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Original Investigation |

A 3-Year Follow-up of Sun Behavior in Patients With Cutaneous Malignant Melanoma

Luise Winkel Idorn, MD, PhD1; Pameli Datta, MD1; Jakob Heydenreich, MSc, Engin1; Peter Alshede Philipsen, PhD, MSc, Engin1; Hans Christian Wulf, MD, DMSc1
[+] Author Affiliations
1Dermatological Research Department D92, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
JAMA Dermatol. 2014;150(2):163-168. doi:10.1001/jamadermatol.2013.5098.
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Importance  UV radiation (UVR) exposure is the primary environmental risk factor for developing cutaneous malignant melanoma (CMM).

Objective  To measure changes in sun behavior from the first until the third summer after the diagnosis of CMM using matched controls as a reference.

Design, Setting, and Participants  Three-year follow-up, observational, case-control study performed from May 7 to September 22, 2009, April 17 to September 15, 2010, and May 6 to July 31, 2011, at a university hospital in Denmark of 21 patients with CMM and 21 controls matched to patients by sex, age, occupation, and constitutive skin type participated in the study. Exposure to UVR was assessed the first and second summers (n = 20) and the first and third summers (n = 22) after diagnosis. Data from 40 participants were analyzed.

Main Outcomes and Measures  Exposure to UVR was assessed by personal electronic UVR dosimeters that measured time-related UVR in standard erythema dose (SED) and corresponding sun diaries (mean, 74 days per participant each participation year).

Results  Patients’ daily UVR dose and UVR dose in connection with various behaviors increased during follow-up (quantified as an increase in daily UVR dose each year; all days: mean, 0.3 SED; 95% CI, 0.05-0.5 SED; days with body exposure: mean, 0.6 SED; 95% CI, 0.07-1.2 SED; holidays: mean, 1.2 SED; 95% CI, 0.3-2.1 SED; days abroad: 1.9 SED; 95% CI, 0.4-3.4 SED; and holidays with body exposure: mean, 2.3 SED; 95% CI, 1.1-3.4 SED). After the second year of follow-up, patients’ UVR dose was higher than that of controls, who maintained a stable UVR dose. No difference was found between groups in the number of days with body exposure or the number of days using sunscreen in the second and third years of follow-up.

Conclusions and Relevance  Our findings suggest that patients with CMM do not maintain a cautious sun behavior in connection with an increase in UVR exposure, especially on days with body exposure, when abroad, and on holidays.

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Figures

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Figure 1.
Patients’ Daily UV Radiation Dose for All Days and Days With Body Exposure

Compared with controls, patients increased their standard erythema dose (SED) during follow-up for all days (P = .02) (A) and for days with body exposure (P = .03) (B). The difference in the slopes of the regression lines between patients and controls was 0.3 (P = .04) for all days and 0.6 (P = .56) for days with body exposure.

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Figure 2.
Patients’ Daily UV Radiation Dose While on Holidays and on Days Abroad

Compared with controls, patients increased their daily standard erythema dose (SED) during follow-up while on holidays (P = .009) (A) and on days abroad (P = .02) (B). The difference in the slopes of the regression lines between patients and controls was 1.3 (P = .008) while on holiday and 2.1 (P = .02) on days abroad.

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