Por si quedan dudas que las maquinas de bronceado son malas... primero con melanoma, ahora con carcinoma epidermoide!

Published in Dermatology

Journal Scan / Research · October 17, 2019

Association of Lifetime Indoor Tanning and Subsequent Risk of Cutaneous Squamous Cell Carcinoma

JAMA Dermatology

TAKE-HOME MESSAGE

• This cohort study identified 597 women diagnosed with incident squamous cell carcinoma (SCC) during the study follow-up period (mean, 16.5 years) from a database including 159,419 women in Norway. Greater risk of developing SCC was observed in women who had ever previously used indoor tanning (HR, 1.43) and among current users of indoor tanning (HR, 1.27). Additionally, the authors observed a significant dose–response association between cumulative indoor tanning sessions and risk of SCC (HR, 1.83; P<.001 for trend).

• These findings support a dose–response association between indoor tanning and SCC risk in women. Based on these data, the authors support the development of policies regulating indoor tanning.

– Caroline Crabtree, MD

Written by

 

 

Ronald L Moy MD

Written by

 

 

Hiren Kolli BS

In this article, Lergenmuller et al present results from a large, prospective cohort study of the association between indoor tanning and squamous cell carcinoma in a large cohort of Norwegian women. These data further support previous findings on the damaging effects of tanning bed exposure. The authors present compelling evidence that a higher number of sessions with tanning beds increases the risk of SCC regardless of age at initiation or duration of use. With a large cohort followed for a mean of 16.5 years, this study lends additional support to previous evidence of the negative effects of tanning beds and provides further justification for stronger initiatives designed to reduce tanning bed use among individuals.

The findings presented in this article regarding the location of incident SCCs can be helpful to the practicing dermatologist. The most common location was the head, with 248 out of 597 women developing SCC in this area. The accumulated DNA damage from both UVB sunlight and UVA tanning light may be the reason for SCC commonly occurring on the head. This is supported by evidence from a recent review, which found that increases in incidence have been greatest for SCC on the skin of the head and neck followed by the trunk and upper and lower limbs.1 Another study demonstrated that high-dose exposure to psoralen and UVA for psoriasis increases the risk of SCC, which also lends support to the harmful effects of direct exposure to UVR.2However, this study showed that only 9% of SCCs occurred on the head and neck whereas the majority of SCCs (62%) occurred on the lower extremities.

This study expands on the existing literature and is important in demonstrating the positive associations between tanning bed use and the three most common types of skin cancers (BCC, SCC, and melanoma). However, it shows a discrepancy in the importance of duration of use and age at initiation, which was significant in the incidence of BCC with tanning bed use in the findings of Rosso et al.3 This suggests that earlier and prolonged exposure is more important in the development of BCC compared with SCC. In addition, this current study did not demonstrate a significant association between blistering sunburns and increased risk of SCC, but a 1998 study in Australia found a positive association.4 In addition, a meta-analysis demonstrated that there is an increased risk of melanoma with an increasing number of sunburns throughout one's lifetime and does not depend on how early in life the sunburns occurred.5 Painful sunburns before the age of 20 years have also been shown to be associated with an increased risk of actinic keratosis.6 The finding that sunburns were not a factor for SCC development in this study may be because the number of painful and blistering sunburns were not distinguished and the specific sites of the sunburn were not correlated with recorded incidence of SCC.

This article adds to the evidence of the harms of indoor tanning bed use. The use of tanning beds should be discouraged. The studies demonstrating the use of nicotinamide to decrease the development of squamous and basal cell carcinomas by decreasing past DNA damage suggest that these indoor tanning patients be recommended to take this vitamin to prevent these skin cancers.7

