UV Exposure Likely Not a Melanoma Risk for People of Color

By Marilynn Larkin

December 23, 2020

NEW YORK (Reuters Health) - The association between ultraviolet (UV) exposure and melanoma is "weak" for skin of color, according to a new systematic review.

"I was not surprised to find little to no evidence supporting the association between UV exposure and melanoma in people with skin of color," Dr. Adewole Adamson of the University of Texas at Austin told Reuters Health by email. "What I continue to be surprised by is inaccurate public-health messaging for melanoma prevention in people with skin of color."

Reducing melanoma-associated disparities in people with skin of color, he said, "should focus on education and improving access to high quality healthcare, not UV protection."

For their systematic review, published in JAMA Dermatology, Dr. Adamson and colleagues searched the literature for studies analyzing UV exposure as a risk factor for cutaneous melanoma in people with skin of color. Because there is no standard definition, they defined skin of color as any race/ethnicity except non-Hispanic white, Fitzpatrick skin type (IV-VI), or tanning ability of rarely or never burns.

Thirteen articles analyzing more than 7,700 melanomas in skin of color were included.

Eleven studies found no association between UV exposure and melanoma, although one U.S. study showed a small positive relationship in Black males, and one showed a weak association in Hispanic males.

In studies outside the U.S., there was also limited evidence of any association between UV exposure and melanoma in skin of color.

All studies were of moderate to low quality (Oxford Centre ratings 2b to 4).

Dr. Adamson noted, "Photoprotection may be associated with benefits in other UV-associated disorders, such as photoaging, melasma, and postinflammatory hyperpigmentation."

Further, he added, "Our findings do not include people who may be at high risk, such as those with compromised immune systems."

"Whether UV exposure is associated with other types of skin cancer in skin of color is less well known," he said, "and will be the subject of future work."

Dr. Nkanyezi Ferguson of the University of Iowa Hospitals and Clinics in Iowa City, author of an accompanying editorial, told Reuters Health by email, "It is important to note when interpreting these results that the studies reviewed were overall low-to-moderate-quality evidence (because) measuring UV exposure is not an easy or reliable task and more objective methods to determine skin color and sunburn susceptibility are needed."

"This study underscores the need for further research to clarify what aspects of skin cancer and melanoma prevention are of highest impact in patients with skin of color," she said.

Like Dr. Adamson, she noted, "Sun protection is still important, as these measures have additional benefits in skin of color in reducing the effects of UV exposure on photoaging and preventing UV-related dyspigmentation."

SOURCE: https://bit.ly/3azKKFW JAMA Dermatology, online December 16, 2020.

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