• All Cancers
• UK Cancer Mortality
• England and Wales Cancer Survival
• Childhood cancer
• 26 types of cancer
  • Bladder cancer
  • Bone cancer
  • Bowel cancer
  • Brain and CNS cancer
  • Breast Cancer
  • Cervical cancer
  • Hodgkin's lymphoma
  • Kidney cancer
  • Laryngeal cancer
  • Leukaemia
  • Liver cancer
  • Lung cancer and Smoking
  • Multiple myeloma
  • Non-Hodgkin lymphoma (NHL)
  • Oesophageal cancer
  • Oral cancer
  • Ovarian cancer
  • Pancreatic cancer
  • Prostate cancer
  • Skin cancer
    • Incidence
    • Mortality
    • Survival
    • Risk Factors
    • Molecular Biology and Genetics
    • Symptoms and Treatment
  • Stomach cancer
  • Testicular cancer
  • Thyroid cancer
  • Uterine cancer
  • Vaginal Cancer
  • Vulva cancer
• Geographic variations
• Causes of cancer
• About CancerStats Reports
• FAQs

Skin Cancer risk factors

The main preventable risk factor for skin cancer is excess exposure to ultraviolet radiation(UVR)1, the principal source of which is the sun (Figure 4.1).

This section contains information on the risk factors of skin cancer and includes ultraviolet radiation, types of sun exposure, sunbeds, skin type and hair and eye colour, sunscreen, Vitamin D and other risk factors.

Skin cancer risk - Ultraviolet radiation

Back to top ^

It is estimated that at least two-thirds of melanomas and 90% of non-melanoma skin cancers are caused by sun exposure.53,54 Table 4.1 gives incidence rates by ethnic group in the USA.3

Download this table (13.5KB)

Back to top ^

Skin cancer risk - Types of sun exposure

Risk of melanoma is most strongly linked to intermittent exposure to high-intensity sunlight, often resulting in sunburn rather than to chronic exposure, typical of that received by people with outdoor occupations.4 A history of sunburn doubles the risk of melanoma.55,56

Sunburn, especially in childhood, also increases risk of basal cell carcinoma.57-62 Risk of squamous cell carcinoma is strongly related to long-term occupational exposure to sunlight.57-59,63

Back to top ^

Skin cancer risk - sunbeds

Sunbeds and sunlamps are a source of artificial UVR. Before the 1980s these appliances primarily emitted UVB and sometimes UVC. 8Since then, commercial salons using mainly UVA lamps (these lamps may also emit some UVB) have become popular.8,9 This variable spectral output over time and also between appliances, complicates the measurement of risk.10

In 1999 a quarter of men and a third of women in Britain reported using a sunbed or tanning machine in the previous six months and there was even higher use amongst young people (Figure 4.2).11 Any impact of sunbed use is therefore likely to be greater in the future.

Download this chart(17.0KB)

Back to top ^

The most recent meta-analysis concluded that the use of sunbeds increases risk of melanoma, especially when used before the age of 35. 64 Use of a sunbed at any age doubled the risk of squamous cell carcinoma.64

One UK study using modelling techniques estimated that sunbed use caused one hundred deaths a year from melanoma in the UK.14

Back to top ^

The possibility that younger people and those with high risk skin types are at greatest risk is widely recognised and in 2003 the International Commission on Non-Ionizing Radiation Protection (ICNIRP)10 and the World Health Organisation (WHO)15 recommended that certain categories of people should not use sunbeds as shown in Table 4.2.

The ICNIRP also concluded that anyone using suntanning appliances is likely to raise their risk of skin cancer, eye damage, photodermatosis, photosensitivity and premature skin ageing.10

Download this table (13.5KB)

Back to top ^

Skin cancer risk - skin type, hair and eye colour

People with light eyes, skin or hair, or who sunburn easily or do not tan, have an increased risk of skin cancer.57,59,62,63,65 In addition, people with a large number of moles, or just one or more unusually shaped or large moles, have an increased risk of melanoma.66 Risk increases with the number of moles. People with very high numbers (100+) of common moles on their bodies have nearly seven times the risk compared to people with very few (0-15 moles).16

People with dysplastic moles and a family history of melanoma (dysplastic mole syndrome) have a 500-fold increased risk of developing melanoma.17Development of moles is caused by exposure to sunlight as well as being genetically determined and most are acquired during childhood. 18, 19

Chronic sun exposure is the most important environmental factor determining development of moles rather than number of sunburn episodes.19 A UK study of moles in twins concluded that the emergence of moles in adolescents is under strong genetic control.20 Freckling is associated with an increased risk of melanoma, independent of number of moles.19

