Association of Non-Melanoma Skin Carcinomas and UV Exposure with Exfoliation Syndrome in Utah

Main Article Content

Chase Paulson D James Barker Christian Pompoco Sam Taylor Matthew Conley Ayesha Patil Nnana Amakiri Brian Stagg Robert Ritch Jae H Kang Janey L Wiggs Karen Curtin Barbara Wirostko


Background: Prior data suggest an association between non-melanoma skin cancer, i.e., basal and squamous cell cancers most often located in areas of sun exposure, and pseudoexfoliation syndrome. This study aimed to evaluate the association between these conditions and UV exposure through a detailed questionnaire in a large and robust Utah population.

Methods: The two arms of this study are a population-based study (evaluated via chart review) and a UV exposure study (evaluated via a questionnaire). Participants answered a questionnaire designed to assess lifelong UV exposure, including leisure and occupational sun exposure, likelihood to tan or burn in early life, eye and hair color, smoking behavior, vitamin D deficiency, skin cancer history, alcohol consumption, and caffeine intake.

Conclusion: Descriptive findings suggest UV exposure over an adult’s lifespan may associate with a higher risk of non-melanoma skin cancer in Utah exfoliation patients vs. unaffected individuals. Patients with exfoliation glaucoma reside at higher elevations than non-glaucoma patients.

Keywords: Non-Melanoma Skin Carcinomas, Non-Melanoma Skin Carcinomas and UV Exposure, Exfoliation Syndrome, Exfoliation Syndrome in Utah

Article Details

How to Cite
PAULSON, Chase et al. Association of Non-Melanoma Skin Carcinomas and UV Exposure with Exfoliation Syndrome in Utah. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 19 june 2024. doi:
Research Articles


