title: Cutaneous vitamin D synthesis versus skin cancer development: The Janus faces of solar UV-radiation.
abstract: In scientific and public communities, there is an ongoing discussion how to balance between positive and negative effects of solar UV-exposure. On the one hand, solar UV-radiation represents the most important environmental risk factor for the development of non-melanoma skin cancer. Consequently, UV protection is an important measure to prevent these malignancies, especially in risk groups. Otherwise, approximately 90% of all vitamin D needed by the human body has to be formed in the skin through the action of UV-radiation. This dilemma represents a serious problem, for an association of vitamin D-deficiency and multiple independent diseases including various types of cancer, bone diseases, autoimmune diseases, infectious diseases, cardiovascular diseases and hypertension has now been reported in a large number of investigative and epidemiologic studies. As a consequence, it has been assumed that for the general population in the US, Europe and other countries, the net effects of solar UV B-radiation on human health are beneficial at or near current levels. We and others have shown that strict sun protection causes vitamin D-deficiency/insufficiency and that detection and treatment of vitamin D-deficiency in sun deprived risk groups is of high importance. Although further work is necessary to define an adequate vitamin D-status and adequate guidelines for solar and artificial UV-exposure, it is at present mandatory that public health campaigns and sun protection recommendations to prevent skin cancer consider these facts. In this review, we analyze the present literature to help developing well-balanced recommendations on sun protection that ensure an adequate vitamin D-status. These recommendations will hopefully protect us against adverse effects of UV protection without significantly increasing the risk to develop UV-induced skin cancer.
authors.affiliation: Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum des Saarlandes; Homburg/Saar, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Reichrath
authors.forename: Bernd
authors.initials: B
authors.lastname: Nürnberg
references.citation: N Engl J Med. 1999 Apr 29;340(17):1341-8
references.pmid: 10219070
references.citation: N Engl J Med. 2007 Jul 19;357(3):266-81
references.pmid: 17634462
references.citation: Melanoma Res. 1995 Feb;5(1):59-65
references.pmid: 7734957
references.citation: Cancer Causes Control. 2004 Feb;15(1):97-8
references.pmid: 15049326
references.citation: J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):163-6
references.pmid: 15225766
references.citation: Anticancer Res. 2009 Sep;29(9):3511-36
references.pmid: 19667145
references.citation: J Clin Endocrinol Metab. 2006 Feb;91(2):526-9
references.pmid: 16303843
references.citation: Am J Prev Med. 2007 Mar;32(3):210-6
references.pmid: 17296473
references.citation: J Photochem Photobiol B. 2005 Mar 1;78(3):189-93
references.pmid: 15708515
references.citation: J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):375-9
references.pmid: 15225804
references.citation: Eur J Cancer. 2005 Jan;41(1):45-60
references.pmid: 15617990
references.citation: Exp Dermatol. 2004;13 Suppl 4:11-5
references.pmid: 15507106
references.citation: Exp Dermatol. 2007 Jul;16(7):618-25
references.pmid: 17576242
references.citation: Carcinogenesis. 2009 Jul;30(7):1170-80
references.pmid: 19403841
references.citation: Lab Invest. 2004 Jun;84(6):693-702
references.pmid: 15077124
references.citation: J Clin Endocrinol Metab. 1992 Oct;75(4):1099-103
references.pmid: 1328275
references.citation: Arch Dermatol. 1995 Feb;131(2):164-9
references.pmid: 7857112
references.citation: Onkologie. 2001 Apr;24(2):128-33
references.pmid: 11441291
references.citation: J Natl Cancer Inst. 2005 Feb 2;97(3):195-9
references.pmid: 15687362
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 Mar;14(3):562-6
references.pmid: 15767329
references.citation: J Invest Dermatol. 2003 Jun;120(6):1087-93
references.pmid: 12787139
references.citation: Ugeskr Laeger. 2007 Apr 23;169(17):1592; author reply 1593
references.pmid: 17489148
references.citation: Dermatoendocrinol. 2009 Jan;1(1):4-6
references.pmid: 20046581
references.citation: Cancer Causes Control. 2004 Mar;15(2):219
references.pmid: 15088627
