A 45-year old Caucasian woman complains of an oval growth on her forehead. She noticed the growth 2 weeks back, and it has gradually grown in size and now bleeds occasionally. She works as a secretary at a dentist's office. She often visits tanning parlors to get a tanned look. She has also had several cosmetic procedures done, including liposuctions in the past to treat her obesity. She gives a history of cocaine abuse in her 20s. She is a hypertensive on treatment with thiazides. On exam, there is an erythematous papule about 3 x 3 cm in size, which bleeds on touch. Her BMI is 30. Biopsy of the lesion reveals squamous cell carcinoma (SCC) of the skin.
What was a risk factor for SCC in this woman?