Back to top ^

In terms of hair colour, people with red and light hair have the highest risk for melanoma.7 The risk for people with red hair is as much as four times higher than for people with dark brown or black hair while people with blond hair had twice the risk of dark-haired individuals.7,21

There is an approximately three-fold risk increase for melanoma associated with very pale skin compared to people with the darkest white skin. There are similar differences in risk for those with skin that does not tan compared with those whose skin develops a strong tan.2

Download this table (13.5KB)

Back to top ^

Malignant melanoma risk - sunscreen

There is divergent evidence for a protective role of sunscreen in melanoma aetiology. Data from in vitro studies have shown significantly higher DNA damage in skin not treated with sunscreen versus treated skin22, and a randomised trial carried out in the 1990s found children randomised to SPF30 sunscreen application developed fewer moles over a three-year period.23

The most recent review considered 18 case-control studies and reported no association overall between sunscreen use and risk of melanoma but it is possible that people use sunscreen in order to spend longer in the sun or to avoid using protective clothing, which would cancel out any protective effect.24,67,68

Skin cancer risk - Vitamin D

It has been known for many decades that the only thoroughly established beneficial effect of solar ultraviolet radiation on the skin is the synthesis of vitamin D and its role in maintaining bone health. But evidence is emerging that suggests that sunlight exposure, and the resulting cutaneous synthesis of vitamin D, might have a beneficial influence for certain major cancers, most notably colorectal cancer.25-29.

However, the picture is by no means clear and more research is needed before exposure to solar UVR could be recommended as a means of reducing the incidence or mortality of cancer.

Back to top ^

Skin cancer - other risk factors

People with a family history of melanoma have roughly double the risk of developing the disease compared to people without a family history.65 Rare families exist in which 3 or more cases occur. In these families a significant proportion have a hereditary susceptibility gene such as CDKN2A and as gene carriers are at considerable lifetime risk of melanoma (see also Molecular Biology section). People with a family history of squamous cell carcinoma or basal cell carcinoma have an increased risk of non-melanoma skin cancer.60,62,69

US registry studies report an increased risk of melanoma in women previously diagnosed with breast cancer and in people previously diagnosed with non-Hodgkin lymphoma. In both cases, the association was bi-directional, supporting a shared genetic or environmental factor but further studies are needed to confirm these findings.32,33.

People with a previous non-melanoma skin cancer have a much higher risk of developing a second one.70-72

People who have had renal transplants have been shown to have a 33-fold increased risk of non-melanoma skin cancer and a higher risk of melanoma also.73

