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Since 1986, participants have reported diagnoses of melanoma, SCC, BCC, and other cancers on biennial surveys. When a diagnosis was reported, the participant was entered into a tracking system. Related medical records were requested with the participant’s permission and reviewed by physicians masked to exposure to confirm the diagnosis. For melanoma and SCC, we excluded self-reported cases that denied the diagnosis in the further follow-up or denied the permission to review their records, and only pathologically confirmed invasive cases in the medical record review were documented as the outcome. For BCC, we did not seek to obtain medical records for all cases, but previous studies have indicated a high validity of self-reports, with more than 90% of BCCs confirmed by histopathological records.25,26
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