1. Lindberg JG. Kliniska Undersokningar over Depigmenteringenav Pupillarranden Och Genomlysbarheten Av Iris Vid Fall Avaldersstarr Samt I Normala Ogon Hos Gamla Personer. In Clinical Studies of Depigmentation of The Pupillary Margin and Transilluminationof the Iris in Cases of Senile Cataract and Also in Normal Eyes in The Aged; Helsinki University: Helsinki, Finland, 1917.
2. Zenkel M, Schlötzer-Schrehardt U. The composition of exfoliation material and the cells involved in its production. J Glaucoma. 2014;23(8 Suppl 1):S12-S14.
3. Wang W, He M, Zhou M, Zhang X. Ocular pseudoexfoliation syndrome and vascular disease: a systematic review and meta-analysis. PLoS One. 2014;9(3):e92767.
4. Djordjevic-Jocic J, Jovanovic P, Bozic M, Tasic A, Rancic Z. Prevalence and early detection of abdominal aortic aneurysm in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Curr Eye Res. 2012;37(7):617-623.
5. Streeten BW, Li ZY, Wallace RN, Eagle RC Jr, Keshgegian AA. Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol. 1992;110(12):1757-1762.
6. Taylor SC, Bernhisel AA, Curtin K, Allingham RR, Ritch R, Wirostko BM. Association between Chronic Obstructive Pulmonary Disease and Exfoliation Syndrome: The Utah Project on Exfoliation Syndrome. Ophthalmol Glaucoma. 2019;2(1):3-10.
7. Wirostko BM, Curtin K, Taylor SC, et al. Risk of atrial fibrillation is increased in patients with exfoliation syndrome: the Utah project on exfoliation syndrome (UPEXS). Acta Ophthalmol. 2022;100(4):e1002-e1009.
8. Pompoco CJ, Curtin K, Taylor S, et al. Summary of Utah Project on Exfoliation Syndrome (UPEXS): using a large database to identify systemic comorbidities. BMJ Open Ophthalmol. 2021;6(1):e000803.
9. Ritch R. Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma. J Glaucoma. 1994;3(2):176-177.
10. Aasved H. Incidence of defects in the pigmented pupillary ruff in eyes with and without fibrillopathia epitheliocapsularis (so-called senile exfoliation or pseudoexfoliation of the anterior lens capsule). Acta Ophthalmol (Copenh). 1973;51(5):710-715.
11. Wirostko B, Allingham R, Wong J, Curtin K. Utah Project on Exfoliation Syndrome (UPEXS): Insight Into Systemic Diseases Associated With Exfoliation Syndrome. J Glaucoma. 2018;27 Suppl 1:S75-S77.
12. Skuta GL, Parrish RK 2nd, Hodapp E, Forster RK, Rockwood EJ. Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome. Arch Ophthalmol. 1987;105(5):632-634.
13. Ruotsalainen J, Tarkkanen A. Capsule thickness of cataractous lenses with and without exfoliation syndrome. Acta Ophthalmol (Copenh). 1987;65(4):444-449.
14. Ritch R. Exfoliation syndrome. Curr Opin Ophthalmol. 2001;12(2):124-130.
15. Pasquale LR, Jiwani AZ, Zehavi-Dorin T, et al. Solar exposure and residential geographic history in relation to exfoliation syndrome in the United States and Israel. JAMA Ophthalmol. 2014;132(12):1439-1445.
16. Thorleifsson G, Magnusson KP, Sulem P, et al. Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science. 2007;317(5843):1397-1400.
17. Besch BM, Curtin K, Ritch R, Allingham RR, Wirostko BM. Association of Exfoliation Syndrome With Risk of Indirect Inguinal Hernia: The Utah Project on Exfoliation Syndrome. JAMA Ophthalmol. 2018;136(12):1368-1374.
18. Bell K, Ozaki M, Mori K, et al. Association of the CYP39A1 G204E Genetic Variant with Increased Risk of Glaucoma and Blindness in Patients with Exfoliation Syndrome. Ophthalmology. 2022;129(4):406-413.
19. Aung T, Ozaki M, Lee MC, et al. Genetic association study of exfoliation syndrome identifies a protective rare variant at LOXL1 and five new susceptibility loci. Nat Genet. 2017;49(7):993-1004.
20. Aung T, Ozaki M, Mizoguchi T, et al. A common variant mapping to CACNA1A is associated with susceptibility to exfoliation syndrome [published correction appears in Nat Genet. 2015 Jun;47(6):689]. Nat Genet. 2015;47(4):387-392.
21. Paulson C, Thomas SC, Gonzalez O, et al. Exfoliation Syndrome in Baja Verapaz Guatemala: A Cross-Sectional Study and Review of the Literature. J Clin Med. 2022;11(7):1795.
22. Jiwani AZ, Pasquale LR. Exfoliation Syndrome and Solar Exposure: New Epidemiological Insights Into the Pathophysiology of the Disease. Int Ophthalmol Clin. 2015;55(4):13-22.
23. Stein JD, Pasquale LR, Talwar N, et al. Geographic and climatic factors associated with exfoliation syndrome. Arch Ophthalmol. 2011;129(8):1053-1060.
24. Kang JH, VoPham T, Laden F, et al. Cohort Study of Nonmelanoma Skin Cancer and the Risk of Exfoliation Glaucoma. J Glaucoma. 2020;29(6):448-455.
25. Huang JJ, Geduldig JE, Jacobs EB, et al. Head and Neck Region Dermatological Ultraviolet-Related Cancers are Associated with Exfoliation Syndrome in a Clinic-Based Population [published online ahead of print, 2022 Apr 22]. Ophthalmol Glaucoma. 2022;S2589-4196(22)00065-5.
26. Smith KR, Mineau GP. The Utah Population Database. The Legacy of Four Decades of Demographic Research. Historical Life Course Studies. 2021;11:48-73.
27. Duvall SL, Fraser AM, Kerber RA, Mineau GP, Thomas A. The impact of a growing minority population on identification of duplicate records in an enterprise data warehouse. Stud Health Technol Inform. 2010;160(Pt 2):1122-1126.
28. Schlötzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141(5):921-937.
29. Vojniković B, Njirić S, Coklo M, Toth I, Spanjol J, Marinović M. Sunlight and incidence of pterygium on Croatian Island Rab--epidemiological study. Coll Antropol. 2007;31 Suppl 1:61-62.
30. Thomas, R.; Nirmalan, P.K.; Krishnaiah, S. Pseudoexfoliation in southern India: The Andhra Pradesh Eye Disease Study. Investig Ophthalmol. Vis. Sci. 2005, 46, 1170–1176.
31. Forsius H, Forsman E, Fellman J, Eriksson AW. Exfoliation syndrome: frequency, gender distribution and association with climatically induced alterations of the cornea and conjunctiva. Acta Ophthalmol Scand. 2002;80(5):478-484.
32. Forsius H. Exfoliation syndrome in various ethnic populations. Acta Ophthalmol Suppl (1985). 1988;184:71-85.
33. Karabegović I, Portilla-Fernandez E, Li Y, et al. Epigenome-wide association meta-analysis of DNA methylation with coffee and tea consumption. Nat Commun. 2021;12(1):2830.
34. Mohammed S, Kazmi N. Subluxation of the lens and ocular hypertension in exfoliation syndrome. Pak. J. Ophthalmol. 1986;2:77–78.
35. Kozobolis VP, Papatzanaki M, Vlachonikolis IG, Pallikaris IG, Tsambarlakis IG, Epidemiology of pseudoexfoliation in the island of Crete (Greece). Acta Ophthalmol. Scand. 1997;75:726–729.
36. Kang JH, Loomis S, Wiggs JL, Stein JD, Pasquale LR. Demographic and geographic features of exfoliation glaucoma in 2 United States-based prospective cohorts. Ophthalmology. 2012;119(1):27-35.