Back to top ^

References for skin cancer risk factors

1. Clavel, J., et al., .Incidence of childhood leukaemia and non-Hodgkin's lymphoma in France: National Registry of Childhood Leukaemia and Lymphoma, 1990-1999. Eur J Cancer Prev, 2004. 13(2): p. 97-103
2. Armstrong, B.K. and Kricker, A., The epidemiology of UV induced skin cancer. J Photochem Photobiol B, 2001. 63(1-3): p. 8-18.
3. L. Ries, et al.SEER Cancer Statistics Review, 1998-2002, 2004, National Cancer Institute: Bethesda.
4. Gandini, S., et al., Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer, 2005. 41(1): p. 45-60.
5. Holman, C.D. and Armstrong, B.K.Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: an analysis separating histogenetic types. J Natl Cancer Inst, 1984. 73(1): p. 75-82
6. Whiteman, D.C., Whiteman, C.A., and Green, C.A., Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control, 2001. 12(1): p. 69-82.
7. Cho, E., et al., Risk factors and individual probabilities of melanoma for whites. J Clin Oncol, 2005. 23(12): p. 2669-75.
8. Gallagher, R.P., Spinelli, J.J., and Lee, T.K., Tanning beds, sunlamps, and risk of cutaneous malignant melanoma. Cancer Epidemiol Biomarkers Prev, 2005. 14(3): p. 562-6.
9. IARC Monographs on the evaluation of carcinogenic risks to humans, Solar and ultraviolet radiation. 1997. Vol 55:
10. International Commission on Non-Ionizing Radiation Protection,Health Issues of Ultraviolet Tanning Appliances Used for Cosmetic Purposes. ICNIRP Statement, 2003.
11. ONS Omnibus Survey, Knowledge of the Solar UV Index. Sept 1999.
12. Bataille, V., et al., Exposure to the sun and sunbeds and the risk of cutaneous melanoma in the UK: a case-control study. Eur J Cancer, 2004. 40(3): p. 429-35.
13. Bataille, V., et al., A multicentre epidemiological study on sunbed use and cutaneous melanoma in Europe. Eur J Cancer, 2005. 41(14): p. 2141-9.
14. Diffey, B.L., A quantitative estimate of melanoma mortality from ultraviolet A sunbed use in the UK. Br J Dermatol, 2003. 149(3): p. 578-81.
15. WHO, WHO guidance brochure: artificial tanning sunbeds - risks and guidance. 2003.
16. Gandini, S., et al., Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer, 2005. 41(1): p. 28-44.
17. Greene, M.H., et al., High risk of malignant melanoma in melanoma-prone families with dysplastic nevi. Ann Intern Med, 1985. 102(4): p. 458-65.
18. Dulon, M., et al., Sun exposure and number of nevi in 5- to 6-year-old European children. J Clin Epidemiol, 2002. 55(11): p. 1075-81.
19. Bauer, J. and Garbe, C., Acquired melanocytic nevi as risk factor for melanoma development. A comprehensive review of epidemiological data. Pigment Cell Res, 2003. 16(3): p. 297-306.
20. Wachsmuth, R.C., et al., Heritability and gene-environment interactions for melanocytic nevus density examined in a U.K. adolescent twin study. J Invest Dermatol, 2001. 117(2): p. 348-52.
21. Veierod, M.B., et al., A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women. J Natl Cancer Inst, 2003. 95(20): p. 1530-8.
22. IARC IARC Handbooks of Cancer Prevention: Sunscreens. Vol. 5. 2001, Lyon: IARC Press.
23. Gallagher, R.P., et al., Broad-spectrum sunscreen use and the development of new nevi in white children: A randomized controlled trial. Jama, 2000. 283(22): p. 2955-60.
24. Dennis, L.K., Beane Freeman, L.E., and VanBeek, M.J., Sunscreen use and the risk for melanoma: a quantitative review. Ann Intern Med, 2003. 139(12): p. 966-78.
25. Wu, K., et al.,A nested case control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer J Natl Cancer Inst, 2007. 99(14): p. 1120-9.
26. Wactawski-Wende, J., et al., Calcium plus vitamin D supplementation and the risk of colorectal cancer N Engl J Med, 2006. 354(7): p. 684-96.
27. Feskanich, D., et al.,Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev, 2004. 13(9): p. 1502-8.
28. Freedman, D.M., et al., Prospective study of serum vitamin D and cancer mortality in the United States. J Natl Cancer Inst, 2007. 99(21): p. 1594-602.
29. Giovannucci, E., et al., Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst, 2006. 98(7): p. 451-9.
30. Giovannucci, E., The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes Control, 2005. 16(2): p. 83-95.
31. Moon, S.J., Fryer, A.A., and Strange, R.C., Ultraviolet radiation: effects on risks of prostate cancer and other internal cancers. Mutat Res, 2005. 571(1-2): p. 207-19.
32. Goggins, W., Gao, W., and Tsao, H., Association between female breast cancer and cutaneous melanoma. Int J Cancer, 2004. 111(5): p. 792-4.
33. Goggins, W.B., Finkelstein, D.M., and Tsao, H.,Evidence for an association between cutaneous melanoma and non-Hodgkin lymphoma. Cancer, 2001. 91(4): p. 874-80.
34. Pion, I.A., et al., Occupation and the risk of malignant melanoma. Cancer, 1995. 75(2 Suppl): p. 637-44.
35. Graham, S., et al., An inquiry into the epidemiology of melanoma. Am J Epidemiol, 1985. 122(4): p. 606-19.
36. Goodman, K.J., et al., Proportional melanoma incidence and occupation among white males in Los Angeles County (California, United States). Cancer Causes Control, 1995. 6(5): p. 451-9.
37. Cooke, K.R., Skegg, D.C., and Fraser, J., Socio-economic status, indoor and outdoor work, and malignant melanoma. Int J Cancer, 1984. 34(1): p. 57-62.
