Lill Tove Nilsen

Trends in UV Irradiance of Tanning Devices in Norway: 1983–2005

Indoor tanning increases skin cancer risk, but the importance of different parts of the UV spectrum is unclear. We assessed irradiance of tanning devices in Norway for the period 1983–2005. Since 1983, all tanning models needed approval before being sold or used. UV Type 3 limits were valid from late 1992 (<0.15 W m−2 for CIE‐weighted, i.e. erythemally weighted, short and long wave irradiances). We analyzed data from 90% of the approved tanning models (n = 446 models) and two large inspection surveys in 1998/1999 and 2003 (n = 1341 tanning devices). Mean CIE‐weighted short wave irradiance of approved models increased from 0.050 W m−2 (95% confidence interval [CI] 0.045–0.055) in 1983–1992 to 0.101 W m−2 (95% CI 0.098–0.105) in 1993–2005, and mean long wave from 0.091 W m−2 (95% CI 0.088–0.095) to 0.112 W m−2 (95% CI 0.109–0.115), respectively. Inspection surveys revealed short wave irradiances much higher than that approved. In 1998–1999, only 28% (293/1034) of the devices were equipped with correct sunlamps and only 1 out of 130 inspected establishments fulfilled all requirements. In 2003, corresponding numbers were 59% (180/307) of devices and 2 out of 52 establishments. Mean short and long wave irradiances of the inspected tanning devices in 2003 were 1.5 and 3.5 times, respectively, higher than the irradiance of natural summer sun in Oslo. In conclusion, the short wave irradiance has increased in indoor tanning devices in Norway over the last 20 years. Due to the high long wave irradiance throughout this period, the percentage of short wave irradiance was much lower than for natural sun.

Ultraviolet exposure from indoor tanning devices: a systematic review.

Use of indoor tanning devices increases the risk of cutaneous melanoma and nonmelanoma skin cancer. Indoor tanning devices have become important sources of ultraviolet (UV) exposure, both UVB and UVA. This systematic review assessed UV measurements performed in indoor tanning devices related to irradiance level, wavelength distribution and similarities to natural sun. The study was performed in accordance with the MOOSE and PRISMA guidelines. We searched PubMed, Embase and Web of Science from inception to May 2015, and also examined the reference lists of the retrieved studies. Eighteen studies were included. Twelve studies examined the erythema‐weighted UV irradiances of indoor tanning devices, 11 studies examined UVB and 13 studies studied UVA. Compliance with irradiance limits was reported in nine studies. Erythema‐weighted irradiances were highest in the most recent studies. Most studies had mean values higher than from natural sun and with large variations between devices. All studies except two had mean unweighted UVB irradiances lower than from natural summer sun (at latitudes from 37°S to 35°N), while mean unweighted UVA irradiances were, with one exception, substantially higher than from natural sun. The high values of UVA exposure from modern tanning devices are alarming in light of the increased focus on UVA irradiance as a carcinogen, and as UVA exposure confers little protection against subsequent UV exposure.

Estimated ultraviolet doses to psoriasis patients during climate therapy

Background/purpose: Psoriasis is a chronic inflammatory disease affecting about 2–3% of the population. Sun exposure has a positive effect on most lesions, but ultraviolet (UV) radiation also constitutes a carcinogenic potential. Climate therapy is frequently used to treat patients, with the consequence that they may receive high doses of UV. This paper explores UV doses to patients treated in Gran Canaria.

High UV-A exposure from sunbeds.

