title: Relationship between sun exposure and melanoma risk for tumours in different body sites in a large case-control study in a temperate climate.
abstract: OBJECTIVE
  A melanoma case-control study was conducted to elucidate the complex relationship between sun exposure and risk.
  
  
  METHODS
  Nine hundred and sixty population-ascertained cases, 513 population and 174 sibling controls recruited in England provided detailed sun exposure and phenotype data; a subset provided serum 25-hydroxyvitamin D(2)+D(3) levels.
  
  
  RESULTS
  Phenotypes associated with a tendency to sunburn and reported sunburn at ≥ 20 years of age were associated with increased melanoma risk (odds ratio (OR) 1.56, 95% confidence intervals (CI) 1.23-1.99). Holiday sun exposure was not associated with an increased melanoma risk although this may be in part because reported sun exposure overall was much lower in those with a sun-sensitive phenotype, particularly among controls. Head and neck melanoma was associated with less sun exposure on holidays at low latitudes (OR 0.39, 95% CI (0.23-0.68) for >13 h/year compared to <3.1). Overall the clearest relationship between reported sun exposure and risk was for average weekend sun exposure in warmer months, which was protective (OR 0.67, 95% CI 0.50-0.89 for highest versus lowest tertile of exposure). Serum vitamin D levels were strongly associated with increased weekend and holiday sun exposure.
  
  
  CONCLUSIONS
  Sun-sensitive phenotypes and reported sunburn were associated with an increased risk of melanoma. Although no evidence was seen of a causal relationship between holiday sun exposure and increased risk, this is consistent with the view that intense sun exposure is causal for melanoma in those prone to sunburn. A protective effect of regular weekend sun exposure was seen, particularly for limb tumours, which could be mediated by photoadaptation or higher vitamin D levels.
authors.affiliation: Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK. j.a.newton-bishop@leeds.ac.uk
authors.forename: Julia A
authors.initials: JA
authors.lastname: Newton-Bishop
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Chang
authors.forename: Faye
authors.initials: F
authors.lastname: Elliott
authors.forename: May
authors.initials: M
authors.lastname: Chan
authors.forename: Susan
authors.initials: S
authors.lastname: Leake
authors.forename: Birute
authors.initials: B
authors.lastname: Karpavicius
authors.forename: Sue
authors.initials: S
authors.lastname: Haynes
authors.forename: Elaine
authors.initials: E
authors.lastname: Fitzgibbon
authors.forename: Kairen
authors.initials: K
authors.lastname: Kukalizch
authors.forename: Juliette
authors.initials: J
authors.lastname: Randerson-Moor
authors.forename: David E
authors.initials: DE
authors.lastname: Elder
authors.forename: D Timothy
authors.initials: DT
authors.lastname: Bishop
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Barrett
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004739:England; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D005127:Eye Color / Q000502:physiology; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000097:blood; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D010641:Phenotype; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012880:Skin Pigmentation / Q000502:physiology; D013471:Sunburn / Q000150:complications / Q000453:epidemiology; D013472:Sunlight / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D006887:Hydroxycholecalciferols