The risk of ultraviolet exposure for melanoma in Fitzpatrick skin types I-IV: A 20-year systematic review with meta-analysis for sunburns.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 39230206 · doi:10.1111/jdv.20316
What was done
A systematic review and meta-analysis evaluated studies published between January 2002 and December 2021 assessing the association between various forms of ultraviolet (UV) exposure and melanoma risk in individuals with Fitzpatrick skin types I–IV. From 19,852 screened records, 26 studies spanning national and multinational cohorts (USA, Europe, Australia, Asia, and South America) met inclusion criteria.
What was found
Twenty of 26 studies (77%) identified a significant positive association between UV exposure and melanoma incidence. Sunburn was the primary risk factor evaluated; across 13 studies encompassing 3,417 melanoma cases, 11 showed significant positive odds ratios ranging from 1.23 (95% CI: 1.01–1.49) to 8.48 (95% CI: 4.35–16.54). Pooled meta-analysis of sunburn history demonstrated an unadjusted odds ratio (OR) of 1.66 (95% CI: 1.40–1.97) and an adjusted OR of 1.23 (95% CI: 1.04–1.46). Cumulative sun exposure (913 melanoma cases) was the second most common factor, with ORs ranging from 1.1 (95% CI: 1.0–1.2) to 5.2 (95% CI: 2.1–12.5). Significant associations were also found for UV index (6 of 9 studies), outdoor leisure activity (3 of 3 studies), and left-sided laterality (1 of 1 study).
Why it matters
This review updates two decades of epidemiological evidence, reaffirming that UV exposure—especially acute sunburns and cumulative exposure—persists as a primary modifiable risk factor for melanoma in fair-skinned populations.
Limits
The included literature consists of observational studies subject to recall and reporting bias for historical UV and sunburn exposure. Heterogeneity in how exposure was quantified (e.g., hours of sun vs calculated UV flux) limited pooled meta-analysis primarily to sunburns rather than cumulative exposure metrics. Outcomes were aggregated across Fitzpatrick types I through IV rather than stratified by individual phototype.