references.citation: Int J Cancer. 1997 Oct 9;73(2):198-203
references.pmid: 9335442
references.citation: Med J Aust. 1983 Apr 30;1(9):407-10
references.pmid: 6835157
references.citation: Br J Dermatol. 2009 Sep;161(3):630-4
references.pmid: 19519827
references.citation: Dermatoendocrinol. 2009 Jan;1(1):25-33
references.pmid: 20046585
references.citation: J Natl Cancer Inst. 2006 Apr 5;98(7):451-9
references.pmid: 16595781
references.citation: Am J Clin Nutr. 1999 May;69(5):842-56
references.pmid: 10232622
references.citation: Proc R Soc Med. 1965 May;58:295-300
references.pmid: 14283879
references.citation: Am J Clin Nutr. 1991 Jul;54(1 Suppl):193S-201S
references.pmid: 2053561
references.citation: J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):708-11
references.pmid: 17368188
references.citation: Clin Cancer Res. 2000 Feb;6(2):498-504
references.pmid: 10690530
references.citation: Br J Cancer. 2004 Aug 16;91(4):765-70
references.pmid: 15238985
references.citation: Praxis (Bern 1994). 2005 Aug 24;94(34):1295-300
references.pmid: 16170998
references.citation: Cancer. 2002 Mar 15;94(6):1867-75
references.pmid: 11920550
references.citation: Br J Dermatol. 2002 Aug;147(2):197-213
references.pmid: 12174089
references.citation: Br J Dermatol. 2005 Jan;152(1):43-51
references.pmid: 15656799
references.citation: Int J Cancer. 1990 Sep 15;46(3):356-61
references.pmid: 2394501
references.citation: J Cell Biochem. 2003 May 1;89(1):6-8
references.pmid: 12682903
references.citation: J Invest Dermatol. 2005 May;124(5):1080-2
references.pmid: 15854055
references.citation: Int J Cancer. 1988 Sep 15;42(3):319-24
references.pmid: 3417359
references.citation: Eur J Cancer. 2005 Sep;41(14):2141-9
references.pmid: 16125927
references.citation: N Engl J Med. 2001 Mar 29;344(13):975-83
references.pmid: 11274625
references.citation: Arch Dermatol. 2005 Apr;141(4):477-81
references.pmid: 15837865
references.citation: J Am Acad Dermatol. 2007 Mar;56(3):380-6
references.pmid: 17097387
references.citation: Adv Exp Med Biol. 2008;624:16-30
references.pmid: 18348444
references.citation: Clin Cancer Res. 2005 Aug 1;11(15):5370-80
references.pmid: 16061850
references.citation: Cancer Res. 2016 Jan 15;76(2):185
references.pmid: 26773094
references.citation: Photochem Photobiol Sci. 2007 Mar;6(3):232-51
references.pmid: 17344960
references.citation: J Cutan Pathol. 2004 Mar;31(3):224-31
references.pmid: 14984574
references.citation: N Engl J Med. 1992 Dec 3;327(23):1649-62
references.pmid: 1435901
references.citation: Am J Pathol. 1999 Aug;155(2):583-9
references.pmid: 10433950
references.citation: J Immunol. 2004 Sep 1;173(5):2909-12
references.pmid: 15322146
references.citation: Epidemiol Infect. 2006 Dec;134(6):1129-40
references.pmid: 16959053
references.citation: Lancet. 2001 Jan 6;357(9249):4-6
references.pmid: 11197362
references.citation: J Photochem Photobiol B. 2001 Oct;63(1-3):8-18
references.pmid: 11684447
references.citation: FASEB J. 2005 Jul;19(9):1067-77
references.pmid: 15985530
references.citation: Adv Exp Med Biol. 2008;624:125-36
references.pmid: 18348453
references.citation: Lancet. 1989 Nov 18;2(8673):1176-8
references.pmid: 2572900
references.citation: Int J Cancer. 1985 Apr 15;35(4):427-33
references.pmid: 3988369
references.citation: Int J Epidemiol. 1990 Dec;19(4):820-4
references.pmid: 2084008
references.citation: Cancer. 2008 Nov 1;113(9):2398-407
references.pmid: 18816636
references.citation: Recent Results Cancer Res. 2003;164:3-28
references.pmid: 12899511
references.citation: Br J Dermatol. 1994 Oct;131(4):455-64
references.pmid: 7947197
references.citation: Am J Clin Nutr. 1995 May;61(5):1140-5
references.pmid: 7733040
references.citation: Lung Cancer. 2007 Mar;55(3):263-70
references.pmid: 17207891
references.citation: Prog Biophys Mol Biol. 2006 Sep;92(1):9-16
references.pmid: 16603232
references.citation: Adv Exp Med Biol. 2008;624:55-71
references.pmid: 18348447
references.citation: Cancer Epidemiol Biomarkers Prev. 1998 May;7(5):391-5
references.pmid: 9610788
references.citation: Nat Genet. 2000 Jun;25(2):144-6
references.pmid: 10835626
references.citation: Science. 2006 Mar 24;311(5768):1770-3
references.pmid: 16497887
references.citation: Cancer Causes Control. 1994 Jul;5(4):367-92
references.pmid: 8080949
references.citation: QJM. 1996 Aug;89(8):579-89
references.pmid: 8935479