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Review
December 16, 2020

UV Exposure and the Risk of Cutaneous Melanoma in Skin of Color: A Systematic Review

Author Affiliations
  • 1Division of Dermatology, Department of Internal Medicine, Dell Medical School, The University of Texas at Austin
  • 2LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin
  • 3Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
  • 4Life Science Library, University of Texas Libraries, The University of Texas at Austin
  • 5Department of Internal Medicine, Dell Medical School, The University of Texas at Austin
  • 6Associate Editor and Web Editor, JAMA Dermatology
JAMA Dermatol. Published online December 16, 2020. doi:10.1001/jamadermatol.2020.4616
Key Points

Question  What is the association between UV exposure and the risk of cutaneous melanoma in skin of color?

Findings  Thirteen studies with more than 7700 melanomas in people with skin of color were analyzed; 11 studies showed no association between melanoma and UV exposure, and 2 studies showed small, statistically significant positive associations only among Black and Hispanic males. The studies included were of moderate to low quality.

Meaning  The association between UV exposure and melanoma is weak in skin of color; there is limited evidence supporting UV protection for melanoma prevention in skin of color.

Abstract

Importance  While current evidence supports UV exposure as an important risk factor for cutaneous melanoma in fair-skinned populations, the evidence for this association in skin of color is less certain.

Objective  To critically assess and synthesize the published data regarding the association between UV exposure and the risk of cutaneous melanoma in skin of color.

Evidence Review  A search was conducted including PubMed, Cochrane, and Web of Science databases from database origin to June 3, 2020. Only peer-reviewed original studies were screened in full text. Eligible studies analyzed UV exposure as a risk factor for cutaneous melanoma in people with skin of color, which was defined broadly as any race/ethnicity other than non-Hispanic White, Fitzpatrick skin types IV through VI, or tanning ability of rarely or never burns. Measures of UV exposure included UV index, irradiance, latitude, history of phototherapy, and history of sunburn. Evidence quality was assessed using criteria from the Oxford Centre for Evidence-Based Medicine.

Findings  After duplicate removal, 11 059 database records were screened, 548 full-text articles were assessed, and 13 met inclusion criteria. Study types included 7 ecological studies, 5 cohort studies, and 1 case-control study. All studies used race and/or ethnicity to categorize the participants, and more than 7700 melanomas in skin of color were included. Of the 13 studies that met inclusion criteria, 11 found no association between UV exposure and melanoma in skin of color, 1 study showed a small positive relationship in Black males, and 1 showed a weak association in Hispanic males. All studies were of moderate to low quality (Oxford Centre ratings 2b to 4).

Conclusions and Relevance  In this systematic review, the evidence suggests that UV exposure may not be an important risk factor for melanoma development in people with skin of color. Current recommendations promoting UV protection for melanoma prevention in skin of color are not supported by most current studies. However, evidence is of moderate to low quality, and further research is required to fully elucidate this association.

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