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Review ArticleProceedings of the Joint International Symposium “Vitamin D in Prevention and Therapy” and “Biologic Effects of Light”, June 21-23, 2017 (Homburg/Saar, Germany)R

Solarium Use and Risk for Malignant Melanoma: Meta-analysis and Evidence-based Medicine Systematic Review

BARBARA BURGARD, JAKOB SCHÖPE, ISABEL HOLZSCHUH, CLAUDIA SCHIEKOFER, SANDRA REICHRATH, WAGENPFEIL STEFAN, STEFAN PILZ, JOSE ORDONEZ-MENA, WINFRIED MÄRZ, THOMAS VOGT and JÖRG REICHRATH
Anticancer Research February 2018, 38 (2) 1187-1199;
BARBARA BURGARD
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
2Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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JAKOB SCHÖPE
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
3Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany
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ISABEL HOLZSCHUH
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
2Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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CLAUDIA SCHIEKOFER
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
2Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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SANDRA REICHRATH
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
2Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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WAGENPFEIL STEFAN
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
3Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany
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STEFAN PILZ
4Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
5Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
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JOSE ORDONEZ-MENA
6Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
7Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
8Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K.
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WINFRIED MÄRZ
9Medical Clinic V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, Ruperto-Carola University of Heidelberg, Heidelberg, Germany
10Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
11Synlab Medical Center of Human Genetics Mannheim, Mannheim, Germany
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THOMAS VOGT
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
2Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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JÖRG REICHRATH
1Center for Clinical and Experimental Photodermatology, Saarland University, Campus Homburg, Homburg, Germany
2Department of Dermatology, The Saarland University Hospital, Homburg, Germany
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  • For correspondence: Joerg.reichrath@uks.eu
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Abstract

Background: There is an ongoing debate whether solarium use (indoor tanning/artificial UV) may increase the risk for primary cutaneous malignant melanoma. Aim: A systematic literature search was conducted using MEDLINE and ISI Web of Science. Included studies were critically assessed regarding their risk of bias, and methodological shortcomings. Levels of evidence and grades of recommendation were determined according to guidelines of the Oxford Centre for Evidence-Based Medicine. Summary risk estimates and 95% confidence intervals for four different outcomes (ever exposure, exposure at younger age, high/low exposure vs. non-exposure) were derived from random-effects meta-analyses to account for possible heterogeneity across studies. Results: Two cohort and twenty-nine case–control studies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95% confidence interval (CI)=1.04-1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95%CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95%CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95%CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a–) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding. Conclusion: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.

  • Malignant melanoma
  • solarium
  • UV
  • review

Footnotes

  • ↵* These Authors contributed equally to this study.

  • Author's Disclosures

    BB, JS, IH, CS, SR, SW, SP, JOM, WM have nothing to disclose. Saarland University (TV, JR) received funding from Jörg Wolff Foundation and Immundiagnostik AG. JR received speakers honoraria from Wörwag and Dermapharm.

  • Received October 31, 2017.
  • Revision received December 13, 2017.
  • Accepted December 29, 2017.
  • Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved
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February 2018
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Solarium Use and Risk for Malignant Melanoma: Meta-analysis and Evidence-based Medicine Systematic Review
BARBARA BURGARD, JAKOB SCHÖPE, ISABEL HOLZSCHUH, CLAUDIA SCHIEKOFER, SANDRA REICHRATH, WAGENPFEIL STEFAN, STEFAN PILZ, JOSE ORDONEZ-MENA, WINFRIED MÄRZ, THOMAS VOGT, JÖRG REICHRATH
Anticancer Research Feb 2018, 38 (2) 1187-1199;

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Solarium Use and Risk for Malignant Melanoma: Meta-analysis and Evidence-based Medicine Systematic Review
BARBARA BURGARD, JAKOB SCHÖPE, ISABEL HOLZSCHUH, CLAUDIA SCHIEKOFER, SANDRA REICHRATH, WAGENPFEIL STEFAN, STEFAN PILZ, JOSE ORDONEZ-MENA, WINFRIED MÄRZ, THOMAS VOGT, JÖRG REICHRATH
Anticancer Research Feb 2018, 38 (2) 1187-1199;
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Keywords

  • malignant melanoma
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  • review
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