Skin cancer risk factors

Prevention

Preventable cases of malignant melanoma, UK

Sunshine UV

Skin cancer cases linked to ultraviolet (UV) radiation from the sun, UK

Sunbed UV

Skin cancer cases linked to ultraviolet (UV) radiation from sunbeds, UK

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 compounds[a]
  • 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 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.

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 around 3 times higher in people who have had sunburn (often caused by intermittent exposure to high-intensity sunlight[1]) once every two years, or 10 times in a decade, compared with people who have never been sunburned, a meta-analysis showed.[2] Malignant melanoma risk is 2-3 times higher 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.[1-4]

Basal cell carcinoma (BCC) risk is around twice as high in people who burn and never tan when exposed to the sun, compared with those who tan and never burn, a meta-analysis showed.[5] BCC risk is 69% higher in people who tan and rarely burn, and 55% higher in people who often burn then tan, compared with those who tan and never burn.[5]

Squamous cell carcinoma (SCC) risk is not associated with a history of sunburn, a cohort study showed.[6]

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.[7] Holidays abroad by UK residents have become increasingly popular in recent decades.[8] 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.[9] 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.[10-17]

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. 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 Aug;18(8):614-27.
  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. Khalesi M, Whiteman DC, Tran B, et al. A meta-analysis of pigmentary characteristics, sun sensitivity, freckling and melanocytic nevi and risk of basal cell carcinoma of the skin. Cancer Epidemiol. 2013 Oct;37(5):534-43.
  6. 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.
  7. Office for National Statistics. ONS Omnibus Survey, Knowledge of the Solar UV Index. 2000.
  8. Office for National Statistics. Travel Trends. Available from:http://www.ons.gov.uk/ons/rel/ott/travel-trends/index.html. Accessed May 2014.
  9. 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.
  10. 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.
  11. Diffey BL. Sunscreens as a preventative measure in melanoma: an evidence-based approach or the precautionary principle? Br J Dermatol 2009;161:25-7.
  12. Weinstock MA. Do sunscreens increase or decrease melanoma risk: an epidemiologic evaluation. J Investig Dermatol Symp Proc 1999;4:97-100.
  13. 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.
  14. 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.
  15. International Agency for Research on Cancer. IARC Handbook on Cancer Prevention Vol.5: Sunscreens. 2001.
  16. Sánchez G, Nova J, Rodriguez-Hernandez AE, et al. Sun protection for preventing basal cell and squamous cell skin cancers. Cochrane Database Syst Rev. 2016.
  17. Xie F, Xie T, Song Q, et al. Analysis of association between sunscreens use and risk of malignant melanoma. Int J Clin Exp Med. 2015 Feb 15;8(2):2378-84.
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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 twice as high in people with skin phototype I compared with people with skin phototype IV, a meta-analysis showed.[1] Malignant melanoma risk is around twice as high for all skin phototype II, and 35% higher for skin phototype III compared with skin phototype IV, a meta-analysis showed.[1]

Basal cell carcinoma (BCC) risk is 70% higher in people with skin phototype I/II compared with people with skin phototype III/IV, a meta-analysis showed.[2]

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.

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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) risk is 68% higher in people with blue/blue-grey eyes, compared with dark-eyed people, a meta-analysis showed.[2] BCC risk is 61% higher in people with green/green-grey-hazel eyes, and 58% higher in people with blue-grey/green-hazel eyes, compared with dark-eyed people.[2]

Squamous cell carcinoma (SCC) risk is not associated with eye colour, a cohort study showed.[3]

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Malignant melanoma risk is up to three times as high in people with red/red-blonde hair, compared with dark-haired people, meta-analyses have shown.[1,2] Malignant melanoma risk is around twice as high 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) risk is around twice as high in people with red hair, compared with dark-haired people, a meta-analysis showed.[3] BCC risk is 69% higher in people with red/blonde hair, 38% higher in blondes, and 27%higher in people with light brown hair, compared with dark-haired people.[3]

