Skip to main content
NCBI home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1996 Jun;73(11):1440–1446. doi: 10.1038/bjc.1996.274

The multicentre south European study 'Helios'. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin.

R Zanetti 1, S Rosso 1, C Martinez 1, C Navarro 1, S Schraub 1, H Sancho-Garnier 1, S Franceschi 1, L Gafà 1, E Perea 1, M J Tormo 1, R Laurent 1, C Schrameck 1, M Cristofolini 1, R Tumino 1, J Wechsler 1
PMCID: PMC2074488  PMID: 8645595

Abstract

The aim of this study was to investigate constitutional and environmental determinants of non-melanocytic skin cancer among different populations from south Europe. Between 1989 and 1993 we interviewed incident cases and a random population sample of controls from five centres where a cancer registry was operating, whereas we selected a sample of hospital-based cases and controls from three other centres. Controls were stratified according to the age and sex distribution of cases. In all, 1549 cases of basal cell carcinoma (BCC), 228 of squamous cell carcinoma (SCC) and 1795 controls were interviewed. Both cancers affected primarily sun-exposed sites such as face, head and neck, but the prevalence of BCC on the trunk was higher than for SCC. Pigmentary traits such as hair and eye colour as well as tendency to sunburn were strong and independent indicators of risk for both BCC and SCC. In SCC, adjusted odds ratios (ORs) ranged from 1.6 for fair hair colour to 12.5 for red hair. Light-blonde hair entailed a risk of about 2 for BCC. Pale eye colour was associated with a risk of 1.8 for SCC and 1.4 for BCC. Subjects who always burn and never tan showed an adjusted OR of 2.7 for BCC and 2.0 for SCC. A history of sunburns and a young age at first sunburn were associated with an increased risk for BCC only (OR 1.7). Pigmentary traits and sun sensitivity of the skin confirmed their role as risk indicators. The effect of sunburns, as an indicator of both exposure and sun sensitivity of the skin, is less clear. Nevertheless, its association with BCC suggests, by analogy with melanoma, a relationship with intense sun exposure. Conversely, SCC would require prolonged exposure to sunlight.