Dear Editor, Sunbeds have become an important source of UV-A exposure; up to 95–100% of the body is exposed in a sunbed compared to 15–50% during outdoor activities (Berwick, 2008). Recent publications in this journal have studied the effects of both UV-A (315–400 nm) and UV-B (290–315 nm) exposure on skin mutagenesis and carcinogenesis (e.g., Bennett, 2008), and this is further supported by Noonan et al. (2012). Fisher (2011) and Fears et al. (2011) emphasized that the use of sunbeds for indoor tanning is common and increases melanoma risk. Coelho and Hearing (2010) and Miyamura et al. (2011) described how UV-A exposure does not increase melanin production and confers little or no protection against subsequent UV exposure. However, as recently pointed out by authors such as Autier et al. (2011), it is important to understand which UV wavelengths actually increase melanoma risk, and at present, UV wavelengths from sunbeds have only rarely been measured in epidemiological studies. In an effort to try and fill this knowledge gap, we compare herein our recent findings on UV-A and UV-B exposure from sunbeds and natural sun. Spectral (unweighted) UV irradiance was measured in 191 sunbeds in 78 tanning facilities throughout Norway using a mini spectroradiometer (Nilsen et al., 2011). Mean unweighted UV-A and UV-B irradiances and erythema weighted UV irradiance (W ⁄ m) were presented for the bench, canopy and facial position of the sunbed. The erythema weighted UV irradiance was found by multiplying the unweighted total UV irradiance by the reference action spectrum for UV-induced erythema in human skin (Commission Internationale de L’Eclairage, 1999). UV irradiances from natural sun at 35 N (Crete, Greece) and 60 N (Oslo, Norway) were also estimated for a clear day in summer at noon (when the sun’s intensity is at its maximum). Figure 1 shows these values normalized to values from natural sun at 35 N. Normalized values were calculated for 10 min of sunbed exposure and 10 min of natural sun exposure, that is, the typical duration of a sunbed session. However, these normalized values would have been the same if we had used somewhat longer exposure times or if we had used UV irradiances alone (i.e., measured intensity without considering exposure time). Compared to natural sun, UV-A exposure from sunbeds was highest at the facial position (five times higher), although it was also higher at the bench and canopy (3.2 and 3.4 times higher, respectively). UV-B exposure from sunbeds was lower at all sunbed positions compared to that from natural sun (0.7–0.8 times), whereas the erythema weighted UV exposure was about the same from sunbeds and natural sun at 35 N. The 10-min UV exposure

Anthropometric factors and cutaneous melanoma: Prospective data from the population-based Janus Cohort

The aim of the present study was to prospectively examine risk of cutaneous melanoma (CM) according to measured anthropometric factors, adjusted for exposure to ultraviolet radiation (UVR), in a large population‐based cohort in Norway. The Janus Cohort, including 292,851 Norwegians recruited 1972–2003, was linked to the Cancer Registry of Norway and followed for CM through 2014. Cox regression was used to estimate hazard ratios (HRs) of CM with 95% confidence intervals (CIs). Restricted cubic splines were incorporated into the Cox models to assess possible non‐linear relationships. All analyses were adjusted for attained age, indicators of UVR exposure, education, and smoking status. During a mean follow‐up of 27 years, 3,000 incident CM cases were identified. In men, CM risk was positively associated with body mass index, body surface area (BSA), height and weight (all ptrends < 0.001), and the exposure‐response curves indicated an exponential increase in risk for all anthropometric factors. Weight loss of more than 2 kg in men was associated with a 53% lower risk (HR 0.47, 95% CI: 0.39, 0.57). In women, CM risk increased with increasing BSA (ptrend = 0.002) and height (ptrend < 0.001). The shape of the height‐CM risk curve indicated an exponential increase. Our study suggests that large body size, in general, is a CM risk factor in men, and is the first to report that weight loss may reduce the risk of CM among men.

Anthropometric factors and Breslow thickness

Melanoma is the most rapidly increasing cancer form in Norway, and in 2016, 2114 men and women were diagnosed with the disease. This form of cancer is often diagnosed at an early stage, and if you follow changes in your skin you will be able to detect the cancer at an early stage. Melanoma with metastasis (spreading elsewhere in the body), however, is a serious disease that is difficult to treat, and more than 300 people die in Norway from melanoma each year. The thickness of the tumour (called Breslow thickness) is an important factor for survival after melanoma; those with a thin tumour at diagnosis live longer than those with a thick tumour. In a new Norwegian study, researchers explored associations between certain factors (called anthropometric factors ‐ such as body mass index (BMI), body surface area (BSA), height, weight and weight change) and Breslow thickness, overall and by anatomical site and histological subtype (type of melanoma). Nearly 300,000 Norwegian men and women who were enrolled into a study group called the Janus population‐based cohort 1972–2003 were followed for melanoma. By 2014, 2570 cases of melanoma with information on tumour thickness were identified. This large case‐series of incident melanomas, demonstrated positive associations between BMI, BSA, weight and Breslow thickness, and showed that Breslow thickness increased with increasing BMI, BSA and weight, before levelling off or declining at high values, suggesting that behavioural or other mechanisms apply at high values.

