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Clinical Report

Modifiable Risk-factors for Keratinocyte Cancers in Australia: A Case-control Study

Lina Maria Serna-Higuita, Simone L. Harrison, Petra Buttner, Margaret Glasby, Beverly A. Raasch, Angelika Iftner, Claus Garbe, Peter Martus, Thomas Iftner
DOI: 10.2340/00015555-3107

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This article has been accepted for publication in Acta Dermato-Venereologica and is currently being edited and typeset. Readers should note that article shown below have been fully refereed, but have not been through the copy-editing and proof correction process. Only Abstract is possible to read. When this process is finalized the complete paper will be able to find.


Keratinocyte cancer (KC) is the most common malignancy in Caucasians. The incidence of KC has increased over the past 40 years. This case-control study investigated the environmental and host risk-factors respons­ible for development of KC in Australia’s high-risk population. Cases were immune-competent adults from Townsville, Australia (19.3°S) who had a new basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) histologically-confirmed during 2004 to 2009. Cases were age-matched (±5 years) to immunocompetent, community-based controls from Townsville with no prior history of KC. Binary logistic regression was performed to evaluate correlation between KC, sun exposure and other potential risk-factors. A total of 112 cases of SCC, 95 cases of BCC and 122 controls were analysed. Freckling during adolescence (SCC: odds ratio (OR) = 1.04, p < 0.01; BCC: OR = 1.05, p < 0.01), propensity to sunburn (SCC: OR = 2.75, p = 0.01, BCC: OR = 2.68 p = 0.01) and high cumulative sun-exposure (SCC: OR = 2.43, p = 0.04; BCC: OR = 2.36 p = 0.04) were independent risk-factors for both SCC and BCC. Solar lentigines (SCC: OR = 1.02, p = 0.01), and lower academic qualifications (OR = 2.35, p = 0.01) were also risk factors for SCC. No significant differences were found for gender [AQ1], history of internal cancers, smoking, alcohol consumption, diet or sun-protective practices. This study provides further evidence that a sun-sensitive phenotype and excessive sun-exposure during adulthood contribute to the risk of developing KC. Wearing a hat, long-sleeved shirts, and sunscreen did not significantly reduce the risk of KC in this study.

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