Full text

PDF
1440

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen B. R., Van Epps D. E. Suppression of chemotatic activity of human neutrophils by streptolysin O. J Infect Dis. 1972 Apr;125(4):353–359. doi: 10.1093/infdis/125.4.353. [DOI] [PubMed] [Google Scholar]
  2. Coebergh J. W., Neumann H. A., Vrints L. W., van der Heijden L., Meijer W. J., Verhagen-Teulings M. T. Trends in the incidence of non-melanoma skin cancer in the SE Netherlands 1975-1988: a registry-based study. Br J Dermatol. 1991 Oct;125(4):353–359. doi: 10.1111/j.1365-2133.1991.tb14171.x. [DOI] [PubMed] [Google Scholar]
  3. Elwood J. M., Whitehead S. M., Davison J., Stewart M., Galt M. Malignant melanoma in England: risks associated with naevi, freckles, social class, hair colour, and sunburn. Int J Epidemiol. 1990 Dec;19(4):801–810. doi: 10.1093/ije/19.4.801. [DOI] [PubMed] [Google Scholar]
  4. Engel A., Johnson M. L., Haynes S. G. Health effects of sunlight exposure in the United States. Results from the first National Health and Nutrition Examination Survey, 1971-1974. Arch Dermatol. 1988 Jan;124(1):72–79. [PubMed] [Google Scholar]
  5. Fears T. R., Scotto J. Changes in skin cancer morbidity between 1971-72 and 1977-78. J Natl Cancer Inst. 1982 Aug;69(2):365–370. [PubMed] [Google Scholar]
  6. Gallagher R. P., Hill G. B., Bajdik C. D., Coldman A. J., Fincham S., McLean D. I., Threlfall W. J. Sunlight exposure, pigmentation factors, and risk of nonmelanocytic skin cancer. II. Squamous cell carcinoma. Arch Dermatol. 1995 Feb;131(2):164–169. [PubMed] [Google Scholar]
  7. Gallagher R. P., Hill G. B., Bajdik C. D., Fincham S., Coldman A. J., McLean D. I., Threlfall W. J. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma. Arch Dermatol. 1995 Feb;131(2):157–163. [PubMed] [Google Scholar]
  8. Gallagher R. P., Ma B., McLean D. I., Yang C. P., Ho V., Carruthers J. A., Warshawski L. M. Trends in basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin from 1973 through 1987. J Am Acad Dermatol. 1990 Sep;23(3 Pt 1):413–421. doi: 10.1016/0190-9622(90)70234-9. [DOI] [PubMed] [Google Scholar]
  9. Green A., Battistutta D. Incidence and determinants of skin cancer in a high-risk Australian population. Int J Cancer. 1990 Sep 15;46(3):356–361. doi: 10.1002/ijc.2910460303. [DOI] [PubMed] [Google Scholar]
  10. Green A., Beardmore G., Hart V., Leslie D., Marks R., Staines D. Skin cancer in a Queensland population. J Am Acad Dermatol. 1988 Dec;19(6):1045–1052. doi: 10.1016/s0190-9622(88)70270-4. [DOI] [PubMed] [Google Scholar]
  11. Green A., Martin N. G. Measurement and perception of skin colour in a skin cancer survey. Br J Dermatol. 1990 Jul;123(1):77–84. doi: 10.1111/j.1365-2133.1990.tb01826.x. [DOI] [PubMed] [Google Scholar]
  12. Green A., Siskind V., Bain C., Alexander J. Sunburn and malignant melanoma. Br J Cancer. 1985 Mar;51(3):393–397. doi: 10.1038/bjc.1985.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hogan D. J., To T., Gran L., Wong D., Lane P. R. Risk factors for basal cell carcinoma. Int J Dermatol. 1989 Nov;28(9):591–594. doi: 10.1111/j.1365-4362.1989.tb02534.x. [DOI] [PubMed] [Google Scholar]
  14. Hunter D. J., Colditz G. A., Stampfer M. J., Rosner B., Willett W. C., Speizer F. E. Risk factors for basal cell carcinoma in a prospective cohort of women. Ann Epidemiol. 1990 Oct;1(1):13–23. doi: 10.1016/1047-2797(90)90015-k. [DOI] [PubMed] [Google Scholar]
  15. Kaldor J., Shugg D., Young B., Dwyer T., Wang Y. G. Non-melanoma skin cancer: ten years of cancer-registry-based surveillance. Int J Cancer. 1993 Apr 1;53(6):886–891. doi: 10.1002/ijc.2910530603. [DOI] [PubMed] [Google Scholar]
  16. Kricker A., Armstrong B. K., English D. R., Heenan P. J. A dose-response curve for sun exposure and basal cell carcinoma. Int J Cancer. 1995 Feb 8;60(4):482–488. doi: 10.1002/ijc.2910600410. [DOI] [PubMed] [Google Scholar]
