Armstrong B K, Kricker A, English D R
NSW Cancer Council, Sydney, New South Wales, Australia.
Australas J Dermatol. 1997 Jun;38 Suppl 1:S1-6. doi: 10.1111/j.1440-0960.1997.tb01000.x.
By 1927 for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and by 1955 for melanoma, the broad grounds for relating sun exposure to skin cancer had been established: that these are more frequent in residents of areas of high ambient solar irradiance, are more frequent in sun-sensitive people, occur mainly on sun-exposed body sites, are more frequent in people with high sun exposure, and are more frequent in people with benign sun-related skin conditions. The past 40 years have added both quantity and quality to the epidemiological evidence and, most recently, provided direct evidence that sun exposure is the cause of mutations in critical tumour suppressor genes in BCC, SCC and melanoma. Complete or more convincing answers are still needed to many questions of detail. They include whether the pattern of sun exposure is really important in, and acts independently of amount of sun exposure in, affecting the risk of melanoma and BCC; what the shape of the relationship between the amount of sun exposure and risk of BCC and melanoma is when the pattern of exposure is held constant; whether there really is a plateau in risk of BCC and melanoma beyond some level of the amount of exposure; whether this exposure-response relationship depends on cutaneous sensitivity to the sun and in what way; whether sunburn makes a specific contribution to the risk of skin cancer independent of the amount of sun exposure; whether sun exposure close to the time of diagnosis of skin cancer contributes anything to the development of the cancer; what the solar radiation action spectrum is for each kind of skin cancer; and whether sunscreens are effective in protecting against skin cancer.
到1927年，关于基底细胞癌（BCC）和鳞状细胞癌（SCC），以及到1955年关于黑色素瘤，将阳光照射与皮肤癌相关联的广泛依据已经确立：这些癌症在环境太阳辐照度高的地区的居民中更为常见，在对阳光敏感的人群中更为常见，主要发生在阳光暴露的身体部位，在阳光暴露量高的人群中更为常见，以及在患有良性阳光相关皮肤疾病的人群中更为常见。在过去的40年里，流行病学证据在数量和质量上都有所增加，最近还提供了直接证据，表明阳光照射是BCC、SCC和黑色素瘤关键肿瘤抑制基因突变的原因。对于许多细节问题仍需要完整或更有说服力的答案。这些问题包括：阳光照射模式在影响黑色素瘤和BCC风险方面是否真的重要，以及是否独立于阳光照射量起作用；当照射模式保持不变时，阳光照射量与BCC和黑色素瘤风险之间的关系形状是怎样的；在超过一定暴露量水平后，BCC和黑色素瘤的风险是否真的存在一个平台期；这种暴露-反应关系是否取决于皮肤对阳光的敏感性以及以何种方式取决于；晒伤是否独立于阳光照射量对皮肤癌风险有特定贡献；在皮肤癌诊断时间附近的阳光照射是否对癌症发展有任何影响；每种皮肤癌的太阳辐射作用光谱是什么；以及防晒霜在预防皮肤癌方面是否有效。
