptives (melanoma[2] and NMSC[3]).
  • Hormone replacement therapy (melanoma[2])
  • Reproductive factors (melanoma; observed associations probably reflect socio-economic factors[2]).
  • Smoking (melanoma[4,5] and NMSC[6]) (though some evidence of higher risk for NMSC[5]).
  • Alcohol (melanoma[7] and NMSC[8] (though some evidence of higher risk for NMSC[9]).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) (melanoma[10,11] and NMSC[12]).
  • Aspirin (melanoma; though some evidence of lower risk in case-control studies[10,11]).
  • Low-fat diet (melanoma[13]).
  • Folate supplements (melanoma[14]).
  • Vitamin A (melanoma[15]).
  • Beta-carotene (melanoma[15]).
  • Statins (melanoma[16] and NMSC[16]).
  • Coeliac disease (melanoma[17], though some evidence of higher risk for NMSC[18]).
  • Vitamin D (blood levels) (melanoma[19], though some evidence of higher risk for NMSC, probably limited to

    basal cell carcinoma (BCC)[19]).

  • Omega-3 fatty acids (NMSC[20]).

References

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  2. Gandini S, Iodice S, Koomen E, et al. Hormonal and reproductive factors in relation to melanoma in women: Current review and meta-analysis. European Journal of Cancer 2011;47:2607-17.
  3. Birch-Johansen F, Jensen A, Olesen AB, et al. Does hormone replacement therapy and use of oral contraceptives increase the risk of non-melanoma skin cancer?Cancer Causes Control 2012;23(2):379-88.
  4. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  5. Song F, Qureshi AA, Gao X, et al. Smoking and risk of skin cancer: a prospective analysis and a meta-analysis. Int J Epidemiol 2012;41(6):1694-705.
  6. Leonardi-Bee J, Ellison T, Bath-Hextall F. Smoking and the Risk of Nonmelanoma Skin Cancer: Systematic Review and Meta-analysis. Arch Dermatol 2012:1-8.
  7. Rota M, Pasquali E, Bellocco R, et al. Alcohol drinking and cutaneous melanoma risk - A systematic review and dose-risk meta-analysis. Br J Dermatol. 2014 Feb 3.
  8. Jensen A, Birch-Johansen F, Olesen AB, et al. Intake of alcohol may modify the risk for non-melanoma skin cancer: results of a large Danish prospective cohort study. J Invest Dermatol 2012;132(12):2718-26.
  9. Kubo JT, Henderson MT, Desai M, et al. Alcohol consumption and risk of melanoma and non-melanoma skin cancer in the Women's Health Initiative. Cancer Causes Control. 2013 Oct 31.
  10. Li S, Liu Y, Zeng Z, et al. Association between non-steroidal anti-inflammatory drug use and melanoma risk: a meta-analysis of 13 studies. Cancer Causes Control May 2013 doi: 10.1007/s10552-013-0227-8.
  11. Hu H, Xie Y, Yang G, et al. Nonsteroidal anti-inflammatory drug use and the risk of melanoma: a meta-analysis. Eur J Cancer Prev 2013 doi: 10.1097/CEJ.0b013e328360f479
  12. Zhang B, Liang X, Ye L, Wang Y. No chemopreventive effect of nonsteroidal anti-inflammatory drugs on nonmelanoma skin cancer: evidence from meta-analysis. PLoS One 2014;9(5):e96887.
  13. Gamba CS, Stefanick M, Shikany J, et al. Low fat diet and skin cancer risk: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. Cancer Epidemiol Biomarkers Prev 2013. doi: 10.1158/1055-9965.EPI-13-0341
  14. Vollset SE, Clarke R, Lewington S, et al. Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50,000 individuals. Lancet 2013;381(9871):1029-36.
  15. Zhang YP, Chu RX, Liu H. Vitamin A intake and risk of melanoma: a meta-analysis.. PLoS One 2014 Jul;9(7):e102527.
  16. Li X, Wu XB, Chen Q. Statin use is not associated with reduced risk of skin cancer: a meta-analysis. Br J Cancer. 2014 Feb 4;110(3):802-7.
  17. Lebwohl B, Eriksson H, Hansson J, Green PH, Ludvigsson JF. Risk of cutaneous malignant melanoma in patients with celiac disease: a population-based study. J Am Acad Dermatol 2014;71(2):245-8.
  18. Ilus T, Kaukinen K, Virta LJ, Pukkala E, Collin P. Incidence of Malignancies in Diagnosed Celiac Patients: A Population-based Estimate. Am J Gastroenterol 2014.
  19. Caini S, Boniol M, Tosti G, et al. Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: a comprehensive review and meta-analysis.. Eur J Cancer 2014;50(15):2649-58.
  20. Noel SE, Stoneham AC, Olsen CM, et al. Consumption of omega-3 fatty acids and the risk of skin cancers: a systematic review and meta-analysis. Int J Cancer. 2013 Nov 21. doi: 10.1002/ijc.28630.
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