Previous studies examining sun exposure and ocular melanoma have produced inconsistent results. We investigated this association in a population-based case-control study in Australia. Cases (n ؍ 290) aged 18 -79 years were diagnosed between January 1996 and July 1998. Controls (n ؍ 893) were randomly selected from the electoral rolls and frequencymatched to cases by age, sex and state. A self-administered questionnaire and a telephone interview measured sun exposure on weekdays and weekends at 10, 20, 30 and 40 years of age and over the whole of life for specific jobs and recreations. Multivariate logistic regression models of ocular melanoma and sun exposure contained age, sex, region of birth, eye color and measures of ocular and cutaneous sun sensitivity as covariates. Choroid and ciliary body melanoma (n ؍ 246) was positively associated with time outdoors on weekdays and, less persuasively, total time outdoors but not ambient solar irradiance. Odds ratios increased with increasing exposure to OR 1.8 (95% confidence interval 1.1-2.8) for the highest quarter of sun exposure on weekdays up to 40 years of age for men and women together. The strongest positive associations were for total exposure up to 40 years of age, lifetime occupational exposure and total exposure at about 20 years of age in men; all had odds ratios between 2 and 3 in the highest exposure categories. There was inconclusive evidence for an association between sun exposure and iris (n ؍ 25) or conjunctival (n ؍ 19) melanomas. Sun exposure is an independent risk factor for choroidal and ciliary body melanoma in Australia. © 2002 Wiley-Liss, Inc.
Key words: ocular melanoma; aetiology; sun exposure; UV radiation; AustraliaThe estimated risks of ocular melanoma associated with personal sun exposure, ambient solar irradiance and use of protective wear have been inconsistent both within and between case-control studies. [1][2][3][4][5][6][7][8][9] However, positive associations with factors less prone to measurement error, such as indicators of sun sensitivity 10 and exposure to artificial sources of UV radiation (e.g., welding arcs and sunlamps), 4,9 suggest a positive association with solar radiation.Possible explanations for past inconclusive results include nonpopulation-based ascertainment of cases and controls, use of qualitative or crude quantitative sun-exposure measures and inadequate control of potential confounding factors, particularly sun sensitivity. Moreover, previous studies collected little or no sun-exposure data for the early years of life. If sun exposure is a risk factor for melanoma of the choroid and ciliary body, the commonest subsites of ocular melanoma, the aetiologically relevant exposure period is probably from birth to the early 20s, when there is some transmission of UV radiation by the crystalline lens to these posterior ocular sites. 11,12 Finally, the unique exposure characteristics of the eye necessitate accounting for personal protective behaviors and environmental factors in estimating ocular sun exposure...