title: Sun exposure and melanoma prognostic factors.
abstract: Previous studies have reported an association between sun exposure and the increased survival of patients with cutaneous melanoma (CM). The present study analyzed the association between ultraviolet (UV) light exposure and various prognostic factors in the Italian Clinical National Melanoma Registry. Clinical and sociodemographic features were collected, as well as information concerning sunbed exposure and holidays with sun exposure. Analyses were performed to investigate the association between exposure to UV and melanoma prognostic factors. Between December 2010 and December 2013, information was obtained on 2,738 melanoma patients from 38 geographically representative Italian sites. A total of 49% of the patients were >55 years old, 51% were men, 50% lived in the north of Italy and 57% possessed a high level of education (at least high school). A total of 8 patients had a family history of melanoma and 56% had a fair phenotype (Fitzpatrick skin type I or II). Of the total patients, 29% had been diagnosed with melanoma by a dermatologist; 29% of patients presented with a very thick melanoma (Breslow thickness, >2 mm) and 25% with an ulcerated melanoma. In total, 1% of patients had distant metastases and 13% exhibited lymph node involvement. Holidays with sun exposure 5 years prior to CM diagnosis were significantly associated with positive prognostic factors, including lower Breslow thickness (P<0.001) and absence of ulceration (P=0.009), following multiple adjustments for factors such as sociodemographic status, speciality of doctor performing the diagnosis and season of diagnosis. Sunbed exposure and sun exposure during peak hours of sunlight were not significantly associated with Breslow thickness and ulceration. Holidays with sun exposure were associated with favorable CM prognostic factors, whereas no association was identified between sunbed use and sun exposure during peak hours of sunlight with favorable CM prognostic factors. However, the results of the present study do not prove a direct causal effect of sun exposure on melanoma prognosis, as additional confounding factors, including vitamin D serum levels, may have a role.
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan I-20146, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gandini
authors.affiliation: Department of Epidemiology, National Cancer Institute 'G. Pascale' Foundation, Naples I-80131, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Montella
authors.affiliation: Unit of Medical Oncology and Innovative Therapies, National Cancer Institute 'G. Pascale' Foundation, Naples I-80131, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ayala
authors.affiliation: Unit of Medical Oncology and Innovative Therapies, National Cancer Institute 'G. Pascale' Foundation, Naples I-80131, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Benedetto
authors.affiliation: Department of Surgical Oncological and Gastroenterological Sciences, Padua University, Padua I-35122, Italy; Melanoma and Sarcoma Unit, Veneto Oncological Institute for Research and Treatment, Padua I-35128, Italy.
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
authors.affiliation: Melanoma and Sarcoma Unit, Veneto Oncological Institute for Research and Treatment, Padua I-35128, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Vecchiato
authors.affiliation: Department of Dermatology, Society of Clinical Oncology Santa Maria Degli Angeli Oncological Hospital, Pordenone I-33170, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Corradin
authors.affiliation: Department of Dermatology, Tuscan Orthopaedic Institute Hospital 'Palagi', University of Florence, Florence I-50125, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: DE Giorgi
authors.affiliation: Department of Medical Oncology, Company University Hospital San Martino, National Institute for Cancer Research, Genova I-16132, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Queirolo
authors.affiliation: Plastic Surgery Unit, St. Orsola-Malpighi Hospital, Bologna I-40138, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Zannetti
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Bari I-70121, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giudice
authors.affiliation: Dermatalogical Clinic, Institute for Research and Treatment San Matteo Hospital, Pavia I-27100, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Borroni
authors.affiliation: Oncological Unit, Vito Fazzi Hospital, Lecce I-73100, Italy.
authors.forename: Rosachiara
authors.initials: R
authors.lastname: Forcignanò
authors.affiliation: Dermatological Institute, Catholic University of America, Rome I-00153, Italy.
authors.forename: Ketty
authors.initials: K
authors.lastname: Peris
authors.affiliation: Melanoma Unit, European Institute of Oncology, Milan I-20146, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Tosti
authors.affiliation: Melanoma Unit, European Institute of Oncology, Milan I-20146, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Testori
authors.affiliation: Dermatalogical Clinic, Maggiore Hospital, Trieste I-34125, Italy.
authors.forename: Giusto
authors.initials: G
authors.lastname: Trevisan
authors.affiliation: Department of Plastic and Reconstructive Surgery, Company University Hospital San Martino, National Institute for Cancer Research, Genova I-16132, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Spagnolo
authors.affiliation: Unit of Medical Oncology and Innovative Therapies, National Cancer Institute 'G. Pascale' Foundation, Naples I-80131, Italy.
authors.forename: Paolo A
authors.initials: PA
authors.lastname: Ascierto
keywords: Breslow thickness; melanoma; prognosis; sun exposure; sunbed; ulceration