Why a randomized melanoma screening trial is not a good idea

DEAR EDITOR, Skin cancer screening is an intervention targeting a specific population with the aim of detecting skin cancer at an early, curable stage. It can be organized as a programme where people are invited to a skin examination by general practitioners, dermatologists or specially trained healthcare personnel to detect suspicious skin lesions for potential biopsy excision. Before cancer screening is implemented in larger populations, its effect on disease-specific mortality should be documented in carefully planned randomized trials. Screening for cutaneous melanoma, a leading cause of skin cancer death, has been advocated in many countries, but the evidence of an effect of such screening is limited. After initially encouraging results from the SCREEN study, an observational study of skin cancer screening in the German state of Schleswig-Holstein, we set out to design a largescale, definitive randomized trial on skin cancer screening in Norway, which has the highest melanoma mortality in Europe. Norway should be well suited to perform such a trial with a stable population of 5 3 million inhabitants, wellfunctioning public healthcare system, high-quality registries for cancer and other health-related outcomes, and an active scientific environment in cancer screening and prevention. We reviewed the skin cancer screening literature and invited the investigators of the SCREEN study to a workshop in Oslo, Norway. After follow-up meetings and much discussion, our group came to the conclusion not to launch a large-scale randomized skin cancer screening trial in Norway and we will outline why here. The SCREEN study is the pivotal study for a possible reduction in melanoma mortality, and hence we initially considered this study as the best available basis for planning our randomized trial. However, after scrutiny of the results and helpful discussions with the investigators, we found that the reported mortality reduction in the trial occurred too early in time to be attributable to the skin examination alone. Other factors, for example, public awareness, may have played a role. Also, we do not find it plausible that the low participation rate (10 4% for men and 27% for women) could translate into the reported mortality reduction (47% for men and 49% for women). Later analyses, with longer follow-up and additional mortality data from Schleswig-Holstein, surrounding states and Germany, have created serious doubts about the effect of the German screening

Anthropometric factors and Breslow thickness: prospective data on 2570 cases of cutaneous melanoma in the population-based Janus Cohort

Breslow thickness is the most important prognostic factor of localized cutaneous melanoma (CM), but associations with anthropometric factors have been sparsely and incompletely investigated.

Modeling Effective Albedo as a Function of Land Cover Type and Snow Type

The Center for Environmental Radioactivity (CERAD) project UVmaps aims to obtain geographically distributed time-series of solar ultraviolet (UV) radiation in Norway. Since UV-measurements are limited to a few monitoring stations, a full representation of the spatial and temporal distribution needs to be based on a radiative transfer model (RTM). A key parameter is the regional albedo distribution. The albedo model developed here use a gridded set of local albedo values to derive the regional, effective albedo at any given point. In Norway there is a UV-monitoring network that has been operating since 1996, delivering almost continuous 20-years time series of UV data, and the stations are used as reference points for the model. The albedo model uses land cover information and snow dispersion data from 11 years. Land cover classifications combined with snow classifications constitute a matrix of albedo values, with one albedo value for each combination of land cover type and snow type, under the hypothesis that the snow albedo is affected by the underlying land type. ∗Corresponding author Email address: martin.album.ytre-eide@nrpa.no (Martin Album Ytre-Eide) Submitted to FOSS4G 2017 Conference Proceedings, Boston, USA. September 20, 2017 FOSS4G 2017 Academic Program Modeling Effective Albedo

UV Doses and Skin Effects during Psoriasis Climate Therapy

Psoriasis is a common autoimmune disease with inflammatory symptoms affecting skin and joints. One way of dealing with psoriasis is by controlled solar UV exposure treatment. However, this treatment should be optimized to get the best possible treatment effect and to limit negative side effects such as erythema and an increased risk of skin cancer. In this study 24 patients at Valle Marina Treatment Center in Gran Canaria were monitored throughout a treatment period of three weeks starting at the beginning of November. The total UV dose to the location was monitored by UV-meters placed on the roof of the treatment centere, and the patients wore individual film dosimeters throughout the treatment period. Skin parameters were accessed by reflection spectroscopy (400-850nm). This paper presents preliminary findings from the skin measurements in the visible part of the spectrum, such as blood oxygenation, erythema and melanin indexes. Reflection spectroscopy was found to be a good tool for such treatment monitoring.