title: Seasonal Variation in Skin Cancer Diagnosis.
abstract: OBJECTIVE
  Seasonality of skin cancer is well known, and it is influenced by a number of variables, such as exposure and personal characteristics, but also health service factors. We investigated the variations in the diagnosis melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC) during the year.
  
  
  METHODS
  We analyzed incident cases recorded in the Umbria Regional Cancer registry from 1994 to 2010 (1745 cases of MSC, 50% females, and 15,992 NMSC, 41% females). The Walter-Elwood test was used to assess seasonal effects. Relative risks were analyzed using negative binomial regression and splines.
  
  
  RESULTS
  Seasonality of MSC and NMSC was similar. Incidence peaks were observed in weeks 8, 24, and 43 (February, July, and October) and troughs in weeks 16, 32, 52, and 1 (August and December). Both NMSC and MSC cancers showed most elevated risks in autumn. A seasonal effect was present for trunk (p < 0.001) and absent for face cancers (p = 0.3).
  
  
  CONCLUSIONS
  The observed pattern of diagnoses presumably depends on health service factors (e.g., organization of melanoma days, reduced access to care in August and during Christmas holidays) and personal factors (e.g., unclothing in the summer and delays in seeking care). High incidence rates in autumn could also in part depend on a late cancer progression effect of UV exposure. More efforts should be placed in order to guarantee uniform access to care through the year.
authors.affiliation: Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy; Umbrian Population Cancer Registry, Regional Government of Umbria, University of Perugia, Perugia, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Bianconi
authors.affiliation: Public Health Section, Department of Experimental Medicine, University of Perugia , Perugia , Italy.
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Masanotti
authors.affiliation: Department of Medicine and Surgery, University of Foggia , Foggia , Italy.
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Liso
authors.affiliation: Umbrian Population Cancer Registry, Regional Government of Umbria, University of Perugia , Perugia , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: La Rosa
authors.affiliation: Department of Health, Regional Government of Umbria , Perugia , Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Duca
authors.affiliation: Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy; Umbrian Population Cancer Registry, Regional Government of Umbria, University of Perugia, Perugia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stracci
keywords: UV; access to care; cancer registry; melanoma; seasonal variation; skin cancers