黑素细胞痣、日光性角化病以及皮肤黑色素瘤的不同发展途径。

Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma.

作者信息

Whiteman David C, Watt Peter, Purdie David M, Hughes Maria Celia, Hayward Nicholas K, Green Adèle C

机构信息

Division of Population Studies and Human Genetics, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Queensland, Australia.

出版信息

J Natl Cancer Inst. 2003 Jun 4;95(11):806-12. doi: 10.1093/jnci/95.11.806.

DOI:10.1093/jnci/95.11.806

PMID:12783935

Abstract

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.

摘要

背景

一些黑色素瘤形成于身体暴露于阳光的部位，而另一些则并非如此。我们之前提出，不同身体部位的黑色素瘤通过不同途径产生，这些途径与黑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的一项黑色素瘤患者病例对照比较研究中对这一假设进行了检验。

方法

我们从向基于人群的昆士兰州癌症登记处报告的三个预先指定的组中随机选择患者：躯干浅表扩散型或结节型黑色素瘤患者（n = 154，参照组）、头颈部此类黑色素瘤患者（n = 77，主要比较组）以及恶性雀斑样痣黑色素瘤（LMM）患者（n = 75，长期暴露于阳光组）。每位参与者完成一份问卷，一名研究护士对黑素细胞痣和日光性角化病进行计数。我们计算暴露比值比（OR）和95%置信区间（CI），以量化感兴趣的因素与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有超过60颗痣的可能性在统计学上显著更低（OR = 0.34，95%CI = 0.15至0.79），但有超过20处日光性角化病的可能性在统计学上显著更高（OR = 3.61，95%CI = 1.42至9.17），并且也倾向于有切除过日光性皮肤病变的既往史（OR = 1.87，95%CI = 0.89至3.92）。LMM患者有超过60颗痣的可能性也低于躯干黑色素瘤患者（OR = 0.32，95%CI = 0.14至0.75），并且倾向于有更多的日光性角化病（OR = 2.14，95%CI = 0.88至5.16）。