References

1. Green AC, Olsen CM. Cutaneous squamous cell carcinoma: an epidemiological review. Br J Dermatol. 2017;177(2):373-381. https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.15324
2. Stern R, Lunder E. Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA): a meta-analysis. Arch Dermatol. 1998;134(12):1582-1585. https://jamanetwork.com/journals/jamadermatology/fullarticle/189673
3. Rosso S, Zanetti R, Martinez C, et al. The multicentre south European study 'Helios'. II: different sun exposure patterns in the aetiology of basal cell and squamous cell carcinomas of the skin. Br J Cancer. 1996;73(11):1447-1454. https://www.nature.com/articles/bjc1996274
4. English DR, Armstrong BK, Kricker A, et al. Case-control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer. 1998;77(3):347-353. https://onlinelibrary.wiley.com/doi/abs/10.1002/%28SICI%291097-0215%2819980729%2977%3A3%3C347%3A%3AAID-IJC7%3E3.0.CO%3B2-O?sid
5. Dennis LK, Vanbeek MJ, Freeman LEB, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol. 2008;18(8):614-627. https://www.sciencedirect.com/science/article/abs/pii/S104727970800094X
6. Kennedy C, Bajdik CD, Willemze R, et al. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003;120(6):1087-1093. https://www.jidonline.org/article/S0022-202X(15)30273-6/fulltext
7. Chen AC, Martin AJ, Choy B, et al. A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention. N Engl J Med. 2015;373(17):1618-1626. https://www.nejm.org/doi/10.1056/NEJMoa1506197

Abstract

IMPORTANCE

No study, to our knowledge, has prospectively investigated a dose-response association between lifetime indoor tanning and risk of cutaneous squamous cell carcinoma (SCC).

OBJECTIVE

To investigate the dose-response association between lifetime indoor tanning and SCC risk, the association between duration of use and age at initiation with SCC risk, and the association between age at initiation and age at diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included data from women born from 1927 to 1963 from the Norwegian Women and Cancer study, established in 1991 with follow-up through December 31, 2015. Baseline questionnaires were issued to participants from 1991 to 2007, with follow-up questionnaires given every 5 to 7 years. Data analysis was performed from January 2, 2018, to March 2, 2019.

EXPOSURES

Participants reported pigmentation factors. Sunburns, sunbathing vacations, and indoor tanning were reported for childhood, adolescence, and adulthood.

MAIN OUTCOMES AND MEASURES

Information on all cancer diagnoses and dates of emigration or death were obtained through linkage to the Cancer Registry of Norway, using the unique personal identification number of Norwegian citizens.

RESULTS

A total of 159 419 women (mean [SD] age at inclusion, 49.9 [8.3] years) were included in the study. During follow-up (mean [SD], 16.5 [6.4] years), 597 women were diagnosed with SCC. Risk of SCC increased with increasing cumulative number of indoor tanning sessions. The adjusted hazard ratio (HR) for highest use vs never use was 1.83 (95% CI, 1.38-2.42; P < .001 for trend). A significantly higher risk of SCC was found among women with 10 years or less of use (HR, 1.41; 95% CI, 1.08-1.85) and more than 10 years of use (HR, 1.43; 95% CI, 1.16-1.76) and among women with age at initiation of 30 years or older (HR, 1.36; 95% CI, 1.11-1.67) and younger than 30 years (HR, 1.51; 95% CI, 1.18-1.92) vs never users. No significant association was found between age at initiation and age at diagnosis (estimated regression coefficient, -0.09 [95% CI, -1.11 to 0.94] for age at initiation of ≥30 years and -0.02 [95% CI, -1.27 to 1.22] for <30 years vs never use).

CONCLUSION AND RELEVANCE

The findings provide supporting evidence that there is a dose-response association between indoor tanning and SCC risk among women. The association between cumulative exposure to indoor tanning and SCC risk was the same regardless of duration of use and age at initiation. These results support development of policies that regulate indoor tanning.

JAMA Dermatology

Association of Lifetime Indoor Tanning and Subsequent Risk of Cutaneous Squamous Cell Carcinoma

JAMA Dermatol 2019 Oct 02;[EPub Ahead of Print], S Lergenmuller, R Ghiasvand, TE Robsahm, AC Green, E Lund, CS Rueegg, MB Veierød 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.