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Exposure to the sun's ultraviolet (UV) rays is the most important risk factor in the development of skin cancer. But other factors can also increase the risk of skin cancer.

The beach, poolside and golf course are not the only places where you need sun protection. UV radiation can pierce your car window and damage your skin as you drive. Sun exposure also can damage facial skin in winter when you go skiing or sledding.

Development of sun-induced skin cancer is a very slow process. Research suggests that long-term exposure to UV radiation raises your skin cancer risk visibly through sunburn and invisibly by damaging the DNA in skin cells.

Nearly 90 percent of all skin cancers are thought to stem from the sun's UV radiation. But other factors also can cause skin cancer, according to the American Cancer Society. They include:

• Chemical exposure. Exposure to arsenic, a heavy metal used in making some insecticides, raises the risk of developing non-melanoma skin cancer. Occupational exposure to industrial tar, coal, paraffin and certain types of oil also may increase this risk.
• Radiation exposure. People who have had radiation therapy have an increased risk of getting non-melanoma skin cancer.
• Long-term or severe skin inflammation or injury. In rare cases, non-melanoma skin cancers grow in scars from severe burns, on areas of skin over severe bone infections and on skin damaged by certain severe inflammatory skin diseases.
• Psoriasis treatment. People treated with the drug psoralen and ultraviolet light (PUVA) may have an elevated risk of squamous cell carcinoma and possibly other skin cancers.
• Xeroderma pigmentosum. This very rare hereditary disease makes it difficult for the skin to repair DNA damaged by UV light. People with this condition typically suffer many skin cancers, which may begin in childhood.
• Basal cell nevus syndrome. People born with this rare condition develop multiple basal cell carcinomas and other health problems.
• Reduced immunity. People whose immune system is weakened because of HIV infection, drugs that prevent rejection of donor organs or chemotherapy are at increased risk for non-melanoma skin cancer.
• HPV infection. A small number of skin cancers of the genital and anal areas seem to be linked to infection with human papilloma virus (HPV). This group of viruses can cause warts different from the common type of warts that people get on their hands and feet.
• Smoking. Smoking can raise your risk not only for lung cancer but also for squamous cell skin cancer.
• Actinic keratosis. These flat, scaly growths on the skin can turn into squamous cell cancer, although this is rare.
• Bowen's disease. This disease is a type of scaly or thickened patch on the skin. It may turn into squamous cell skin cancer.

Sources: National Cancer Institute. What you need to know about skin cancer. risk factors. Accessed May 28, 2008. American Cancer Society. What causes basal cell and squamous cell skin cancer? Accessed May 28, 2008.

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