Non-melanoma skin cancer, sun exposure and sun protection

The incidence of skin tumors including squamous cell carcinoma (SCC), and its biological precursor, the actinic keratosis, and basal cell carcinoma (BCC) often named together non-melanoma skin cancer (NMSC) is growing all over the world in people of Caucasian ancestry. A plenty of clinical and epidemiological studies have demonstrated the causal relationship with high cumulative solar dosages and number of sunburns, although the hazard may be different for different tumors according to the modalities of ultraviolet (UV) exposure. BCC is much more strongly related to measures of intermittent ultraviolet exposure (particularly those of childhood or adolescence) than to measures of cumulative exposure. In contrast, SCC is more strongly related to constant or cumulative sun exposure. Photobiological studies have clarified that sunlight and UVB radiation are complete carcinogens for AK and SCC although the relationship with UVA exposure is much less known. Also the likelihood of BCC has been related to either sunburns and high lifetime solar, UVA and UVB cumulative doses but the pathogenetic pathways of both UVB and UVA radiation for BCC development need to be clarified so far. The lack of a complete knowledge of the photocarcinogenic pathways of keratinocytes has contributed to the limited results of solar photoprotection strategies, beside the limitations of the available sunscreens and present EU regulations.