***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective The aim of the study was to examine the relation between sun exposure and other selected risk factors and the development of different clinico-pathological variants of cutaneous malignant melanoma ( CMM ) at different body locations . Methods : We analysed data from a  case-control study conducted in Italy between 1992 and 1994 on 542 cases of CMM and 538 hospital controls . Clinico-pathological variants included 391 superficial spreading ( SSM ) , 72 nodular ( NM ) and 39 lentigo maligna ( LMM ) melanomas . Results : The risk of SSM increased for a high education level ( odds ratio , OR = 1.5 , 95 % confidence interval , CI , 1.0–2.2 ) , sunburn episodes before age 15 ( OR = 1.8 , 95 % CI , 1.1–2.8 ) , light eye colour ( OR = 1.6 , 95 % CI , 1.1–2.4 ) and solar lentigines ( OR = 1.4 , 95 % CI , 1.0–1.8 ) . The ORs for total number of nevi > 30 were 4.4 ( 95 % CI , 2.9–6.7 ) for SSM , 5.7 ( 95 % CI , 2.6–12.5 ) for NM and 2.2 ( 95 % CI , 0.5–9.4 ) for LMM . The risk of CMM located on the trunk seemed to be higher for a high education level ( OR = 1.6 , 95 % CI , 1.0–2.6 ) and propensity to sunburn ( OR = 1.6 , 95 % CI , 0.8–3.2 ) . The ORs for sunburn episodes , eye and skin colour , and solar lentigines tended to be higher for CMM located on the face/neck and on the upper limbs than the trunk . Total number of nevi was strongly associated with all anatomic locations . Conclusions : Total number of nevi was the major risk factor associated with all melanoma variants and locations . A higher level of education and sunburn episodes in early childhood appeared to be more strongly related to SSM than to other variants BACKGROUND Although sun exposure is an established cause of cutaneous malignant melanoma , possible interactions with host factors remain incompletely understood . Here we report the first results from a large prospect i ve cohort study of pigmentation factors and sun exposure in relation to melanoma risk . METHODS The Women 's Lifestyle and Health Cohort Study included 106 379 women from Norway and Sweden who were aged 30 - 50 years in 1991 or 1992 when they completed an extensive question naire on personal characteristics and exposures . Linkages to national registries ensured complete follow-up through December 31 , 1999 . Poisson regression models were used to estimate relative risks ( RRs ) . All statistical tests were two-sided . RESULTS During an average follow-up of 8.1 years , 187 cases of melanoma were diagnosed . Risk of melanoma was statistically significantly associated with increasing body surface area ( RR for > or = 1.79 m2 versus < or = 1.61 m2 = 1.60 , 95 % confidence interval [ CI ] = 1.03 to 2.48 ; P(trend ) = .02 ) , number of large asymmetric nevi on the legs ( RR for > or = 7 nevi versus 0 nevi = 5.29 , 95 % CI = 2.33 to 12.01 ; P(trend)<.001 ) , hair color ( RR for red versus dark brown or black = 4.05 , 95 % CI = 2.11 to 7.76 ; P(trend)<.001 ) , sunburns per year at ages 10 - 19 , 20 - 29 , and 30 - 39 years ( P(trend)<.001 , P(trend ) = .03 , and P(trend ) = .05 , respectively ) , and use of a device that emits artificial light ( solarium ) one or more times per month ( P = .04 ) . CONCLUSIONS Our results confirm previous findings that hair color , number of nevi on the legs , and history of sunburn are risk factors for melanoma and suggest that use of a solarium is also associated with melanoma risk . Adolescence and early adulthood appear to be among the most sensitive age periods for the effects of sunburn and solarium use on melanoma risk . However , it may be too early to see the full effect of adult exposures in this cohort This population -based case-control study systematic ally examined reported malignant melanoma risk factors by anatomic site . Study subjects consisted of 548 invasive melanoma cases diagnosed in Connecticut during 1987 - 1989 and 494 r and omly selected controls .  Multivariate polychotomous logistic regression was used to determine whether risk factors differed across anatomic sites . Risk factors examined included demographic and pigmentary characteristics , sun exposure-related factors , anatomic site-specific sunburn , recreational water activity clothing habits and number of nevi . A pattern of site-specificity was observed for sunburn . A history of sunburn at an anatomic site was specifically related to the development of malignant melanoma at that site more so than at other sites . This site-specificity was consistent with a direct role for intense , intermittent sun exposure in the development of melanoma . Age and gender were the only risk factors that differed significantly in effect across anatomic sites . The age difference was explained by differences in histologic subtype across sites . The gender difference could not be explained by sex differences in anatomic site-specific sunburns or in recreational water activity clothing habits . Alternative explanations include sex differences in behavioral patterns of sun exposure that we did not measure and as yet uneluci date d differences in susceptibility to melanoma according to sex and anatomic site BACKGROUND Dark-skinned individuals are less likely than light-skinned individuals to become sunburned or develop skin cancer . Some have extrapolated this relationship and surmised that developing and maintaining a tan will reduce the risk of sunburns and melanoma . In order to examine whether this strategy indeed protects against sunburns , we surveyed college students about both their tanning habits prior to spring break and their spring break activities . METHODS Sorority and fraternity students were recruited after spring break . Analyses examined associations between potential risk factors and the development of one or more sunburns during spring break . RESULTS As expected , the risk of obtaining a sunburn increased with : time spent in the sun during spring break ; light complexion , as assessed by various sun-sensitivity factors ; and lack of sunscreen use . We also found that tanning using an artificial UV source during the 10 weeks prior to spring break was not associated with reduced risk of sunburns during spring-break , but rather with a marginal increase in this risk . CONCLUSIONS These data provide evidence that maintaining a tan may not provide protection from sunburns . Public health messages need to address this misconception , stating clearly that a tan does not protect against or reduce the chances of developing a sunburn BACKGROUND Sunbathing and other types of exposure to ultraviolet radiation are the major preventable risk factors for skin cancer . Due to the continued increase in incidence of melanoma in Northern Irel and , we have conducted a question naire survey in an attempt to gather information about sunbathing habits and other forms of ultraviolet light exposure amongst the Northern Irel and population . AIM The aim of this study was to examine the test-retest reliability of a question naire used in a large-scale cross-sectional population survey pertaining to sunbathing habits , use of sun screen , skin types , and frequencies of sunburn and to assess the responses given by the subjects to determine the nature of their sun-related behaviour . METHODS Thirty control subjects were r and omly selected from a population control sample participating in a large case-control study investigating melanoma in the Northern Irel and population . All participants completed the interview question naire on two occasions , with a median of 15 days ( range , 12 - 42 days ) between interviews . We r and omly chose control subjects who had been visited by the same research nurse , thus ruling out interobserver bias in the analyses . We used the test-retest method . Kappa statistics were used to calculate the association between test and retest scores of all the individual items . If the items contained within the question naire are reliable , then repeated measurement after a fairly short period of time should result in high within-subject repeatability . RESULTS Questions pertaining to hours spent in the sun and sun bed usage showed high reliability ( kappa > 0.7 ) . Questions about sunscreen usage showed moderately high reliability ( kappa > 0.6 ) in all but one of the 10-year age b and s and complete agreement ( kappa = 1 ) in one age category ( > 50 years ) . CONCLUSION This question naire is a reliable method of assessing sun-associated behaviour identifying high-risk sun-related behaviour and misconceptions about tanning , which can be targeted for improvement in public health We studied the test – retest reproducibility of melanoma risk factors , including the use of sunscreen and sun protection factor ( SPF ) , in a self-administered exposure follow-up question naire from the Norwegian Women and Cancer Study , a large national population -based cohort . In 2002 , a r and om sample of 2000 women ( 46–75 years ) received the question naire twice , about 3 months a part ( response 75 % ) . Kappa ( κ ) was 0.77 for freckling when sunbathing [ 95 % confidence interval ( CI ) , 0.74 - 0.81 ] . Weighted kappa , κw , for sunbathing vacations to southern latitudes and solarium use last 5 years was 0.71 ( 95 % CI , 0.68–0.74 ) and 0.70 ( 95 % CI , 0.67–0.73 ) , respectively . Reproducibility was also good for sunscreen use ( yes/no ) on specific occasions ( 0.64≤κ≤0.74 ) and the corresponding SPF . Spearman 's correlation coefficient ( rs ) for SPF on sunbathing vacations to southern latitudes was 0.73 ( 95 % CI , 0.69–0.77 ) for today and 0.71 ( 95 % CI , 0.66–0.76 ) for 10 years ago . For the eight most common sunscreen br and s , reproducibility was lower for use ( yes/no ) ( 0.31≤κ≤0.60 ) than for SPF ( 0.38≤rs≤0.87 ) . The frequency of sunburn and sunbathing vacations in Norway or outside southern latitudes had fair reproducibility ( κw was 0.49 and 0.47 , respectively ) . Other studies have also found it challenging to measure sunburn . This study was larger than previous studies , permitting subgroup analyses . In conclusion , the overall reproducibility of the question naire was acceptable and not affected by age , education or skin color . In particular , our study has added new knowledge about the reproducibility of sunscreen use and SPF OBJECTIVE Exposure to ultraviolet radiation has consistently been linked to an increased risk of melanoma .  Epidemiologic studies are susceptible to measurement error , which can distort the magnitude of observed effects . Although the reliability of self-report of many sun exposure factors has been previously described in several studies , self-report of use of artificial tanning devices and self-tanning creams has been less well characterized . STUDY DESIGN AND METHODS A mailed survey was re-administered 2 - 4 weeks after completion of the initial survey to 76 r and omly selected participants in a case-control study of melanoma . Cases and controls were individuals diagnosed in 1999 and 2000 who were ascertained from the Iowa Cancer Registry in 2002 . We assessed the consistency of self-reported use of sunlamps and self-tanning creams , sun sensitivity , and history of sunburns . RESULTS There was substantial reliability in reporting the use of  sunlamps  or  self-tanning creams  ( cases : Kappa (kappa)=1.0 for both exposures ; controls : kappa=0.71 and 0.87 , respectively ) . kappa estimates of 0.62 - 0.78 were found for overall reliability of several sun sensitivity factors . CONCLUSION Overall , the survey instrument demonstrated substantial reproducibility for factors related to the use of sunlamps or tanning beds , self-tanning creams , and sun sensitivity factors The purpose of this case-control study was to identify susceptible subgroups , primarily based on pigmentary characteristics , at higher risk of developing melanoma when exposed to the sun . The study group , which was interviewed from 1979 to 1982 , consisted of 289 consecutive patients with melanoma and 527 r and omly selected controls without cancer . In general , the risk of melanoma associated with sun exposure was greater for individuals expected to be susceptible on the basis of poor ability to tan , but not other pigmentary traits . There were , in addition , some noteworthy interactions between age and sun exposure . Among subjects with poor tanning ability , the risk of melanoma associated with outdoor occupation  was more than 3-fold [ odds ratio ( OR ) = 3.3 ] compared to indoor occupation . In contrast , the analogous OR was much less elevated among subjects with a good ability to tan ( OR = 1.5 ) . Mixed indoor and outdoor job exposure was protective among good tanners ( OR = 0.80 ) , but not among poor tanners ( OR = 1.5 ) . A similar pattern was seen for recreational sun exposure and , when applying multiple logistic regression , for the patient 's overall subjective assessment of his lifetime sun exposure . However , quantitative assessment of average hours of sun exposure did not prove to be a good indicator of melanoma risk , even among susceptible individuals . A history 
    Output:
    
Using tanning beds is associated with a subsequent melanoma diagnosis .
Exposure from more than 10 tanning sessions is most strongly associated and there was no statistically significant difference in this association before and after 2000 , suggesting that newer tanning technology is not safer than older models