Garbe C
Universitäts-Hautklinik und Poliklinik, Klinikum Steglitz, Freien Universität Berlin.
Hautarzt. 1992 May;43(5):251-7.
The aetiological role of sunlight in the development of cutaneous malignat melanoma (CMM) is still controversial. The aim of the present review is to discuss the contradictory findings and to reinterpret them in the light of recent epidemiological results. The following clinical and epidemiological features have raised doubts on an aetiological impact of sunlight in CMM development: the anatomical distribution of CMM does not closely match the body areas most exposed to sunlight, and CMM is most common during the middle decades of life (except for the subtype of lentigo maligna melanoma, which accounts for 10% of all CMM). Furthermore, no elevated CMM risk after sunburns or increased sun exposure has been detected in most of the case control studies performed so far. The most important risk factors, however, were the total number of melanocytic naevi in whole-body counts followed by such pigmentation characteristics as skin type and hair colour. On the other hand, the CMM incidence increases in white populations with increasing proximity of domicile to the equator and thus with increasing intensity of UV irradiation, and 5-10 times higher incidence rates have been reported from Australia and the southern states of the USA than from Europe. In industrialized nations with white populations a steep increase in CMM incidence has been described, with the main rise in body regions more frequently exposed to the sun in the last decades (trunk in men and boys and lower extremities in girls and women). Two results from recent epidemiological studies may help to clarify the contradictory findings above: first, sunburn in childhood and adolescence was shown in several case control studies to significantly elevate the risk of melanoma development, but further sunburn during adulthood did not contribute to any further risk elevation. Secondly, a study in Canadian school children revealed significantly higher naevus counts in subjects with numerous or severe episodes of sunburn in the previous 5 years. In conclusion, exposure to the sun in childhood and adolescence induces melanocytic naevi, which are known as markers of an elevated melanoma risk as well as possible precursors of CMM. Strategies to reduce melanoma incidence should therefore begin by restricting exposure to sunlight in young children and adolescents.
阳光在皮肤恶性黑色素瘤（CMM）发生发展中的病因学作用仍存在争议。本综述的目的是讨论这些相互矛盾的研究结果，并根据近期的流行病学结果对其进行重新解读。以下临床和流行病学特征对阳光在CMM发生中的病因学影响提出了质疑：CMM的解剖分布与阳光照射最多的身体部位并不紧密匹配，且CMM在中年时期最为常见（除恶性雀斑样黑色素瘤亚型外，该亚型占所有CMM的10%）。此外，在迄今为止进行的大多数病例对照研究中，未检测到晒伤或阳光暴露增加后CMM风险升高。然而，最重要的风险因素是全身计数中黑素细胞痣的总数，其次是皮肤类型和头发颜色等色素沉着特征。另一方面，随着白人居住地与赤道距离的增加，即紫外线辐射强度的增加，CMM发病率上升，据报道，澳大利亚和美国南部各州的发病率比欧洲高5至10倍。在有白人人口的工业化国家，CMM发病率急剧上升，主要上升部位是过去几十年中更频繁暴露于阳光下的身体部位（男性和男孩的躯干以及女孩和女性的下肢）。近期流行病学研究的两项结果可能有助于澄清上述相互矛盾的研究结果：第一，几项病例对照研究表明，儿童和青少年时期的晒伤会显著增加黑色素瘤发生的风险，但成年期的进一步晒伤并不会导致风险进一步升高。第二，一项针对加拿大在校儿童的研究显示，在过去5年中有多次或严重晒伤的受试者中，痣的数量明显更多。总之，儿童和青少年时期暴露于阳光下会诱发黑素细胞痣，黑素细胞痣是黑色素瘤风险升高的标志以及CMM可能的前体。因此，降低黑色素瘤发病率的策略应首先从限制幼儿和青少年暴露于阳光下开始。
