Melanoma, altitud y radiación UVB / Melanoma, altitude, and UV-B radiation

Introducción: La radiación ultravioleta (UV) es el principal factor de riesgo ambiental modificable en el desarrollo del melanoma cutáneo. Muchas de las poblaciones de nuestra provincia están situadas a gran altitud, recibiendo elevadas dosis de radiación UVB. Nuestro objetivo es analizar una posible asociación entre melanoma y altitud y medir la dosis eritemática diaria a diferentes altitudes. Material y métodos: Realizamos un estudio ecológico, en el que se trató de relacionar la prevalencia de melanoma, la altitud y la dosis eritemática diaria. El periodo de estudio comprendió los últimos 25 años (1982-2007). Calculamos la prevalencia de melanoma con aquellos pacientes diagnosticados clínica e histológicamente de melanoma, procedentes del Hospital Clínico Universitario ‘‘San Cecilio’’. Los individuos del estudio debían tener su lugar de residencia en la provincia de Granada. Calculamos la prevalencia de melanoma a intervalos de 100 m de altitud y estimamos la dosis eritemática diaria a partir de las medidas de radiación UVB realizadas con piranómetros situados a 0, 680, 1.200, 2.100 y 3.398 m de altitud durante la campañaVELETA-2002. Resultados: La prevalencia de melanoma más alta está situada en el intervalo comprendido entre los 1.400-1.499 m a.s.l (intervalo con núcleos de población situados a mayor altitud) con 2,36 por 1.000 habitantes IC al 95% (0,64-6,03) por 1.000 habitantes. A partir de los 700 m de altura la dosis eritemática diaria aumenta de forma exponencial a medida que ascendemos en altitud. Conclusiones: Este estudio encuentra una tendencia al aumento en la prevalencia de melanoma al ascender en altitud, siendo más intenso a partir de los 700 m a.s.l (AU)

Background and objectives: UV radiation is the main modifiable risk factor for the development of cutaneous melanoma. Many people in the Spanish province of Granada live at high altitudes and, therefore, receive high doses of UV-B radiation. The aims of this study were to assess the possible association between melanoma and altitude and to measure the daily erythemal dose at different altitudes. Material and methods: An epidemiological study was carried out between 1982 and 2007 to assess the relationship between altitude, daily erythemal dose, and the prevalence of melanoma. We calculated the prevalence of melanoma in patients with a clinical and histological diagnosis of melanoma at Hospital Clínico Universitario San Cecilio in Granada, Spain. All individuals were required to be residents of the province of Granada in order to be included in the study. The prevalence of melanoma was calculated for altitude intervals of 100 m. Daily erythemal dose was estimated using measures of UV-B radiation obtained with pyranometer sat altitudes of 0, 680, 1200, and 3398 m above sea level during the Evaluation of the Effects of Elevation and Aerosols on UV Radiation (VELETA) 2002 field campaign. Results: The highest prevalence of melanoma was found between 1400 and 1499 m above sea level (the interval at which the highest settlements are found), with a rate of 2.36 cases per 1000 inhabitants (95% confidence interval, 0.64—6.03). Above 700 m, the daily erythemal dose increased exponentially with increasing altitude. Conclusions: We observed a tendency toward increased prevalence of melanoma at higher altitude, with higher prevalences observed beyond 700 m above sea level (AU)

[Melanoma, altitude, and UV-B radiation]. / Melanoma, altitud y radiación UVB.

BACKGROUND AND OBJECTIVES: UV radiation is the main modifiable risk factor for the development of cutaneous melanoma. Many people in the Spanish province of Granada live at high altitudes and, therefore, receive high doses of UV-B radiation. The aims of this study were to assess the possible association between melanoma and altitude and to measure the daily erythemal dose at different altitudes. MATERIAL AND METHODS: An epidemiological study was carried out between 1982 and 2007 to assess the relationship between altitude, daily erythemal dose, and the prevalence of melanoma. We calculated the prevalence of melanoma in patients with a clinical and histological diagnosis of melanoma at Hospital Clínico Universitario San Cecilio in Granada, Spain. All individuals were required to be residents of the province of Granada in order to be included in the study. The prevalence of melanoma was calculated for altitude intervals of 100 m. Daily erythemal dose was estimated using measures of UV-B radiation obtained with pyranometers at altitudes of 0, 680, 1200, and 3398 m above sea level during the Evaluation of the Effects of Elevation and Aerosols on UV Radiation (VELETA) 2002 field campaign. RESULTS: The highest prevalence of melanoma was found between 1400 and 1499 m above sea level (the interval at which the highest settlements are found), with a rate of 2.36 cases per 1000 inhabitants (95% confidence interval, 0.64-6.03). Above 700 m, the daily erythemal dose increased exponentially with increasing altitude. CONCLUSIONS: We observed a tendency toward increased prevalence of melanoma at higher altitude, with higher prevalences observed beyond 700 m above sea level.

