Dianne E. Godar, Madhan Subramanian, and Stephen J. Merrill

Accepted 23 November 2016

ABSTRACT

Because the incidence of cutaneous malignant melanoma (CMM) was reported to increase withincreasing terrestrial UVR (290–400 nm) doses in the US back in 1975 and a recent publicationshowed no association exists with UVR exposure at all, we set out to fully elucidate the role of UVRin CMM. To achieve this goal, we analyzed the CMM incidences over latitude and estimated theaverage personal UVR dose in the US and numerous countries (> 50) on 5 continents around theworld. Using data from the International Agency for Research on Cancer in 2005, we performedworldwide analysis of CMM over UVR dose by sex, age group (0–14, 15–29, 30–49, 50–69, 70–85C)and Fitzpatrick skin types I-VI. Surprisingly, increasing UVR doses, which represent erythemally-weighted doses comprised primarily of UVB (290–315 nm) radiation, did not significantly correlatewith increasing CMM incidence for people with any skin type anywhere in the world. Paradoxically,we found significant correlations between increasing CMM and decreasing UVB dose in Europeanswith skin types I-IV. Both Europeans and Americans in some age groups have significant increasingCMM incidences with decreasing UVB dose, which shows UVB is not the main driver in CMM andsuggests a possible role for lower cutaneous vitamin D3 levels and UVA (315–400 nm) radiation.CMM may be initiated or promoted by UVA radiation because people are exposed to it indoorsthrough windows and outdoors through some sunscreen formulations. Thus, our findings mayexplain why some broad-spectrum sunscreen formulations do not protect against getting CMM.

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