Squamous cell carcinoma (SCC) risk is higher in people with red and light blonde hair, compared with people with black hair, case-cohort study has shown.[4]

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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]

Basal cell carcinoma (BCC) risk is 57% higher in people with freckles as a child, compared with people without freckles as a child, a meta-analysis showed.[3] BCC risk is not associated with the presence of freckles in adulthood.[3]

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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]

Basal cell carcinoma (BCC) risk is 60% higher in people with moles, compared with people without moles, a meta-analysis showed.[3]

Most moles are genetically determined, appearing during childhood or adolescence.[4-6] Sun exposure can increase the number of moles, with chronic sun exposure more influential than number of sunburn episodes.[4]

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. Khalesi M, Whiteman DC, Tran B, et al. A meta-analysis of pigmentary characteristics, sun sensitivity, freckling and melanocytic nevi and risk of basal cell carcinoma of the skin. Cancer Epidemiol. 2013 Oct;37(5):534-43.
  4. 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.
  5. 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.
  6. 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 around 10 times as high in people with a previous malignant melanoma, compared with the general population, a meta-analysis showed.[1] The effect may be stronger in women.[2,3]

Malignant melanoma risk is 30-fold higher in people with a previous malignant melanoma and a parent with malignant melanoma.[4] Malignant melanoma risk may be around 3 times higher in people with a previous non-melanoma skin cancer (NMSC), a case-control study showed.[5]

Malignant melanoma risk is up to twice as high among people with a previous diagnosis of various other cancers, including female breast cancer;[6,7] non-Hodgkin lymphoma;[8-10] renal cell carcinoma;[11] certain childhood cancers;[12,13] prostate cancer;[6,14,15] thyroid cancer;[6] and leukaemia (such as chronic lymphocytic leukaemia[16]).[6] Often these associations are bi-directional,[3] 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.[17-19] BCC risk is ten times higher in people with previous BCC. SCC risk is inflated to a lesser extent in BCC survivors.[17-19] NMSC risk is three times higher in people with previous malignant melanoma.[20]

References

  1. van der Leest RJ, Flohil SC, Arends LR, et al. Risk of subsequent cutaneous malignancy in patients with prior melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015 Jun;29(6):1053-62.
  2. 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.
  3. 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.
  4. 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.
  5. Rees JR, Zens MS, Gui J, et al. Non melanoma skin cancer and subsequent cancer risk. PLoS One 2014 Jun;9(6):e99674.
  6. 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.
  7. Goggins W, Gao W, Tsao H. Association between female breast cancer and cutaneous melanoma. Int J Cancer 2004;111:792-4.
  8. 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.
  9. 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.
  10. Lens MB, Newton-Bishop JA. An association between cutaneous melanoma and non-Hodgkin's lymphoma: pooled analysis of published data with a review. Ann Oncol. 2005 Mar;16(3):460-5.
  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. Olsen CM, Lane SW, Green AC. Increased risk of melanoma in patients with chronic lymphocytic leukaemia: systematic review and meta-analysis of cohort studies. Melanoma Res. 2016 Apr;26(2):188-94.
  17. 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.
  18. Levi F, Randimbison L, Maspoli M, et al. High incidence of second basal cell skin cancers. Int J Cancer 2006;119:1505-7.
  19. 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.
  20. 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 is 51% higher in people with Parkinson’s disease, compared with those without, a meta-analysis showed.[1]

Non-melanoma skin cancer (NMSC) risk is 20% higher in people with Parkinson’s disease, compared with those without, a meta-analysis showed.[1]

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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.

