Sun behaviour after cutaneous malignant melanoma: a study based on ultraviolet radiation measurements and sun diary data

Summary Background It has been reported that patients with cutaneous malignant melanoma (CMM) can lower their risk of a second primary melanoma by limiting recreational sun exposure. Previous studies based on questionnaires and objective surrogate measurements indicate that before their diagnosis, patients with CMM are exposed to higher ultraviolet radiation (UVR) doses than controls, followed by a reduction after diagnosis. Objectives In a prospective, observational case–control study, we aimed to assess sun exposure after diagnosis of CMM by objective measurements to substantiate advice about sun behaviour. Methods The study population consisted of 24 patients recently diagnosed with CMM during the 7 months preceding the start of the study; 51 controls who matched these recently diagnosed patients in age, sex, occupation and constitutive skin type; and 29 patients diagnosed with CMM between 12 months and 6 years before the start of the study. During a summer season participants filled in sun exposure diaries daily and wore personal electronic UVR dosimeters in a wristwatch that continuously measured time‐stamped UVR doses in standard erythema dose. Results The UVR dose of recently diagnosed patients on days with body exposure was one‐third lower, and the number of days using sunscreen was double that of matched controls. However, in patients diagnosed more than 12 months earlier, the UVR dose on days with body exposure was one‐third higher and the number of days using sunscreen was half that of recently diagnosed patients. Conclusions Patients with CMM limited their UVR dose on days with body exposure, and by using sunscreen further reduced UVR reaching the skin, although only immediately after diagnosis. What’s already known about this topic? • Patients with cutaneous malignant melanoma (CMM) can lower their risk of a further CMM by limiting recreational sun exposure. • Objective measurements are needed to substantiate advice about sun behaviour. What does this study add? • Ultraviolet radiation (UVR) measurements and sun diary data showed a lower UVR exposure dose and a higher protection level in recently diagnosed patients with CMM compared with matched controls. • Data from patients diagnosed in the past indicate that this behaviour is not lasting.