@article{3106203,
    title = "Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign",
    author = "Suppa, M. and Gandini, S. and Njimi, H. and Bulliard, J.L. and Correia, O. and Duarte, A.F. and Peris, K. and Stratigos, A.J. and Nagore, E. and Longo, M.I. and Bylaite-Bucinskiene, M. and Karls, R. and Helppikangas, H. and del Marmol, V. and Euromelanoma Working Group",
    journal = "Journal of the European Academy of Dermatology and Venereology",
    year = "2019",
    volume = "33",
    pages = "76-88",
    publisher = "Wiley-Blackwell Publishing Ltd",
    issn = "0926-9959, 1468-3083",
    doi = "10.1111/jdv.15307",
    keywords = "sunscreen, adult;  age distribution;  Article;  cancer prevention;  cancer risk;  cutaneous parameters;  dermatological procedure;  educational status;  Europe;  family history;  female;  health program;  health promotion;  high risk population;  human;  indoor tanning;  major clinical study;  male;  medical history;  oncological parameters;  priority journal;  risk assessment;  risk factor;  sex difference;  skin cancer;  sun exposure;  sunbed;  basal cell carcinoma;  Europe;  lentigo;  middle aged;  nevus;  pathology;  questionnaire;  skin tumor;  squamous cell carcinoma;  statistics and numerical data;  sunbathing;  tumor volume, Adult;  Carcinoma, Basal Cell;  Carcinoma, Squamous Cell;  Europe;  Female;  Humans;  Lentigo;  Male;  Middle Aged;  Nevus;  Risk Factors;  Skin Neoplasms;  Sunbathing;  Surveys and Questionnaires;  Tumor Burden",
    abstract = "Introduction: Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants’ data, including sunbed use and phenotype, are collected via questionnaires. Objectives: To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. Methods: To ensure reliability of the data, we defined inclusion and exclusion criteria for countries’ eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. Results: Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I–II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01–1.10)], atypical nevi [SOR = 1.04 (1.00–1.09)], lentigines [SOR = 1.16 (1.04–1.29)] and suspicion of melanoma [SOR = 1.13 (1.00–1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91–1.10)]. Conclusions: Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes. © 2019 European Academy of Dermatology and Venereology"
}