High variability in anatomic patterns of cutaneous photodamage: a population‐based study

다국어 초록 (Multilingual Abstract)

Skin cancer is strongly associated with photodamaged skin, but body sites are often referred to as ‘exposed’ or ‘unexposed’ to sun without recognizing extent of site‐specific variation.
To assess whole‐body patterns of photodamage in an Australian population.
A random sample of adult residents of Queensland underwent imaging across 10 body sites. Photodamage was graded from images using an ordinal photonumeric scale. We used cluster analysis to identify whole‐body photodamage patterns and prevalence proportion ratios (PPRs) to assess associated factors.
Of 190 adults (median age 52; 58% males), 58% showed severe or moderate‐to‐severe photodamage on most body sites. A higher proportion of woman had severe photodamage on the arms (upper: P = 0.002, lower: P = 0.034). A higher proportion of men had moderate or severe photodamage on the lower back (P = 0.004). We identified four photodamage patterns: ‘severe general’ (n = 24, 13%), ‘moderate‐severe general’ (n = 86, 45%), ‘moderate‐severe v‐neck’ (n = 40, 21%) and ‘mild‐moderate upper body’ (n = 12, 6%). All participants with ‘severe‐general’ photodamage were >50 years and more likely to have past skin cancer (PPR: 2.54, 95% CI: 1.44–4.49) than those with 'moderate‐severe v‐neck' photodamage. Those with ‘moderate‐severe general’ photodamage showed similar associations and were more likely female (PPR: 1.33, 95% CI: 1.04–1.69). Past or current smoking was associated with having higher levels of photodamage, with no smokers in those with ‘mild‐moderate upper body’ photodamage.
Moderate‐to‐severe photodamage across much of the body is common in Queensland adults and associated with age, sex, past skin cancer and smoking. Assuming a universal pattern of site‐specific sun exposure could lead to spurious correlations, while accurate and objective assessment of site‐specific photodamage can add to understanding of the development of sun‐associated skin cancers, in particular site‐specific skin carcinogenesis. Additionally, degree of site‐specific photodamage has the potential to assist skin cancer screening.