Melanoma skin cancer risk

Preventable cases

Melanoma skin cancer cases are preventable, UK, 2015

 

Caused by UV

Melanoma skin cancer cases caused by overexposure to ultraviolet radiation, UK, 2015

 

The estimated lifetime risk of being diagnosed with melanoma skin cancer is 1 in 36 (3%) for males, and 1 in 47 (2%) for females born after 1960 in the UK.[1]

These figures take account of the possibility that someone can have more than one diagnosis of melanoma skin cancer in their lifetime (‘Adjusted for Multiple Primaries’ (AMP) method).[2]

References

  1. Lifetime risk estimates calculated by the Statistical Information Team at Cancer Research UK. Based on Office for National Statistics (ONS) 2016-based Life expectancies and population projections. Accessed December 2017, and Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016. 
  2. Sasieni PD, Shelton J, Ormiston-Smith N, et al. What is the lifetime risk of developing cancer?: The effect of adjusting for multiple primaries. Br J Cancer, 2011. 105(3): p. 460-5. 

About this data

Data is for UK, past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961, ICD-10 C43.

The calculations used past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961 to project risk over the lifetime of those born in 1961 (cohort method).[1] Projections are based on observed incidence and mortality rates and therefore implicitly include changes in cancer risk factors, diagnosis and treatment.

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86% of melanoma skin cancer cases in the UK are preventable.[1]

Melanoma skin cancer is associated with a number of risk factors.[2,3]

Melanoma 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
  • Coal tar pitch and distillation
  • Mineral and shale oils
  • Soot
  • Arsenic and inorganic arsenic compounds[a]
  • Methoxsalen plus UVA
  • Polychlorinated biphenyls
  • Creosotes
  • Nitrogen mustard
  • Petroleum refining
  • Selenium supplements
 

 

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

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

See also

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Find out more about the definitions and evidence for this data

Learn how attributable risk is calculated

References

  1. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. 
  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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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

86% of melanoma skin cancer cases in the UK are caused by overexposure to ultraviolet radiation.[2]

Intermittent sun exposure

Melanoma skin cancer 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.[3]

Melanoma skin cancer 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.[3]

Sunburn

Melanoma skin cancer risk is around 3 times higher in people who have had sunburn once every two years, or 10 times in a decade, compared with people who have never been sunburned, a meta-analysis showed.[4] Melanoma skin cancer risk is 2-3 times higher in women who had 26+ 'painful' or 'severe' sunburns in their lifetime, a pooled analysis showed.[5] Melanoma skin cancer melanoma risk is increased regardless of whether sunburn occurred in childhood or adulthood.[3-5]

Sunbathing

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.[6] Holidays abroad by UK residents have become increasingly popular in recent decades.[7] 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.[8] 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.[9-16]

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

Chronic sun exposure

Melanoma skin cancer 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.[3]

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.[17]

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References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 119. Accessed September 2017.
  2. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018. 
  3. 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.
  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 Aug;18(8):614-27.
  5. 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.
  6. Office for National Statistics. ONS Omnibus Survey, Knowledge of the Solar UV Index. 2000.
  7.  Office for National Statistics. Travel Trends. Available from: http://www.ons.gov.uk/ons/rel/ott/travel-trends/index.html. Accessed May 2014.
  8. 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.
  9. 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.
  10. Diffey BL. Sunscreens as a preventative measure in melanoma: an evidence-based approach or the precautionary principle?. Br J Dermatol 2009;161:25-7.
  11. Weinstock MA. Do sunscreens increase or decrease melanoma risk: an epidemiologic evaluation. J Investig Dermatol Symp Proc 1999;4:97-100.
  12. 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.
  13. 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.
  14. International Agency for Research on Cancer. IARC Handbook on Cancer Prevention Vol.5: Sunscreens. 2001.
  15. 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.
  16. 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.
  17. Strouse JJ, Fears TR, Tucker MA, et al. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005;23:4735-41.
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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] An estimated 100 melanoma skin cancer deaths each year in the UK are caused by sunbed use.[2,3]

