title: A meta-analysis of pigmentary characteristics, sun sensitivity, freckling and melanocytic nevi and risk of basal cell carcinoma of the skin.
abstract: OBJECTIVE
  To calculate pooled risk estimates of the association between pigmentary characteristics and basal cell carcinoma (BCC) of the skin.
  
  
  METHODS
  We searched three electronic databases and reviewed the reference lists of the retrieved articles until July 2012 to identify eligible epidemiologic studies. Eligible studies were those published in between 1965 and July 2012 that permitted quantitative assessment of the association between histologically-confirmed BCC and any of the following characteristics: hair colour, eye colour, skin colour, skin phototype, tanning and burning ability, and presence of freckling or melanocytic nevi. We included 29 studies from 2236 initially identified. We calculated summary odds ratios (ORs) using weighted averages of the log OR, using random effects models.
  
  
  RESULTS
  We found strongest associations with red hair (OR 2.02; 95% CI: 1.68, 2.44), fair skin colour (OR 2.11; 95% CI: 1.56, 2.86), and having skin that burns and never tans (OR 2.03; 95% CI: 1.73, 2.38). All other factors had weaker but positive associations with BCC, with the exception of freckling of the face in adulthood which showed no association.
  
  
  CONCLUSIONS
  Although most studies report risk estimates that are in the same direction, there is significant heterogeneity in the size of the estimates. The associations were quite modest and remarkably similar, with ORs between about 1.5 and 2.5 for the highest risk level for each factor. Given the public health impact of BCC, this meta-analysis will make a valuable contribution to our understanding of BCC.
authors.affiliation: Department of Population Health, Queensland Institute of Medical Research, Brisbane, Queensland, Australia. mohammad.khalesi@qimr.edu.au
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khalesi
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
authors.forename: Bich
authors.initials: B
authors.lastname: Tran
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kimlin
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Olsen
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Neale
mesh_terms: D002280:Basal Cell Carcinoma / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D006200:Hair Color; D006801:Humans; D008548:Melanosis / Q000453:epidemiology*; D009508:Nevus, Pigmented / Q000453:epidemiology*; D010858:Pigmentation; D012878:Skin Neoplasms / Q000453:epidemiology*; D012880:Skin Pigmentation; D013471:Sunburn / Q000453:epidemiology*
keywords: AK; BCC; Basal cell carcinoma; Burning; CI; Eye colour; Freckling; Hair colour; Melanocytic nevi; Meta-analysis; OR; Pigmentary; RR; SCC; Skin colour; Tanning; UVR; actinic keratoses; basal cell carcinoma; confidence interval; odds ratio; relative risk; squamous cell carcinoma; ultraviolet radiation