Evolución de la incidencia del cáncer de piel en el período 1978–2002 / Changes in the incidence of skin cancer between 1978 and 2002

Introducción: La radiación ultravioleta es el principal factor de riesgo en el desarrollo del cáncer de piel. En las últimas décadas se ha producido un cambio en los estilos de vida que conlleva mayores exposiciones a la radiación ultravioleta, lo que unido a un mayor envejecimiento de la población aumenta el riesgo de desarrollar cáncer de piel. Nuestro objetivo es analizar la tendencia temporal en la incidencia del cáncer de piel a nivel mundial, europeo y español durante el período comprendido entre 1978–2002. Material y métodos: Se estudiaron la incidencia y la tendencia del cáncer de piel en el período 1978–2002 a través de la publicación Cancer Incidence in Five Continents. Resultados: La incidencia del melanoma cutáneo aumentó de forma continua durante todo el período, con tasas más elevadas en mujeres. Las incidencias máximas se registraron en Australia. En España, las tasas estandarizadas de melanoma llegaron a triplicarse en ambos sexos al final del período de estudio. La incidencia del cáncer cutáneo no melanoma (CCNM) aumentó durante el período de estudio (1978–2002), con tasas más elevadas en varones. Las incidencias máximas se registraron en Australia, Brasil y en la población europea de Zimbabue. En España, las tasas estandarizadas de CCNM llegaron a duplicarse o triplicarse en ambos sexos al final del período. Conclusiones: El aumento de la incidencia del cáncer de piel nos hace pensar que las medidas de prevención primaria están fallando, son insuficientes o que aún no ha llegado el momento de evaluar su eficacia. Como limitaciones a nuestro estudio, cabe señalar que no se ha podido analizar el período más actual 2003–2007 y el hecho de que no todas las poblaciones tienen un registro de cáncer (AU)

Background: Ultraviolet radiation is the main risk factor for skin cancer. Changes in lifestyle over recent decades have led to greater exposure to ultraviolet radiation; this phenomenon, coupled with aging of the population, increases the risk of developing skin cancer. Our objective was to analyze the trends in the incidence of skin cancer worldwide, in Europe, and in Spain during the period 1978 to 2002. Material and methods: Both skin cancer incidence and trends were investigated during the period 1978 to 2002 using the publication Cancer Incidence in Five Continents. Results: The incidence of cutaneous melanoma increased progressively throughout the period, with higher rates among women. The highest incidence was found in Australia. In Spain, the standardized rates of melanoma had tripled in both sexes by the end of the study period. The incidence of nonmelanoma skin cancer (NMSC) increased throughout the study period, with higher rates among men. The highest incidences were found in Australia, Brazil, and among the European inhabitants of Zimbabwe. Within Spain, the standardized rates of NMSC doubled or tripled in both sexes by the end of the study period. Conclusion: The rise in the incidence of skin cancer leads us to conclude that measures of primary prevention are failing or insufficient, or that it is still too soon to evaluate their efficacy. There are certain limitations to this study, such as the fact that it was impossible to analyze the most recent period, from 2003 to 2007, and that cancer registries are not available for all populations (AU)

[Changes in the incidence of skin cancer between 1978 and 2002]. / Evolución de la incidencia del cáncer de piel en el período 1978-2002.

BACKGROUND: Ultraviolet radiation is the main risk factor for skin cancer. Changes in lifestyle over recent decades have led to greater exposure to ultraviolet radiation; this phenomenon, coupled with aging of the population, increases the risk of developing skin cancer. Our objective was to analyze the trends in the incidence of skin cancer worldwide, in Europe,and in Spain during the period 1978 to 2002. MATERIAL AND METHODS: Both skin cancer incidence and trends were investigated during the period 1978 to 2002 using the publication Cancer Incidence in Five Continents. RESULTS: The incidence of cutaneous melanoma increased progressively throughout the period, with higher rates among women. The highest incidence was found in Australia. In Spain, the standardized rates of melanoma had tripled in both sexes by the end of the study period. The incidence of non melanoma skin cancer (NMSC) increased throughout the study period, with higher rates among men.The highest incidences were found in Australia, Brazil, and among the European inhabitants of Zimbabwe. Within Spain, the standardized rates of NMSC doubled or tripled in both sexes by the end of the study period. CONCLUSION: The rise in the incidence of skin cancer leads us to conclude that measures of primary prevention are failing or insufficient, or that it is still too soon to evaluate their efficacy. There are certain limitations to this study, such as the fact that it was impossible to analyze the most recent period, from 2003 to 2007, and that cancer registries are not available for all populations.