title: Sun exposure and melanoma survival: a GEM study.
abstract: BACKGROUND
  We previously reported a significant association between higher UV radiation exposure before diagnosis and greater survival with melanoma in a population-based study in Connecticut. We sought to evaluate the hypothesis that sun exposure before diagnosis was associated with greater survival in a larger, international population-based study with more detailed exposure information.
  
  
  METHODS
  We conducted a multicenter, international population-based study in four countries-Australia, Italy, Canada, and the United States-with 3,578 cases of melanoma with an average of 7.4 years of follow-up. Measures of sun exposure included sunburn, intermittent exposure, hours of holiday sun exposure, hours of water-related outdoor activities, ambient ultraviolet B (280-320 nm) dose, histologic solar elastosis, and season of diagnosis.
  
  
  RESULTS
  Results were not strongly supportive of the earlier hypothesis. Having had any sunburn in 1 year within 10 years of diagnosis was inversely associated with survival; solar elastosis-a measure of lifetime cumulative exposure-was not. In addition, none of the intermittent exposure measures-water-related activities and sunny holidays-were associated with melanoma-specific survival. Estimated ambient UVB dose was not associated with survival.
  
  
  CONCLUSIONS
  Although there was an apparent protective effect of sunburns within 10 years of diagnosis, there was only weak evidence in this large, international, population-based study of melanoma that sun exposure before diagnosis is associated with greater melanoma-specific survival.
  
  
  CONCLUSIONS
  This study adds to the evidence that sun exposure before melanoma diagnosis has little effect on survival with melanoma.
authors: Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, New Mexico. mberwick@salud.unm.edu.
authors: Marianne
authors: M
authors: Berwick
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Anne S
authors: AS
authors: Reiner
authors: Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, New Mexico.
authors: Susan
authors: S
authors: Paine
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Bruce K
authors: BK
authors: Armstrong
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Anne
authors: A
authors: Kricker
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Chris
authors: C
authors: Goumas
authors: University of Sydney, Sydney, New South Wales, Australia.
authors: Anne E
authors: AE
authors: Cust
authors: Departments of Dermatology and Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
authors: Nancy E
authors: NE
authors: Thomas
authors: Departments of Dermatology and Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
authors: Pamela A
authors: PA
authors: Groben
authors: Women's College Hospital, Toronto, Ontario, Canada.
authors: Lynn
authors: L
authors: From
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Klaus
authors: K
authors: Busam
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Irene
authors: I
authors: Orlow
authors: Cancer Care Ontario, Toronto, Ontario, Canada.
authors: Loraine D
authors: LD
authors: Marrett
authors: British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors: Richard P
authors: RP
authors: Gallagher
authors: Keck School of Medicine, University of Southern California, Los Angeles, California.
authors: Stephen B
authors: SB
authors: Gruber
authors: Department of Epidemiology, University of California, Irvine, California.
authors: Hoda
authors: H
authors: Anton-Culver
authors: AOU San Giovanni Battista, Turin, Italy.
authors: Stefano
authors: S
authors: Rosso
authors: Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy.
authors: Roberto
authors: R
authors: Zanetti
authors: Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida.
authors: Peter A
authors: PA
authors: Kanetsky
authors: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors: Terry
authors: T
authors: Dwyer
authors: Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
authors: Alison
authors: A
authors: Venn
authors: Atmospheric Chemistry Division, National Center for Atmospheric Research, Boulder, Colorado.
authors: Julia
authors: J
authors: Lee-Taylor
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Colin B
authors: CB
authors: Begg
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality*; D016016:Proportional Hazards Models; D012878:Skin Neoplasms / Q000401:mortality*; D013471:Sunburn / Q000150:complications / Q000453:epidemiology*; D013472:Sunlight / Q000009:adverse effects*