Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma
Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma
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DOI：
10.1093/jnci/95.11.806
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发表时间：
2003-06-04
期刊：
影响因子：
--
通讯作者：
Green, AC
中科院分区：
文献类型：
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作者：
Whiteman, DC;Watt, P;Green, AC
背景：一些黑色素瘤形成于暴露在阳光下的身体部位，而另一些则不形成。我们先前提出，黑色素瘤发生在不同的身体部位，通过不同的途径与黑色素细胞痣和日光性角化病有不同的关联。我们在澳大利亚昆士兰州对黑色素瘤患者进行的病例对病例比较研究中验证了这一假设。方法：我们从昆士兰癌症登记中心报告的三个预先指定的组中随机选择患者：躯干浅表性播散性或结节性黑色素瘤患者(n=154，参考组)，头颈部此类黑色素瘤患者(n=77，主要对照组)，以及恶性雀斑黑色素瘤(LMM)患者(n=75，慢性阳光暴露组)。每个参与者都完成了一份调查问卷，一名研究护士计算了黑色素细胞痣和日光性角化病的数量。我们计算暴露优势比(OR)和95%可信区间(CI)来量化感兴趣的因素和每个黑色素瘤组之间的关联。结果：与躯干黑色素瘤患者相比，头颈部黑色素瘤患者发生60个以上色素痣的可能性显著降低(OR=0.34，95%CI=0.15~0.79)，而发生20个以上日光性角化病的可能性显著增加(OR=3.61，95%CI=1.42~9.17)，并且有切除日光皮损的既往病史(OR=1.87，95%CI=0.89~3.92)。与躯干黑色素瘤患者相比，LMM患者出现60个以上色素痣的可能性较小(OR=0.32，95%CI=0.14~0.75)，并倾向于更多的日光性角化(OR=2.14，95%CI=0.88~5.16)。结论：头颈部黑色素瘤或LMM和躯干黑色素瘤的患病率明显不同。皮肤黑色素瘤可能通过两种途径发生，一种与黑素细胞增殖有关，另一种与长期暴露在阳光下有关。
Background: Some melanomas form on sun-exposed body sites, whereas others do not. We previously proposed that melanomas at different body sites arise through different pathways that have different associations with melanocytic nevi and solar keratoses. We tested this hypothesis in a case-case comparative study of melanoma patients in Queensland, Australia. Methods: We randomly selected patients from among three prespecified groups reported to the population-based Queensland Cancer Registry: those with superficial spreading or nodular melanomas of the trunk (n = 154, the reference group), those with such melanomas of the head and neck (n = 77, the main comparison group), and those with lentigo maligna melanoma (LMM) (n = 75, the chronic sun-exposed group). Each participant completed a questionnaire, and a research nurse counted melanocytic nevi and solar keratoses. We calculated exposure odds ratios (ORs) and 95% confidence intervals (CIs) to quantify the association between factors of interest and each melanoma group. Results: Patients with head and neck melanomas, compared with patients with melanomas of the trunk, were statistically significantly less likely to have more than 60 nevi (OR = 0.34, 95% CI = 0.15 to 0.79) but were statistically significantly more likely to have more than 20 solar keratoses (OR = 3.61, 95% CI = 1.42 to 9.17) and also tended to have a past history of excised solar skin lesions (OR = 1.87, 95% CI = 0.89 to 3.92). Patients with LMM were also less likely than patients with truncal melanomas to have more than 60 nevi (OR = 0.32, 95% CI = 0.14 to 0.75) and tended toward more solar keratoses (OR = 2.14, 95% CI = 0.88 to 5.16). Conclusions: Prevalences of nevi and solar keratoses differ markedly between patients with head and neck melanomas or LMM and patients with melanomas of the trunk. Cutaneous melanomas may arise through two pathways, one associated with melanocyte proliferation and the other with chronic exposure to sunlight.