Re: Sun Exposure and


Berwick et al. ( 1) observed that increased sun exposure is associated with increased survival from melanoma, based on 528 case subjects. The esti m ated association is certainly strong (patients with solar elastosis, multivariable haz-ard ratio = 0.4, 95 % confi dence interval [CI] = 0.2 to 0.8), and it creates a serious dilemma because increased sun exposure is also associated with increased risk for melanoma incidence. We recently showed, in patients with invasive cutaneous melanoma from clin-ics in Philadelphia and San Francisco, that individual risk was associated with the individual’s history of exposure to levels of midrange UV radiation (UVB fl ux). A 10 % increase in average annual UVB fl ux was associated with an in-creased odds ratio (OR) for melanoma (for males, OR = 19%, 95 % CI = 5 % t

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