title: Anatomical exposure patterns of skin to sunlight: relative contributions of direct, diffuse and reflected ultraviolet radiation.
abstract: BACKGROUND
  The dose-response between ultraviolet (UV) exposure patterns and skin cancer occurrence is not fully understood. Sun-protection messages often focus on acute exposure, implicitly assuming that direct UV radiation is the key contributor to the overall UV exposure. However, little is known about the relative contribution of the direct, diffuse and reflected radiation components.
  
  
  OBJECTIVE
  To investigate solar UV exposure patterns at different body sites with respect to the relative contribution of the direct, diffuse and reflected radiation.
  
  
  METHODS
  A three-dimensional numerical model was used to assess exposure doses for various body parts and exposure scenarios of a standing individual (static and dynamic postures). The model was fed with erythemally weighted ground irradiance data for the year 2009 in Payerne, Switzerland. A year-round daily exposure (08:00-17:00 h) without protection was assumed.
  
  
  RESULTS
  For most anatomical sites, mean daily doses were high (typically 6.2-14.6 standard erythemal doses) and exceeded the recommended exposure values. Direct exposure was important during specific periods (e.g. midday during summer), but contributed moderately to the annual dose, ranging from 15% to 24% for vertical and horizontal body parts, respectively. Diffuse irradiation explained about 80% of the cumulative annual exposure dose. Acute diffuse exposures were also observed during cloudy summer days.
  
  
  CONCLUSIONS
  The importance of diffuse UV radiation should not be underestimated when advocating preventive measures. Messages focused on avoiding acute direct exposures may be of limited efficiency to prevent skin cancers associated with chronic exposure.
authors.affiliation: Institute of Work and Health, University of Lausanne and Geneva, 1010 Lausanne, Switzerland. david.vernez@hospvd.ch
authors.forename: D
authors.initials: D
authors.lastname: Vernez
authors.forename: A
authors.initials: A
authors.lastname: Milon
authors.forename: L
authors.initials: L
authors.lastname: Vuilleumier
authors.forename: J-L
authors.initials: JL
authors.lastname: Bulliard
mesh_terms: D004307:Dose-Response Relationship, Radiation; D004781:Environmental Exposure / Q000032:analysis*; D006801:Humans; D011829:Radiation Dosage; D012621:Seasons; D012867:Skin / Q000528:radiation effects*; D013472:Sunlight; D013557:Switzerland; D014466:Ultraviolet Rays; D014887:Weather