The recent article by Hemminki et al1 reported interesting results on trends of squamous cell carcinoma (SCC) of the skinin Sweden, namely, that there has been a significant increase in SCC for covered skin starting in the 1980s in addition to the increases in SCC in sun-exposedskin dating back to the 1960s. The interpretation provided was that the increase in SCC for covered skin was likely due to intentional tanning, both duringtrips abroad and in sun beds. No data on gender differences in trips abroad were presented, but it was pointed out that females use sun beds at twicethe rate of males in Sweden. However, males have twice the rate as females for SCC for covered skin. Thus, it is very unlikely that intentional tanningexplains the data unless Swedish men are several times more likely to travel abroad than women. A more likely explanation can be found in the effects of smoking, a well-known risk factor for SCC2,3 andbasal cell carcinoma.4 Smoking would give rise to SCC in covered regions of skin. Deaths due to smoking in Sweden rosefrom 1100 males and just under 100 females in 1955 to 1800 males and 900 females in 1995.5 The recent sex ratio of smokingdeaths is very similar to the sex ratio reported for SCC in covered skin. Also, the adverse effects of smoking generally happen later in life, as isthe case for the SCC data reported. Recent UV exposure practices would not yet be reflected in SCC data. It would be worthwhile to investigate the relationbetween smoking and SCC in Sweden. The author has no relevant financial interest in this letter. References 1. Hemminki KZhang HCzene K Time trends and familial risks in squamous cell carcinoma of the skin Arch Dermatol. 2003;139885- 889PubMedGoogle ScholarCrossref 2. Lear JTTan BBSmith AG et al. A comparison of risk factors for malignant melanoma, squamous cell carcinoma and basal cell carcinoma in the UK Int J Clin Pract. 1998;52145- 149PubMedGoogle Scholar 3. De Hertog SAWensveen CABastiaens MT et al. Relation between smoking and skin cancer J Clin Oncol. 2001;19231- 238PubMedGoogle Scholar 4. Boyd ASShyr YKing Jr LE Basal cell carcinoma in young women: an evaluation of the association of tanning bed use and smoking J Am Acad Dermatol. 2002;46706- 709PubMedGoogle ScholarCrossref 5. World Health Organization, European Region Smoking Prevalence Smoking-Related Disease Impact, Sweden, Available at: http://www.who.int/health_topics/smoking/en/ Accessed July 29, 2003.
Archives of Dermatology – American Medical Association
Published: Mar 1, 2004
Keywords: smoking,squamous cell carcinoma