CUTANEOUS MALIGNANT-MELANOMA AND EXPOSURE TO SUNLAMPS OR SUNBEDS - ANEORTC MULTICENTER CASE-CONTROL STUDY IN BELGIUM, FRANCE AND GERMANY

The study objective was to assess whether exposure to sunlamps and sun beds represents a risk factor for cutaneous malignant melanoma (CMM). A 1 -to- 1 unmatched case-control study was conducted among subjects 2 0 years old or more with naturally non-pigmented skin in Germany, Fran ce and Belgium. A total of 420 consecutive patients with CMM diagnosed from 1 January 1991 onward were derived from hospital registers; 447 controls with no history of skin cancer were chosen at random in the s ame municipality as the cases. Exposure to sunlamps or sunbeds startin g before 1980 is associated with a crude estimated risk of CMM of 2.71 (95% CI: 1.06-7-78) for at least 10 hr of accumulated exposure. This risk is of 2.12 (95% CI: 0.84-5.37) after adjustment for age, sex, hai r colour and average number of holiday weeks each year in sunny resort s. Subjects who experienced skin-burn due to sunlamps or sunbeds, and who had accumulated at least 10 hr of exposure, displayed a crude esti mated CMM risk at 4.47 (95% CI: 1.45-13.7), which rose to 8.97 (95% CI : 2.10-38.6) for those who exposed their skin for tanning purposes. Th e risk associated with skin-burn is only marginally modified after mul tiple adjustments for host characteristics and recreational exposure t o sunlight. Apparently, sunlamps and sunbeds share the increased risk of CMM, which seems to concentrate in subjects exhibiting hazardous be haviour towards ultraviolet radiation sources. However, although it is reasonable to believe that high doses of pure ultraviolet A radiation can be dangerous, this is not firmly established by this study. Most exposures to ultraviolet A tanning devices began after 1980; therefore , epidemiologic studies have difficulty in revealing any increase in r isk of CMM starting after 1980 because of the latent period between ex posure and occurrence of melanoma. Public health authorities should ha ve a cautious approach towards the rapidly developing fashion of tanni ng under sunlamps or sunbeds. (C) 1994 Wiley-Liss, Inc.