Association of Phenotypic Characteristics and UV Radiation Exposure With Risk of Melanoma on Different Body Sites
Association of Phenotypic Characteristics and UV Radiation Exposure With Risk of Melanoma on Different Body Sites
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DOI：
10.1001/jamadermatol.2018.3964
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发表时间：
2019-01-01
期刊：
影响因子：
10.9
通讯作者：
Veierod, Marit B.
中科院分区：
文献类型：
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作者：
Ghiasvand, Reza;Robsahm, Trude E.;Veierod, Marit B.
重要性皮肤黑色素瘤的发展有两种途径：一种通常影响头部和颈部，这是一个慢性日光损伤的部位，另一种影响躯干，这是暴露在阳光下较少。然而，肢体黑色素瘤的可能原因是研究较少，根据这一hypothes. ObjectiveTo调查表型特征，紫外线辐射暴露的模式，和黑色素瘤的风险之间的关联在不同的身体sites.Design，设置，和参与者这项研究使用的数据对161 540名妇女的表型特征和紫外线辐射暴露的信息谁是挪威妇女和癌症研究的一部分，1991年建立的一项基于人群的前瞻性研究，在基线时通过问卷调查收集暴露信息，并在随访期间每4至6年收集一次，直至2015年。从2017年10月到2018年5月进行了数据分析。EXPOSURES参与者报告了头发颜色，眼睛颜色，未晒黑的肤色，小对称和大不对称痣的数量，以及雀斑，以及晒伤，日光浴假期和儿童，青少年，挪威妇女与癌症研究与挪威癌症登记处相联系，以获得关于癌症诊断和死亡或移民日期的数据。原发性黑色素瘤部位分为头颈部、躯干、上肢和下肢。结果在随访的161540名妇女中（平均年龄50岁[范围，34-70岁];平均诊断年龄60岁[范围，34-87岁]），1374例黑色素瘤被确诊。大的不对称痣是所有部位的显著危险因素，下肢最强（相对危险度[RR]，3.38; 95%CI，2.62-4.38），上肢最弱（RR，1.96; 95%CI，1.22-3.17;异质性P = 0.02）。一生中平均日光浴度假次数与躯干黑色素瘤的风险显着相关（RR，1.14; 95% CI，1.07-1.22）和下肢黑色素瘤（RR，1.12; 95% CI，1.05-1.19），但非上肢黑色素瘤（RR，0.98; 95% CI，0.88-1.09）和头颈部黑色素瘤（RR，0.87; 95% CI，0.73-1.04;异质性P = 0.006）。室内晒黑仅与躯干黑色素瘤（最高三分位数的RR，1.49; 95%CI，1.16-1.92）和下肢黑色素瘤（最高三分位数的RR，1.33; 95%CI，1.00-1.76;异质性P = 0.002）相关。皮肤颜色，头发颜色，小对称痣，晒伤的历史与黑色素瘤的风险在所有sites.CONCLUSIONS和RELEVANCE这些结果似乎支持黑色素瘤的不同途径的假设，娱乐性的阳光照射和室内晒黑与黑色素瘤的下肢，最常见的网站在女性中的黑色素瘤。这些发现似乎具有重要的预防意义。
IMPORTANCE Two pathways have been hypothesized for the development of cutaneous melanoma: one typically affects the head and neck, a site with chronic sun damage, and the other affects the trunk, which is less exposed to the sun. However, the possible cause of limb melanomas is less studied under this hypothesis.OBJECTIVE To investigate the association between phenotypic characteristics, pattern of UV radiation exposure, and risk of melanoma on different body sites.DESIGN, SETTING, AND PARTICIPANTS This study used data on 161 540 women with information on phenotypic characteristics and UV radiation exposure who were part of the Norwegian Women and Cancer study, a population-based prospective study established in 1991 with exposure information collected by questionnaires at baseline and every 4 to 6 years during follow-up through 2015. Data analysis was performed from October 2017 through May 2018.EXPOSURES Participants reported hair color, eye color, untanned skin color, number of small symmetric and large asymmetric nevi, and freckling, as well as histories of sunburns, sunbathing vacations, and indoor tanning in childhood, adolescence, and adulthood.MAIN OUTCOMES AND MEASURES The Norwegian Women and Cancer study was linked to the Cancer Registry of Norway for data on cancer diagnosis and date of death or emigration. Primary melanoma site was categorized as head and neck, trunk, upper limbs, and lower limbs.RESULTS During follow-up of the 161540 women in the study (mean age at study entry, 50 years [range, 34-70 years]; mean age at diagnosis, 60 years [range, 34-87 years]), 1374 incident cases of melanoma were diagnosed. Having large asymmetric nevi was a significant risk factor for all sites and was strongest for the lower limbs (relative risk [RR], 3.38; 95% CI, 2.62-4.38) and weakest for the upper limbs (RR, 1.96; 95% CI, 1.22-3.17; P =.02 for heterogeneity). Mean lifetime number of sunbathing vacations was significantly associated with risk of trunk melanomas (RR, 1.14; 95% CI, 1.07-1.22) and lower limb melanomas (RR, 1.12; 95% CI, 1.05-1.19) but not upper limb melanomas (RR, 0.98; 95% CI, 0.88-1.09) and head and neck melanomas (RR, 0.87; 95% CI, 0.73-1.04; P =.006 for heterogeneity). Indoor tanning was associated only with trunk melanomas (RR for the highest tertile, 1.49; 95% CI, 1.16-1.92) and lower limb melanomas (RR for the highest tertile, 1.33; 95% CI, 1.00-1.76; P =.002 for heterogeneity). Skin color, hair color, small symmetric nevi, and history of sunburns were associated with risk of melanoma on all sites.CONCLUSIONS AND RELEVANCE These results appear to support the hypothesis of divergent pathways to melanoma and that recreational sun exposure and indoor tanning are associated with melanoma on the lower limbs, the most common site of melanoma in women. These findings appear to have important preventive implications.