A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women

Background: Although sun exposure is an established cause of cutaneous malignant melanoma, possible interactions with host factors remain incompletely understood. Here we report the first results from a large prospective cohort study of pigmentation factors and sun exposure in relation to melanoma risk. Methods: The Women's Lifestyle and Health Cohort Study included 106379 women from Norway and Sweden who were aged 30-50 years in 1991 or 1992 when they completed an extensive questionnaire on personal characteristics and exposures. Linkages to national registries ensured complete follow-up through December 31, 1999. Poisson regression models were used to estimate relative risks (RRs). All statistical tests were two-sided. Results: During an average follow-up of 8.1 years, 187 cases of melanoma were diagnosed. Risk of melanoma was statistically significantly associated with increasing body surface area (RR for greater than or equal to1.79 m(2) versus less than or equal to1.61 m(2) = 1.60, 95% confidence interval [CI] = 1.03 to 2.48; P-trend = .02), number of large asymmetric nevi on the legs (RR for greater than or equal to7 nevi versus 0 nevi = 5.29, 95% CI = 2.33 to 12.01; P-trend<.001), hair color (RR for red versus dark brown or black = 4.05, 95% CI = 2.11 to 7.76; P-trend<.001), sunburns per year at ages 10-19, 20-29, and 30-39 years (P-trend<.001, P-trend = .03, and P-trend = .05, respectively), and use of a device that emits artificial light (solarium) one or more times per month (P = .04). Conclusions: Our results confirm previous findings that hair color, number of nevi on the legs, and history of sunburn are risk factors for melanoma and suggest that use of a solarium is also associated with melanoma risk. Adolescence and early adulthood appear to be among the most sensitive age periods for the effects of sunburn and solarium use on melanoma risk. However, it may be too early to see the full effect of adult exposures in this cohort.