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Melanoma and sun exposure: Contrasts between intermittent and chronic exposure

  • World Progress In Surgery
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Abstract

The evidence relating cutaneous malignant melanoma to previous sun exposure is now very strong. Major northern hemisphere studies consistently show increases in melanoma in association with recreational and vacation activities related to intermittent sun exposure. These studies have also recorded amounts of sun exposure from such activities. Several studies suggest an increased risk related to short periods of intensive exposure in early adult life. In contrast, regular outdoor occupation confers a decreased risk in these same studies. Australian studies, in populations with much higher levels of total sun exposure, do not show such a clear distinction between intermittent and chronic exposure. The evidence is consistent with a complex relationship of melanoma risk to sun exposure, the risk being increased by intermittent exposure to levels of sun which are higher than normal for that individual, but no increased risk or even a decreased risk related to long term chronic exposure. Possible biological mechanisms for this complex relationship are discussed. In the Western Canada Melanoma Study the effects of occupational and recreational exposure are different in form and are independent. The increased risks seen with various measures of sun exposure do not appear to be systematically different for individuals who have a good tanning response as compared to individuals who do not.

Résumé

La relation de cause à effet entre l'exposition au soleil et le développement d'un mélanome cutané malin est maintenant bien établie. Des études majeures provenant de l'hémisphère nord ont montré que l'exposition intermittente au soleil, pendant les vacances par exemple, augmente les risques de mélanome malin. Elles ont également enregistré les durées d'exposition suivant le type des activités au cours des vacances. Plusieurs études ont suggéré que le risque de mélanome est augmenté par de courtes périodes d'exposition au soleil chez l'adulte jeune. En revanche, dans ces mêmes études, une activité extérieure prolongée est associée à un risque plus faible. Des études, provenant d'Australie, chez des populations qui ont un niveau d'exposition élevé, ne montrent pas une telle distinction entre l'exposition intermittente et chronique. Il semble exister une relation complexe entre le risque de mélanome et l'exposition solaire, risque augmenté par le caractère intermittent et l'intensité de l'exposition. De plus, le risque n'est pas augmenté, mais au contraire diminué, par une exposition chronique. Les mécanismes biologiques responsables de ces phénomènes complexes sont discutés. Dans l'étude du Canada de l'Ouest sur le mélanome, les effets de l'exposition au soleil ne vont pas dans le même sens. Il semble que les risques ne soient pas différents, que le sujet ait ou non une bonne réponse au soleil (bronzage).

Resumen

La evidencia sobre la relación entre el melanoma maligno y la exposición a la luz solar es muy fuerte. Importantes estudios realizados en el hemisferio norte demuestran en forma consistente un aumento en la incidencia de melanoma asociado con actividades de tipo recreacional y vacacional en que hay exposición intermitente al sol; en tales estudios se ha determinado la cantidad de exposición solar relacionada con dichas actividades. Diversos estudios sugieren un mayor riesgo relacionado con períodos cortos de intensa exposición en el curso de la edad adulta temprana; por el contrario, las ocupaciones que regularmente se realizan al aire libre implican un menor riesgo, según estos estudios. Investigaciones australianas sobre poblaciones con mucho mayores niveles de exposición solar total no señalan tan clara diferencia entre la exposición intermitente y la exposición crónica. La evidencia es consistente con una compleja relación entre el riesgo de melanoma y la exposición solar, el riesgo siendo aparentemente mayor con la exposición intermitente a niveles superiores de lo normal para un determinado individuo, pero no aumentado, o aún disminuido, con la exposición crónica prolongada. En este artículo se discuten los posibles mecanismos biológicos involucrados en tan compleja relación. En el estudio sobre Melanoma de Canadá Occidental los efectos de la exposición ocupacional y recreacional aparecen diferentes en su forma, e indepdientes entre sí. Los mayores riesgos observados con diferentes medidas de exposición solar no resultan sistemáticamente diferentes en los individuos que desarrollan una buena respuesta bronceadora en comparación con quienes no la desarrollan.

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  1. Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, University of Otago Medical School, Box 913, Dunedin, New Zealand

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

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  1. J. Mark Elwood M.D., D.Sc.
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Elwood, J.M. Melanoma and sun exposure: Contrasts between intermittent and chronic exposure. World J. Surg. 16, 157–165 (1992). https://doi.org/10.1007/BF02071515

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