Gillgren P, Brattström G, Frisell J, Palmgren J, Ringborg U, Hansson J
Department of Surgery, Stockholm Söder Hospital, and Stockholm University, Sweden.
Melanoma Res. 2003 Jun;13(3):279-86. doi: 10.1097/00008390-200306000-00009.
Individuals with an increased risk of developing cutaneous malignant melanoma (CMM) include members of kindreds with hereditary cutaneous malignant melanoma (HCMM) and patients who have already been treated for a CMM. Some of these patients develop multiple primary cutaneous malignant melanomas (MCMMs). Ultraviolet radiation is the main instigator of CMM. There are indications that patients in these high-risk groups react differently to sunlight than patients who develop a single sporadic CMM. The objectives of this study were to analyse tumour site in patients with HCMM and sporadic MCMM. Data on 2517 patients with 2608 CMMs from a population-based regional cancer registry were used. The new computer program EssDoll was used for the analyses of primary tumour sites. This software is able to analyse any chosen body area(s) with reference to the number of tumours arising there. When the site of the first and second tumours in patients with sporadic MCMM were analysed in a skin 'field division', there was a significant concordance with respect to site (P < 0.0001). In patients with MCMM, the second primary tumour was significantly thinner than the first (P = 0.001). Primary tumour sites in patients with HCMM were compared with those in patients with a single sporadic CMM. In HCMM we found significantly fewer tumours in the head and neck area and more on the trunk. These differences remained significant in two different body area models, even when stratified for age (P < 0.05). In conclusion, a site-concordance was noted for sporadic MCMM. This may be the result of a 'field effect'. Our results indicate that intermittent ultraviolet exposure may be of relatively greater importance than chronic exposure in HCMM.
患皮肤恶性黑色素瘤（CMM）风险增加的个体包括患有遗传性皮肤恶性黑色素瘤（HCMM）的家族成员以及已接受过CMM治疗的患者。这些患者中的一些会发生多发性原发性皮肤恶性黑色素瘤（MCMM）。紫外线辐射是CMM的主要诱因。有迹象表明，这些高危组中的患者对阳光的反应与发生单个散发性CMM的患者不同。本研究的目的是分析HCMM和散发性MCMM患者的肿瘤部位。使用了来自基于人群的区域癌症登记处的2517例患有2608例CMM的患者的数据。新的计算机程序EssDoll用于分析原发性肿瘤部位。该软件能够参照在那里发生的肿瘤数量分析任何选定的身体区域。当在皮肤“区域划分”中分析散发性MCMM患者中第一和第二个肿瘤的部位时，在部位方面存在显著的一致性（P < 0.0001）。在患有MCMM的患者中，第二个原发性肿瘤明显比第一个薄（P = 0.001）。将HCMM患者的原发性肿瘤部位与单个散发性CMM患者的部位进行比较。在HCMM中，我们发现头颈部区域的肿瘤明显较少，而躯干上的肿瘤较多。即使按年龄分层，在两种不同的身体区域模型中这些差异仍然显著（P < 0.05）。总之，散发性MCMM存在部位一致性。这可能是“区域效应”的结果。我们的结果表明，在HCMM中，间歇性紫外线暴露可能比慢性暴露具有相对更大的重要性。
