Effect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals

Intermittent exposure to sunlight is considered to be an important risk factor for melanoma, but the associations reported in most case-control studies are surprisingly weak. The aim of this study was to evaluate whether the incorporation of a subject's background exposure to the sun and pigmentation characteristics (which are assumed to influence a person's susceptibility to sunlight exposure) could produce stronger associations between sunlight exposure and the risk for melanoma. A population-based case-control study was performed in the mid-eastern part of the Netherlands. The study group comprised 141 patients with a histologically verified melanoma and 183 controls with other malignancies who were registered by the same cancer registry. Patients with a lentigo maligna melanoma or an acrolentiginous melanoma were excluded. Information was collected by interviews and physical examination. We categorized subjects as indoor or outdoor workers on the basis of occupational exposure to the sun. Pigmentation characteristics, which are known to be risk indicators for cutaneous melanoma, were summarized as one sun sensitivity score. We used this score to distinguish between sun-sensitive and sun-resistant persons. The odds ratios associated with sunbathing, vacations spent in sunny countries, and sunburns were higher among the indoor workers than among the outdoor workers. After stratification by the sun sensitivity score, the effect of sunbathing, participating in water sports (swimming excluded), vacations to sunny countries, and a history of sunburn was largest for the sun-sensitive persons. The data show a general trend toward higher relative risks among indoor workers and sun-sensitive individuals. The results of this study support the intermittent sunlight hypothesis.