  17. Kricker A., Armstrong B. K., English D. R., Heenan P. J. Does intermittent sun exposure cause basal cell carcinoma? a case-control study in Western Australia. Int J Cancer. 1995 Feb 8;60(4):489–494. doi: 10.1002/ijc.2910600411. [DOI] [PubMed] [Google Scholar]
  18. Kricker A., Armstrong B. K., English D. R., Heenan P. J. Pigmentary and cutaneous risk factors for non-melanocytic skin cancer--a case-control study. Int J Cancer. 1991 Jul 9;48(5):650–662. doi: 10.1002/ijc.2910480504. [DOI] [PubMed] [Google Scholar]
  19. Kricker A., Armstrong B. K., English D. R. Sun exposure and non-melanocytic skin cancer. Cancer Causes Control. 1994 Jul;5(4):367–392. doi: 10.1007/BF01804988. [DOI] [PubMed] [Google Scholar]
  20. Kricker A., English D. R., Randell P. L., Heenan P. J., Clay C. D., Delaney T. A., Armstrong B. K. Skin cancer in Geraldton, Western Australia: a survey of incidence and prevalence. Med J Aust. 1990 Apr 16;152(8):399–407. doi: 10.5694/j.1326-5377.1990.tb125266.x. [DOI] [PubMed] [Google Scholar]
  21. Kubasiewicz M., Starzyński Z., Szymczak W. Case-referent study on skin cancer and its relation to occupational exposure to polycyclic aromatic hydrocarbons. II. Study results. Pol J Occup Med Environ Health. 1991;4(2):141–147. [PubMed] [Google Scholar]
  22. Levi F., La Vecchia C., Te V. C., Mezzanotte G. Descriptive epidemiology of skin cancer in the Swiss Canton of Vaud. Int J Cancer. 1988 Dec 15;42(6):811–816. doi: 10.1002/ijc.2910420601. [DOI] [PubMed] [Google Scholar]
  23. Marks R., Jolley D., Dorevitch A. P., Selwood T. S. The incidence of non-melanocytic skin cancers in an Australian population: results of a five-year prospective study. Med J Aust. 1989 May 1;150(9):475–478. doi: 10.5694/j.1326-5377.1989.tb136588.x. [DOI] [PubMed] [Google Scholar]
  24. Marks R., Staples M., Giles G. G. Trends in non-melanocytic skin cancer treated in Australia: the second national survey. Int J Cancer. 1993 Feb 20;53(4):585–590. doi: 10.1002/ijc.2910530410. [DOI] [PubMed] [Google Scholar]
  25. Osterlind A., Tucker M. A., Stone B. J., Jensen O. M. The Danish case-control study of cutaneous malignant melanoma. II. Importance of UV-light exposure. Int J Cancer. 1988 Sep 15;42(3):319–324. doi: 10.1002/ijc.2910420303. [DOI] [PubMed] [Google Scholar]
  26. Ron E., Modan B., Preston D., Alfandary E., Stovall M., Boice J. D., Jr Radiation-induced skin carcinomas of the head and neck. Radiat Res. 1991 Mar;125(3):318–325. [PubMed] [Google Scholar]
  27. Rosso S., Zanetti R., Martinez C., Tormo M. J., Schraub S., Sancho-Garnier H., Franceschi S., Gafà L., Perea E., Navarro C. 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 Jun;73(11):1447–1454. doi: 10.1038/bjc.1996.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Stenbeck K. D., Balanda K. P., Williams M. J., Ring I. T., MacLennan R., Chick J. E., Morton A. P. Patterns of treated non-melanoma skin cancer in Queensland--the region with the highest incidence rates in the world. Med J Aust. 1990 Nov 5;153(9):511–515. doi: 10.5694/j.1326-5377.1990.tb126188.x. [DOI] [PubMed] [Google Scholar]
  29. Vitasa B. C., Taylor H. R., Strickland P. T., Rosenthal F. S., West S., Abbey H., Ng S. K., Munoz B., Emmett E. A. Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen. Cancer. 1990 Jun 15;65(12):2811–2817. doi: 10.1002/1097-0142(19900615)65:12<2811::aid-cncr2820651234>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  30. Weinstock M. A., Colditz G. A., Willett W. C., Stampfer M. J., Bronstein B. R., Mihm M. C., Jr, Speizer F. E. Melanoma and the sun: the effect of swimsuits and a "healthy" tan on the risk of nonfamilial malignant melanoma in women. Am J Epidemiol. 1991 Sep 1;134(5):462–470. doi: 10.1093/oxfordjournals.aje.a116117. [DOI] [PubMed] [Google Scholar]
  31. Zanetti R., Franceschi S., Rosso S., Colonna S., Bidoli E. Cutaneous melanoma and sunburns in childhood in a southern European population. Eur J Cancer. 1992;28A(6-7):1172–1176. doi: 10.1016/0959-8049(92)90480-p. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES