Article publication date
4 June 2026
ARPANSA review date
June 2026
Summary
This Australian cross-sectional study investigated the prevalence of skin cancer in people participating in outdoor recreational activities in Queensland and exposed to high ultraviolet radiation (UV) levels. It compared the prevalence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma (MM) among people who were involved in aquatic (surfing and swimming) and non-aquatic (walking, running and cycling) activities. A total of 1,403 adults (aquatic n=512, or non-aquatic n=891) attending primary care skin cancer clinic between September 2021 and August 2024 took part in the study. Each participant completed a survey on outdoor activity, sun exposure and sun-protection behaviours and underwent a full-body skin examination, with suspicious lesions confirmed by histopathology.
The study found that those who primarily participate in aquatic activities had a significantly higher prevalence of melanoma compared with non-aquatic participants (9.4% versus 5.4%) with an increased odds ratio of 1.82 (95% confidence interval 1.20-2.75). There was no significant difference for other skin cancers. Aquatic participants reported lower lifetime outdoor time than non-aquatic participants but reported higher participation in activities during peak UV periods (84.2% versus 55.1%). Aquatic participants also reported greater sunscreen use but lower use of protective clothing.
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ARPANSA commentary
The study found that exposure to higher UV levels and the lower use of protective clothing in people participating in aquatic activities may contribute to higher melanoma levels. However, because this is a cross-sectional study and information on exposure and outcome are occurring simultaneously, it cannot prove that the cancer outcome is due to the exposure. The results of the study are consistent with the established evidence that people exposed to higher UV levels are more likely to be diagnosed with melanoma (Wojcik et al., 2018 and Cancer Australia, 2025). Every year in Australia there are approximately 60 cases of melanoma for every 100,000 persons and it is estimated that over 63%, and maybe even up to 95%, of them are attributable to UV exposure (Olsen et al., 2015 and Armstrong and Kricker, 1993).
The findings reinforce the importance of effective UV protection for people who spend substantial time outdoors, particularly those participating in activities without applying UV protection measures. The results also highlight the importance of regular skin surveillance among individuals with high levels of recreational UV exposure. ARPANSA recommends that people minimise UV exposure when the UV Index is 3 or above and use a combination of sun-protection measures including following the Slip, Slop, Slap, Seek and Slide protective measures. ARPANSA also provides a real time UV index and estimation of UV dose. The results also highlight the importance of regular skin surveillance among individuals with high levels of recreational UV exposure.