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Malignant melanoma risk is 2.7 times as high in organ transplant recipients compared with the general population, a meta-analysis showed.[1] Malignant melanoma risk is higher in liver or heart transplant recipients.[1]

Non-melanoma skin cancer (NMSC) risk is 29 times as high in organ transplant recipients compared with the general population, a meta-analysis showed.[2]

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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]

Squamous cell carcinoma (SCC) risk is around five times as high in people with psoriasis, compared with the general population, a meta-analysis showed.[3] Basal cell carcinoma (BCC) risk is around twice as high in people with psoriasis, compared with the general population, a meta-analysis showed.[3] Malignant melanoma risk is not associated with psoriasis;[3] however, malignant melanoma, SCC and BCC risk may be increased in people with severe psoriasis, a cohort study showed.[4]

Malignant melanoma risk may be lower in people with systemic lupus erythematosus, compared with the general population, a meta-analysis showed.[5] NMSC risk is higher in people with systemic lupus erythematosus, compared with the general population.[5]

Malignant melanoma risk is 23% higher in people with rheumatoid arthritis, compared with those without, a meta-analysis showed.[6]

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.
  3. Pouplard C, Brenaut E, Horreau C, et al. Risk of cancer in psoriasis: a systematic review and meta-analysis of epidemiological studies. J Eur Acad Dermatol Venereol. 2013 Aug;27 Suppl 3:36-46.
  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.
  5. Cao L, Tong H, Xu G, et al. Systemic lupus erythematous and malignancy risk: a meta-analysis. PLoS One. 2015 Apr 17;10(4):e0122964.
  6. Simon TA, Thompson A, Gandhi KK, et al. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Res Ther. 2015 Aug 15;17:212.
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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.[1-4]

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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 more than twice as high in people with HIV, compared with those without, a meta-analysis showed.[3] The association may be stronger in men than women.[3]

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Basal cell carcinoma (BCC) risk is 30% higher in people diagnosed with genital warts (associated with infection with HPV types 6 and 11), a cohort study showed.[1]

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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]

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Malignant melanoma risk is 31% higher in men who are overweight (body mass index [BMI] 25-29.9) and obese (BMI 30+), 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.[2,3] Malignant melanoma risk may not be associated with BMI in women,[1-4] 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 12% lower, and squamous cell carcinoma (SCC) risk is 11% lower, per 5-unit BMI increment, a meta-analysis showed.[5] Again, this may reflect self-limited sun exposure in people with higher BMI;[5-7] the association with SCC may be limited to women.[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.[8]

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. Xue K, Li FF, Chen YW, et al. Body mass index and the risk of cancer in women compared with men: a meta-analysis of prospective cohort studies. Eur J Cancer Prev. 2017 Jan;26(1):94-105.
  4. 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.
  5. Zhou D, Wu J, Luo G. Body mass index and risk of non-melanoma skin cancer: cumulative evidence from prospective studies. Sci Rep. 2016 Nov 29;6:37691. doi: 10.1038/srep37691.
  6. 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.
  7. 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.
  8. 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]

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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-suggestive 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]

Melanoma risk is around 16-25% lower in people who consume the most coffee, versus those who consume the least, meta-analyses have shown;[3,5] however this association is possibly limited to females.[3,5]

Non-melanoma skin cancer (NMSC) risk is around 18% lower in people who consume the most coffee, versus those who consume the least, a meta-analysis showed.[6]

