Socioeconomic status and cutaneous malignant melanoma in Northern Europe.

Socioeconomic status (SES) is associated with cutaneous malignant melanoma (CMM) in Northern Europe, despite equal access to health care. SES per se is not responsible for this association, which must be ascribed to important risk factors for CMM such as intermittent ultraviolet radiation (UVR) exposure, and screening for CMM possibly owing to a greater knowledge and understanding of CMM. Our review of the literature showed that high SES is associated with increased risk of CMM, thinner tumours, increased survival and decreased mortality from CMM - the latter shown among women, and in recent studies also among men. There is evidence that high SES is associated with sun holidays, whereas low SES is associated with the use of sunbeds. Findings suggest that high SES is associated with the use of physicians and dermatologists for marks and moles, possibly owing to more knowledge and better understanding of CMM. We conclude that there has been a true increase in CMM incidence among high SES individuals in Northern Europe probably due to past intense intermittent UVR exposure, especially in connection with sun holidays. However, the increased risk of CMM and a better outcome of CMM in high SES individuals may also be conditioned by frequent recourse to physicians, which may be ascribed to more knowledge and better understanding of CMM, although more studies on this subject are warranted. Thicker CMM tumours and increased CMM mortality among low SES individuals in recent decades may reflect exposure to intermittent UVR, such as the use of sunbeds, as well as delayed diagnosis.

Sun behaviour after cutaneous malignant melanoma: a study based on ultraviolet radiation measurements and sun diary data.

BACKGROUND: It has been reported that patients with cutaneous malignant melanoma (CMM) can lower their risk of a second primary melanoma by limiting recreational sun exposure. Previous studies based on questionnaires and objective surrogate measurements indicate that before their diagnosis, patients with CMM are exposed to higher ultraviolet radiation (UVR) doses than controls, followed by a reduction after diagnosis. OBJECTIVES: In a prospective, observational case-control study, we aimed to assess sun exposure after diagnosis of CMM by objective measurements to substantiate advice about sun behaviour. METHODS: The study population consisted of 24 patients recently diagnosed with CMM during the 7 months preceding the start of the study; 51 controls who matched these recently diagnosed patients in age, sex, occupation and constitutive skin type; and 29 patients diagnosed with CMM between 12 months and 6 years before the start of the study. During a summer season participants filled in sun exposure diaries daily and wore personal electronic UVR dosimeters in a wristwatch that continuously measured time-stamped UVR doses in standard erythema dose. RESULTS: The UVR dose of recently diagnosed patients on days with body exposure was one-third lower, and the number of days using sunscreen was double that of matched controls. However, in patients diagnosed more than 12 months earlier, the UVR dose on days with body exposure was one-third higher and the number of days using sunscreen was half that of recently diagnosed patients. CONCLUSIONS: Patients with CMM limited their UVR dose on days with body exposure, and by using sunscreen further reduced UVR reaching the skin, although only immediately after diagnosis.

Sun exposure before and after a diagnosis of cutaneous malignant melanoma: estimated by developments in serum vitamin D, skin pigmentation and interviews.

BACKGROUND: Previous studies on ultraviolet radiation (UVR) exposure before and after a diagnosis of cutaneous malignant melanoma (CMM) have been based primarily on questionnaires. Objective measures are needed. OBJECTIVES: To assess changes in UVR exposure in patients with CMM using objective surrogate parameters in a descriptive study. METHODS: Ten patients recently diagnosed with CMM during the 5 months (autumn and winter) preceding study start in February 2009; 21 patients diagnosed from 12 months to 6 years before study start; and 15 controls, who matched the recently diagnosed patients on age, sex, residential area, constitutive skin type and occupation completed the investigations. UVR exposure before and after diagnosis of CMM was assessed using measures of serum 25-hydro vitamin D [25(OH)D], skin pigmentation and by interviews. Winter 25(OH)D was used as a surrogate parameter of UVR exposure the previous summer - the summer before CMM diagnosis in recently diagnosed patients. RESULTS: Winter 25(OH)D was significantly higher among recently diagnosed patients compared with controls (P = 0·02, R² = 0·60) and patients diagnosed up to 6 years earlier (P = 0·01). The increase in 25(OH)D during the summer after diagnosis was significantly lower for recently diagnosed patients than for controls (P = 0·005, R² = 0·51) and patients diagnosed up to 6 years earlier (P = 0·008). No difference was found in summer 25(OH)D between the groups. CONCLUSIONS: Our findings suggest that patients with CMM had a higher UVR exposure the summer before diagnosis than did controls and patients diagnosed up to 6 years earlier, and that after diagnosis UVR exposure fell to the level of controls in patients with CMM.