Background Differences in tea drinking habits and/or citrus peel use are likely to vary by populations and could contribute to the inconsistencies found between studies comparing their consumption and cancer risk.

      Methods
      A population-based case-control study was used to evaluate the relationships between citrus peel use and black tea intake and squamous cell carcinoma (SCC) of the skin. Moreover, we assessed the independent and interactive effects of citrus peel and black tea in the development of SCC.


      Results
      Hot and iced teas were consumed by 30.7% and 51.8% of the subjects, respectively. Peel consumption was reported by 34.5% of subjects. Controls were more likely than were cases to report citrus peel use (odds ratio (OR) = 0.67) and hot tea intake (OR = 0.79). After adjustment for hot and iced tea intake, the ORs associated with citrus peel use were 0.55 and 0.69, respectively, whereas the corresponding adjusted ORs for hot and iced tea intake after adjustment for citrus peel use were 0.87 and 1.22 respectively. Compared with those who did not consume hot black tea or citrus peel, the adjusted ORs associated with sole consumption of hot black tea or citrus peel were 0.60 and 0.30, respectively. Subjects who reported consumption of both hot black tea and citrus peel had a significant marked decrease (OR= 0.22; 95% CI = 0.10 – 0.51) risk of skin SCC.


      Conclusion
      These results indicate that both citrus peel use and strong (hot) black tea have independent potential protective effects in relation to skin SCC.