This study was performed in efforts to clarify the relationship between sun exposure and incidence of melanoma by considering host susceptibility factors. Susceptible subgroups were primarily based on pigmentary characteristics. The type of sun exposure was identified as chronic or intermittent. Cases and comparisons comprised a 1979 through 1982 subset of an earlier study and contained 289 consecutive patients with melanoma and 527 randomly selected comparisons without cancer. The risk of melanoma associated with sun exposure was shown to be greater for individuals expected to be susceptible on the basis of poor ability to tan, but not other pigmentary traits. There were also some interactions between age and sun exposure. The risk of melanoma among subjects with poor tanning ability associated with outdoor occupation was three times greater than those with poor tanning ability who were employed indoors. Mixed indoor and outdoor job exposures were protective among good tanners, but not among poor tanners. For recreational sun exposure a similar pattern was noted. The quantitative assessment of average hours of sun exposure was not a good indicator of melanoma risk, even among the susceptible individuals. A history of severe sunburn with blistering was associated with nearly a three fold risk among poor tanners but was protective among good tanners. A history of nonmelanoma skin cancer or solar keratosis was a very strong risk factor. This factor did not significantly differ in magnitude among susceptibility subgroups.
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