The association for both melanoma and NMSC is probably limited to caffeinated coffee.[3,4,6] Confounding is possible as heavier coffee drinkers may be more likely to have lower UV exposure (e.g. due to working indoors).[6]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed January 2017.
  2. Zhang YP, Chu RX, Liu H. Vitamin A intake and risk of melanoma: a meta-analysis.. PLoS One 2014 Jul;9(7):e102527.
  3. Yew YW, Lai YC, Schwartz RA. Coffee Consumption and Melanoma: A Systematic Review and Meta-Analysis of Observational Studies. Am J Clin Dermatol. 2016 Apr;17(2):113-23.
  4. Liu J, Shen B, Shi M, Cai J. Higher Caffeinated Coffee Intake Is Associated with Reduced Malignant Melanoma Risk: A Meta-Analysis Study. PLoS One. 2016 Jan 27;11(1):e0147056.
  5. Wang J, Li X, Zhang D. Coffee consumption and the risk of cutaneous melanoma: a meta-analysis. Eur J Nutr. 2016 Jun;55(4):1317-29.
  6. Caini S, Cattaruzza S, Bendinelli B, et al. Coffee, tea and caffeine intake and the risk of non-melanoma skin cancer: a review of the literature and meta-analysis. Eur J Nutr. 2016 Jul 7.
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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 age at menarche;[2] use of fertility drugs;[2] parity;[2] menopausal status;[2] age at menopause;[2] age at first birth[4] (melanoma; observed associations probably reflect socio-economic factors[2]).
  • Smoking (melanoma[5,6] and NMSC[7]) (though some evidence of higher risk for NMSC[6] and lower risk for melanoma[8]).
  • Alcohol (melanoma[9] and NMSC[10] though some evidence of higher risk for melanoma[11] and NMSC[12]).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) (melanoma[13,14], NMSC[15] and basal cell carcinoma (BCC)[16], though some evidence of lower risk for squamous cell carcinoma (SCC)[17]).
  • Aspirin (melanoma; though some evidence of lower risk in case-control studies[13,14], BCC[16], SCC[17]).
  • Low-fat diet (melanoma[18]).
  • Folate supplements (melanoma[19]).
  • Vitamin A (melanoma[20]).
  • Beta-carotene (melanoma[20]).
  • Statins (melanoma[21] and NMSC[21]).
  • Coeliac disease (melanoma[22], though some evidence of higher risk for NMSC[23]).
  • Vitamin D (melanoma[24, 25], though some evidence of higher risk for NMSC, probably limited to basal cell carcinoma[25]).
  • Omega-3 fatty acids (NMSC[26]).
  • Tea (NMSC[27]).
  • Atopic dermatitis (though some evidence of increased risk in BCC).[28]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2016.
  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. Li Z, Gu M, Cen Y. Age at first birth and melanoma risk: a meta-analysis. Int J Clin Exp Med. 2014 Dec 15;7(12):5201-9. eCollection 2014.
  5. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  6. 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.
  7. 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.
  8. Li Z, Wang Z, Yu Y, et al. Smoking is inversely related to cutaneous malignant melanoma: results of a meta-analysis. Br J Dermatol. 2015 Dec;173(6):1540-3.
  9. 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.
  10. 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.
  11. Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-93.
  12. 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.
  13. 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.
  14. 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
  15. 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.
  16. Muranushi C, Olsen CM, Green AC, et al. Can oral nonsteroidal antiinflammatory drugs play a role in the prevention of basal cell carcinoma? A systematic review and metaanalysis. J Am Acad Dermatol. 201674(1):108-119.
  17. Muranushi C, Olsen CM, Pandeya N, et al. Aspirin and nonsteroidal anti-inflammatory drugs can prevent cutaneous squamous cell carcinoma: a systematic review and meta-analysis. J Invest Dermatol. 2015 Apr;135(4):975-83.
  18. 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
  19. 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.
  20. Zhang YP, Chu RX, Liu H. Vitamin A intake and risk of melanoma: a meta-analysis.. PLoS One 2014 Jul;9(7):e102527.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. Park SM, Li T, Wu S, et al. Vitamin D Intake and Risk of Skin Cancer in US Women and Men. PLoS One. 2016 Aug 24;11(8):e0160308.
  26. 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.
  27. Caini S, Cattaruzza S, Bendinelli B, et al. Coffee, tea and caffeine intake and the risk of non-melanoma skin cancer: a review of the literature and meta-analysis. Eur J Nutr. 2016 Jul 7.
  28. Gandini S, Stanganelli I, Palli D, et al. Atopic dermatitis, naevi count and skin cancer risk: A meta-analysis. J Dermatol Sci. 2016 Jul 16.
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Cancer stats explained

See information and explanations on terminology used for statistics and reporting of cancer, and the methods used to calculate some of our statistics.

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