Skin cancer prevalence among outdoor activity participants from Queensland, Australia - aquatic versus land-based sun exposure

Sep 22, 2026

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Background: Determine the prevalence of keratinocyte cancer and melanoma among people undertaking aquatic and non-aquatic outdoor activities, alongside their ultraviolet radiation (UVR) exposures. Methods: Cross-sectional survey plus total body skin cancer screening of 1,403 participants attending a specialist skin cancer-focused general practice from September 2021 to August 2024. Main outcomes: point prevalence of pre-cancerous lesions, keratinocyte cancers (BCC, SCC), and primary cutaneous melanoma. Results: Aquatic participants showed a higher melanoma prevalence despite lower cumulative lifetime UV exposure.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages17

Reading Time43 min

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Abstract

Background

Methods

Results

Conclusions

Introduction

Outdoor activity context and UVR risk

Submitted 21 October 2025 Accepted 1 April 2026 Published 4 June 2026 Corresponding author Ian J. Miller, [ian.miller@scu.edu.au](ian.miller@scu.edu.au)[ ](ian.miller@scu.edu.au)Academic editor Faiza Farhan Additional Information and Declarations can be found on page 13 DOI 10.7717/peerj.21278 Copyright 2026 Miller et al. Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS Skin cancer prevalence among outdoor activity participants from Queensland, Australia: aquatic versus land-based sun exposure Ian J. Miller1 , Michael Stapelberg1 ,2 , Jeremy Hudson1 ,3 , Paul Coxon1 ,3 , Nathaniel Milani1 ,3 , Nedeljka Rosic1 ,4 , Joe Walsh5 ,6 ,7 ,8 and Mike Climstein1 ,9 1 Aquatic Based Research, Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia 2 Skin Clinic Robina, Gold Coast, Queensland, Australia 3 North Queensland Skin Centre, Townsville, Queensland, Australia 4 Biomedical Sciences, Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia 5 Clinical and Health Services Research Group, Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia 6 Faculty of Science and Engineering, Southern Cross University, Biling, Queensland, Australia 7 Sport Science Institute, Sydney, New South Wales, Australia 8 AI Consulting Group, Sydney, New South Wales, Australia 9 Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney, New South Wales, Australia ABSTRACT Background. To determine the prevalence of keratinocyte cancer and melanoma among people conducting aquatic and non-aquatic outdoor activities, and their associated ultraviolet radiation (UVR) exposures. Methods. This was a cross-sectional study incorporating a survey and total body skin cancer screen. There were 1,403 participants attending a specialized skin cancer-focused general practice during the period of September 2021 to August 2024 . The main outcomes measured were the point prevalence of pre-cancerous skin lesions, keratinocyte cancers (KC) (i.e., basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) and primary cutaneous melanoma (MM) . Results. Of 1,403 participants (739 women, 664 men), 512 were identified as aquatic and 891 were identified as non-aquatic. Among aquatic participants, 98 of 512 (19.1%) participants were diagnosed with BCC, compared with 142 of 891 (15.9%) non-aquatic participants. Regarding SCC in the population, 46 of 512 (9.0%) aquatic participants were diagnosed compared with 89 of 891 (10.0%) non-aquatic participants. For melanoma (MM), 48 out of 512 (9.4%) aquatic participants were diagnosed and 48 of 891 (5.4%) non-aquatic participants, resulting in an odds ratio nearly double (1.8 times) for aquatic participants compared with non-aquatic. Participants of increased age and male gender had an increased likelihood of being diagnosed with MM. Primary locations for KC were the head, face and neck (32% aquatic, 36% non-aquatic), which differed for MM, being primarily located on the back (40% aquatic, 37% non-aquatic) . Conclusions. While the prevalence of BCC and SCC was similar across activity groups, aquatic participants demonstrated a significantly higher prevalence of MM, despite reporting lower cumulative lifetime UV exposure. A higher MM risk is likely attributable to greater participant engagement during peak ultraviolet radiation (UVR) How to cite this article Miller IJ, Stapelberg M, Hudson J, Coxon P, Milani N, Rosic N, Walsh J, Climstein M. 2026. Skin cancer prevalence among outdoor activity participants from Queensland, Australia: aquatic versus land-based sun exposure. PeerJ 14:e21278 [http://doi.org/10.7717/peerj.21278](http://doi.org/10.7717/peerj.21278) hours. These findings underscore the need for skin cancer surveillance in aquatic enthusiasts, who should be recognised as a high-risk population within the national melanoma screening framework. Subjects Dermatolo

FAQs

What study question does the research address?

It assesses how common keratinocyte cancers and melanoma are among people doing aquatic versus non-aquatic outdoor activities in Queensland, Australia, and links these to UVR exposure patterns.

How was the study conducted and who participated?

The study used a cross-sectional design combining a survey and total body skin cancer screening of 1,403 participants recruited from a specialist skin cancer-focused general practice between September 2021 and August 2024.

What were the main findings about melanoma compared with keratinocyte cancers?

BCC and SCC prevalence was similar across activity groups, but aquatic participants had a significantly higher prevalence of melanoma. The paper notes this higher melanoma risk despite lower reported cumulative lifetime UV exposure.

Sep 22, 2026

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