Melanoma skin cancer 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.[2,4,5] Melanoma skin cancer risk is 59% higher in people who first used a sunbed before age 35, compared with sunbed never-users, a meta-analysis showed.[4]

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.[2,6] 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.[2,6] BCC risk is 40% higher in people who first used a sunbed before age 25, a meta analysis showed.[6] Melanoma skin cancer 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.[7-9] Early-onset melanoma and BCC risk may be increased by sunbed use, cohort studies have shown.[10]

2% of adults in Britain trying to get a tan do so using a sunbed/tanning machine only, data from 1999 showed.[11] 5-6% of young people use or have used sunbeds, data from 2008 and 2009 showed.[12,13] Higher sunbed use rates in young females than young males may explain their higher melanoma incidence rates.[14,15] 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.[16,17] In addition to increased skin cancer risk, sunbed users may also be at increased risk of eye damage, photodermatosis, photosensivity and premature skin ageing.[16]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 119. Accessed September 2017.
  2. 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.
  3. Diffey BL. A quantitative estimate of melanoma mortality from ultraviolet A sunbed use in the U.K. Br J Dermatol 2003;149:578-81.
  4. 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.
  5. 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.
  6. 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.
  7. Ferrucci LM, Cartmel B, Molinaro AM, et al. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol. 2011.
  8. 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.
  9. 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).
  10. 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.
  11. Office for National Statistics. ONS Omnibus Survey, Knowledge of the Solar UV Index. 2000.
  12. 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.
  13. 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.
  14. Cokkinides V, Weinstock M, Lazovich D, et al. Indoor tanning use among adolescents in the US, 1998 to 2004. Cancer 2009;115:190-8.
  15. 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.
  16. International Commission on Non-Ionizing Radiation Protection. Health issues of ultraviolet tanning appliances used for cosmetic purposes. Health Phys 2003;84:119-27.
  17. World Health Organization. Artificial tanning sunbeds: risk and guidance. 2003.
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Melanoma skin cancer 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] Melanoma skin cancer 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]

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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Hair colour

Melanoma skin cancer 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] Melanoma skin cancer 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]

Eye colour

Melanoma skin cancer risk is 57% higher in people with blue/blue-grey eyes, compared with dark-eyed people, a meta-analysis showed.[1] Melanoma skin cancer risk is 51% higher in people with green/grey/hazel eyes, compared with dark-eyed people.[1]

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.
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Moles

Melanoma skin cancer 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] Melanoma skin cancer 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] Melanoma skin cancer 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]

Freckles

Melanoma skin cancer risk is around doubled in people with freckles, compared with people without freckles, a meta-analysis showed.[2] This is independent of their number of moles.[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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Family history

Melanoma skin cancer 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 melanoma skin cancer cases.[4,5]

Genetic factors

Melanoma skin cancer risk is higher in Europeans with CDKN2A mutation, characteristic of familial atypical multiple mole melanoma (FAMMM); around 6 in 10 develop melanoma skin cancer by age 80.[6,7]

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. Bonadies DC, Bale AE. Hereditary melanoma. Current Problems in Cancer 2011;35:162-72.
  7. 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.
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Inflammatory bowel disease (IBD)

Melanoma skin cancer risk is 80% higher in people with Crohn's disease, a meta-analysis showed.[1] Melanoma skin cancer risk is 23% higher in people with ulcerative colitis, a meta-analysis showed.[1]

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

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Melanoma skin cancer 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] Melanoma skin cancer 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]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1

Airline workers

Melanoma skin cancer risk is 2.2 times higher among airline pilots and cabin crew compared with the general population, a meta-analysis showed.[2] Ultraviolet (UV) exposure both occupational (UV levels are higher at altitude than on the ground) and non-occupational may explain this association.[2,3]

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