Solar Ultraviolet Radiation, Stratospheric Ozone Dynamics, and Photocarcinogenesis in Australia

An Updated Narrative Review of Mechanisms, Clinical Burden, Prevention, and Emerging Technologies

Abstract

Background: Solar ultraviolet (UVR) radiation is the prime etiological environmental agent for most UV-related cutaneous malignancies. Australia is exposed to exceptionally high ambient levels of UVR. The ongoing international control of ozone-depleting substances has started the repair of the stratospheric ozone layer but the reduction in ozone-depletion-related risk cannot offset Australia's high UV exposure.

Objective: This narrative review aims to examine the interactions between stratospheric ozone dynamics, solar UVR exposure, molecular mechanisms of injury, clinical manifestations, contemporary diagnosis and treatment, and population-level prevention strategies.

Methods: A narrative literature review. Publications from January 2000 to June 2025 were prioritized. Landmark publications predating 2000 were included. A search strategy included the key concepts of solar ultraviolet radiation, ultraviolet-A and ultraviolet-B, stratospheric ozone, photocarcinogenesis, melanoma, various forms of keratinocyte, and actinic keratosis. Priority was given to systematic reviews, meta-analysis, randomized trials, cohort studies, experimental studies, and reports from international and Australian health agencies.

Results: UV-B radiation is associated with direct formation of DNA photolesions. UV-A is a significant contributor to oxidative stress through reactive oxygen species. Failure of DNA repair mechanisms, genomic instability, impaired immunity and mutations in TP53, BRAF, NRAS, NF1, and TERT are implicated in the development of actinic keratoses, keratinocyte carcinomas and melanoma. Chronic UV exposure produces a continuum from sunburn and photoaging to premalignant lesions and invasive malignancy. Improvements in photoprotection, dermoscopy and digital surveillance, molecular characterization, targeted therapy and immune checkpoint inhibition improve diagnosis and management. However, prevention remains at the forefront as a substantial proportion of UV-associated skin disease is preventable.

Conclusion: Australia is a unique natural laboratory, where atmospheric science, UV photobiology, molecular carcinogenesis, dermatology, and public health intersect. Enhancement of the stratospheric ozone layer is an important environmental health achievement, but should not be interpreted as a reduction in the immediate need for UV protection. Population-level photoprotection, occupational interventions, early detection, risk-based surveillance, and the inclusion of digital and molecular technologies are needed to reduce the ongoing burden of UV-associated skin disease.