title: Skin cancer and ultraviolet-B radiation under the Antarctic ozone hole: southern Chile, 1987-2000.
abstract: BACKGROUND
  Punta Arenas, Chile, the southernmost city in the world (53 degrees S), with a population of 154,000, is located near the Antarctic ozone hole (AOH) and has been regularly affected by high levels of ultraviolet-B (UV-B) radiation each spring for the last 20 years. Large increases in UV-B associated with the AOH have been measured with increases in UV-B at 297 nm of up to 38 times those of similar days with normal ozone. Recently we reported significant increases in sunburns during the spring of 1999 on days with low ozone because of the AOH.
  
  
  METHODS
  A surveillance of skin cancers occurring from 1987 to 2000 was performed. Age, sex, location, type of skin cancer and skin phototype were recorded. A Brewer Spectrophotometer was used in order to obtain in situ measurements of ozone and UV-B. Total Ozone Mapping Spectrometer (TOMS) data from National Aeronautics and Space Administration (NASA) was used in order to establish pre-ozone hole climatology.
  
  
  RESULTS
  Ozone levels as low as 145 DU (Dobson Units) were recorded, a 56% decrease in ozone, and UV-B levels up to 4.947 J/m2. These levels are close to summertime levels at mid latitudes. For the 14-year period--from 1987 to 2000--173 cases of skin cancer were diagnosed, 65 during the first 7 years, 108 during the second, an increase of 66%. Cutaneous malignant melanoma (CMM), 19% of the cases, increased by 56%, raising the rate from 1.22 to 1.91 per 100,000. Non-melanoma skin cancer (NMSC), 81% of the total, increased the rate from 5.43 to 7.94 per 100 000 (P < 0.05), a 46% increase. Patients with CMM and NMSC had skin phototypes I-II in 59% and 54% of cases, respectively. Days with more than 25% ozone loss occurred in 143 days during the last 20 springs. Significant increases of UV-B were observed under ozone hole conditions, especially around 300 nm, the most carcinogenic wavelengths.
  
  
  CONCLUSIONS
  Highly unusual ozone loss and UV-B increases have occurred in the Punta Arenas area over the past two decades resulting in the non-photoadapted population being repeatedly exposed to an altered solar UV spectrum with a greater effectiveness for erythema and photocarcinogenesis. This phenomenon has not previously been reported over other populated areas and an additional increase in the skin cancer rate attributable to the AOH may be occurring. Research on the clinical and subclinical impact of these abnormalities is urgently needed.
authors.affiliation: Dermatology unit, Hospital Regional de Punta Arenas, Punta Arenas, Chile. drabarca@ctcinternet.cl
authors.forename: Jaime F
authors.initials: JF
authors.lastname: Abarca
authors.forename: Claudio C
authors.initials: CC
authors.lastname: Casiccia
mesh_terms: D000368:Aged; D002677:Chile / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D010126:Ozone; D012621:Seasons; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D014466:Ultraviolet Rays / Q000009:adverse effects*
chemical_list: D010126:Ozone