We thank Dr. Olsen and colleagues for their comments on our recent paper (1). We also have been intrigued by the association of smoking with melanoma and basal cell keratinocyte carcinoma, but wonder if the associations of smoking with these cancers differ by sex. This possibility has not been assessed in detail, but some studies of both cutaneous melanoma (2, 3) and basal cell keratinocyte carcinoma (3, 4) report inverse associations in men but absent or substantially weaker associations in women. In this context, it is relevant that in marked contrast to melanoma and basal cell carcinoma, cigarette smoking is associated with an increased risk of squamous cell keratinocyte carcinoma (3, 5), probably with no sex difference (3). Given these findings, it is difficult to assign a mechanism for smoking's impact on UV-related carcinogenesis.

Olsen and colleagues are concerned about...

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