38. Fincham, S.M., Hanson, J., and Berkel, J., Patterns and risks of cancer in farmers in Alberta. Cancer, 1992. 69(5): p. 1276-85.
39. Hanrahan, L.P., et al., Wisconsin farmer cancer mortality, 1981 to 1990: selected malignancies. J Rural Health, 1996. 12(4 Suppl): p. 273-7.
40. Bouchardy, C., et al., Cancer risk by occupation and socioeconomic group among men--a study by the Association of Swiss Cancer Registries. Scand J Work Environ Health, 2002. 28 Suppl 1: p. 1-88.
41. Linet, M.S., et al., Occupational risks for cutaneous melanoma among men in Sweden. J Occup Environ Med, 1995. 37(9): p. 1127-35.
42. Cristofolini, M., et al., Risk factors for cutaneous malignant melanoma in a northern Italian population. Int J Cancer, 1987. 39(2): p. 150-4.
43. Loomis, D., et al., Cancer mortality among electric utility workers exposed to polychlorinated biphenyls. Occup Environ Med, 1997. 54(10): p. 720-8.
44. Robinson, C.F., Petersen, M., and Palu, S., Mortality patterns among electrical workers employed in the U.S. construction industry, 1982-1987. Am J Ind Med, 1999. 36(6): p. 630-7.
45. Nelemans, P.J., et al., Melanoma and occupation: results of a case-control study in The Netherlands. Br J Ind Med, 1993. 50(7): p. 642-6.
46. Rix, B.A. and Lynge, E., Cancer incidence in Danish health care workers. Scand J Soc Med, 1996. 24(2): p. 114-20.
47. Perez-Gomez, B., et al., Cutaneous melanoma: hints from occupational risks by anatomic site in Swedish men. Occup Environ Med, 2004. 61(2): p. 117-26.
48. Perez-Gomez, B., et al., Cutaneous melanoma in Swedish women: Occupational risks by anatomic site. Am J Ind Med, 2005. 48(4): p. 270-81.
49. Vagero, D., Swerdlow, A.J., and Beral, V., Occupation and malignant melanoma: a study based on cancer registration data in England and Wales and in Sweden. Br J Ind Med, 1990. 47(5): p. 317-24
50. Sont, W.N., et al., First analysis of cancer incidence and occupational radiation exposure based on the National Dose Registry of Canada. Am J Epidemiol, 2001. 153(4): p. 309-18.
51. Puntoni, R., et al., Occupational exposure to carbon black and risk of cancer. Cancer Causes Control, 2004. 15(5): p. 511-6.
52. Krone, B., et al., Impact of vaccinations and infectious diseases on the risk of melanoma--evaluation of an EORTC case-control study. European Journal of Cancer, 2003. 39(16): p. 2372-2378.
53. Armstrong, B.K. and Kricker, A., How much melanoma is caused by sun exposure? Melanoma Res, 1993. 3(6): p. 395-401.
54. Fry, A. and Verne, J., Preventing skin cancer BMJ, 2003. 326(7381): p. 114-115.
55. Gandini, S., et al., Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure Eur J Cancer, 2005. 41(1): p. 45-60.
56. Elwood, J.M. and Jopson, J., Melanoma and sun exposure: an overview of published studies Int J Cancer, 1997. 73(2): p. 198-203.
57. Zanetti, R., et al., Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-centre case-case-control study Br J Cancer, 2006. 94(5): p. 743-51.
58. Kennedy, C., et al., The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer J Invest Dermatol, 2003. 120(6): p. 1087-93.
59. Rosso, S., et al., 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. 73(11): p. 1447-54.
60. Corona, R., et al., Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life Arch Dermatol, 2001. 137(9): p. 1162-8.
61. Gallagher, R.P., et al., Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma Arch Dermatol, 1995. 131(2): p. 157-63.
62. Pelucchi, C., et al., Risk factors for histological types and anatomic sites of cutaneous basal-cell carcinoma: an italian case-control study J Invest Dermatol, 2007. 127(4): p. 935-44.
63. Gallagher, R.P, et al., Sunlight exposure, pigmentation factors, and risk of nonmelanocytic skin cancer. II. Squamous cell carcinoma Arch Dermatol, 1995. 131(2): p. 164-9.
64. The International Agency for Research on Cancer Working Group on Artificial Ultraviolet (UV) light and skin cancer, The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review Int J Cancer, 2007. 120(5): p. 1116-22.
65. Gandini, S., et al., Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors Eur J Cancer, 2005. 41(14): p. 2040-59.
66. Gandini, S., et al., Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi Eur J Cancer, 2005. 41(1): p. 28-44.
67. IARC,Sunscreens. IARC Handbooks of Cancer Prevention. Volume 5, 2001. Lyon: IARCPress
68. Weinstock, M.A.Do sunscreens increase or decrease melanoma risk: an epidemiologic evaluation J Investig Dermatol Symp Proc, 1999. 4(1): p. 97-100.
69. Hemminki, K., et al.,Time trends and familial risks in squamous cell carcinoma of the skin Arch Dermatol, 2003. 139(7): p. 885-9.
70. Hemminki, K., et al.,Skin cancer and non-Hodgkin's lymphoma as second malignancies. markers of impaired immune function? Eur J Cancer, 2003. 39(2): p. 223-9.
71. Levi, F., et al.,High incidence of second basal cell skin cancers Int J Cancer, 2006. 119(6): p. 1505-7.
72. Marcil, I. and Stern, R.S.,Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis Arch Dermatol, 2000. 136(12): p. 1524-30.
73. Moloney, F.J., et al.,A population-based study of skin cancer incidence and prevalence in renal transplant recipients Br J Dermatol, 2006. 154(3): p. 498-504.

Back to top ^

Select the cancer you are interested in