Melanoma, Altitude, and UV-B Radiation

Aceituno-Madera, P.; Buendía-Eisman, A.; Olmo, F.J.; Jiménez-Moleón, J.J.; Serrano-Ortega, S.

doi:10.1016/S1578-2190(11)70785-5

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Abstract

Background and objectives

UV radiation is the main modifiable risk factor for the development of cutaneous melanoma. Many people in the Spanish province of Granada live at high altitudes and, therefore, receive high doses of UV-B radiation. The aims of this study were to assess the possible association between melanoma and altitude and to measure the daily erythemal dose at different altitudes.

Material and methods

An epidemiological study was carried out between 1982 and 2007 to assess the relationship between altitude, daily erythemal dose, and the prevalence of melanoma. We calculated the prevalence of melanoma in patients with a clinical and histological diagnosis of melanoma at Hospital Clínico Universitario San Cecilio in Granada, Spain. All individuals were required to be residents of the province of Granada in order to be included in the study. The prevalence of melanoma was calculated for altitude intervals of 100m. Daily erythemal dose was estimated using measures of UV-B radiation obtained with pyranometers at altitudes of 0, 680, 1200, and 3398 m above sea level during the Evaluation of the Effects of Elevation and Aerosols on UV Radiation (VELETA) 2002 field campaign.

Results

The highest prevalence of melanoma was found between 1400 and 1499m above sea level (the interval at which the highest settlements are found), with a rate of 2.36 cases per 1000 inhabitants (95% confidence interval, 0.64–6.03). Above 700m, the daily erythemal dose increased exponentially with increasing altitude.

Conclusions

We observed a tendency toward increased prevalence of melanoma at higher altitude, with higher prevalences observed beyond 700m above sea level.

Keywords:

Melanoma incidence

Altitude

UVB radiation

Resumen

Introducción

La radiación ultravioleta (UV) es el principal factor de riesgo ambiental modificable en el desarrollo del melanoma cutáneo. Muchas de las poblaciones de nuestra provincia están situadas a gran altitud, recibiendo elevadas dosis de radiación UVB. Nuestro objetivo es analizar una posible asociación entre melanoma y altitud y medir la dosis eritemática diaria a diferentes altitudes.

Material y métodos

Realizamos un estudio ecológico, en el que se trató de relacionar la prevalencia de melanoma, la altitud y la dosis eritemática diaria. El periodo de estudio comprendió los últimos 25 años (1982–2007). Calculamos la prevalencia de melanoma con aquellos pacientes diagnosticados clínica e histológicamente de melanoma, procedentes del Hospital Clínico Universitario “San Cecilio”. Los individuos del estudio debían tener su lugar de residencia en la provincia de Granada. Calculamos la prevalencia de melanoma a intervalos de 100m de altitud y estimamos la dosis eritemática diaria a partir de las medidas de radiación UVB realizadas con piranómetros situados a 0, 680, 1.200, 2.100 y 3.398m de altitud durante la campaña VELETA-2002.

Resultados

La prevalencia de melanoma más alta está situada en el intervalo comprendido entre los 1.400–1.499m a.s.l (intervalo con núcleos de población situados a mayor altitud) con 2,36 por 1.000 habitantes IC al 95% (0,64–6,03) por 1.000 habitantes. A partir de los 700m de altura la dosis eritemática diaria aumenta de forma exponencial a medida que ascendemos en altitud.

Conclusiones

Este estudio encuentra una tendencia al aumento en la prevalencia de melanoma al ascender en altitud, siendo más intenso a partir de los 700m a.s.l.

Palabras clave:

Incidencia melanoma

Altitud

Radiación UVB

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