Risk factors for basal cell carcinoma in a Mediterranean population - Roleof recreational suit exposure early in life

Objective: To investigate the role of pigmentary traits, different patterns of sun exposure, artificial sources of UV radiation, and lifestyle-related factors on the risk of basal cell carcinoma (BCC) in a Mediterranean popul ation from central-southern Italy. Design: Hospital-based case-control study Setting: A referral dermatological hospital in Rome, Italy. Patients: A convenience sample of 166 case patients,with histologically con firmed BCC and 158 cancer-free control subjects with minor dermatological c onditions observed between March 1995 and June 1997. Results: In the multivariate analysis, the mean number of weeks per year sp ent at the beach before the age of 20 years was significantly associated wi th BCC. A dose-response trend was found for subjects who had spent 3 to 4 ( odds ratio, 1.8; 95% confidence interval, 0.8-4.4), 5 to 8 (odds ratio, 3.7 ; 95% confidence interval, 1.5-9.0), or more than 8 (odds ratio, 4.5; 95% c onfidence interval, 1.9-10.5) weeks per year at the beach (P=.01 for trend) . There was a significant association with the presence of actinic keratose s or solar lentigines, whereas no effect was found for skin type, history o f sunburns, exposure to nonsolar UV radiation, and lifestyle-related habits such as cigarette smoking, alcohol consumption, and coffee drinking. Subje cts reporting a family history of skin cancer had an extremely increased ri sk of BCC. Conclusion: The definite association with recreational sun exposure during childhood and adolescence and the strong relation with family history of sk in cancer suggest that genetic predisposition and peculiar exposure pattern s to UV radiation are key independent risk factors for the development of B CC in a southern European population.