Titus-Ernstoff Linda, Perry Ann E, Spencer Steven K, Gibson Jennifer, Ding Jiao, Cole Bernard, Ernstoff Marc S
Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH 03756, USA.
Arch Dermatol. 2006 Apr;142(4):433-8. doi: 10.1001/archderm.142.4.433.
To assess the frequency of occurrence and risk factors for multiple primary melanoma.
Population-based, case-control study.
New Hampshire.
Three-hundred fifty-four New Hampshire residents with a confirmed first diagnosis of cutaneous melanoma.
Diagnosis of a subsequent primary cutaneous melanoma.
An additional melanoma occurred in 27 individuals (8%) within 2 years of their initial diagnosis, including 20 (6%) within the first postdiagnosis year. In 9 (33%) of these 27 cases, at least 1 subsequent melanoma was deeper than the first tumor. The 27 individuals with a subsequent melanoma diagnosis were classified as "cases" and were compared on the basis of risk factors to the 327 "controls" with a single melanoma diagnosis. The data indicate an inverse relation of risk of multiple primary melanomas with multiple blistering sunburns (P = .01 for the trend); the odds ratio (OR) was 0.32 (95% confidence interval [CI], 0.11-0.93) for 2 or more sunburns compared with none. The number of atypical moles was significantly related to increased risk (P = .004 for the trend). The presence of 3 or more atypical moles compared with none was associated with more than a 4-fold risk of multiple primary melanomas (OR, 4.29; 95% CI, 1.51-12.16).
Additional melanomas occur more frequently than previously shown. Our study confirms that atypical moles are strongly associated with risk of multiple primary melanomas but provides little evidence that risk is influenced by pigmentary characteristics, hours of sun exposure, or benign moles. The inverse association with blistering sunburn may reflect the influence of an unmeasured covariate.
评估多发性原发性黑色素瘤的发生频率及危险因素。
基于人群的病例对照研究。
新罕布什尔州。
354名首次确诊为皮肤黑色素瘤的新罕布什尔州居民。
后续原发性皮肤黑色素瘤的诊断。
在初次诊断后的2年内，另外27名个体（8%）发生了黑色素瘤，其中20名（6%）在诊断后的第一年发生。在这27例病例中，有9例（33%）至少有1例后续黑色素瘤比第一例肿瘤更深。这27例后续诊断为黑色素瘤的个体被归类为“病例组”，并根据危险因素与327例仅诊断为单一黑色素瘤的“对照组”进行比较。数据表明，多发性原发性黑色素瘤的风险与多次水疱性晒伤呈负相关（趋势P = 0.01）；与无晒伤相比，2次或更多次晒伤的比值比（OR）为0.32（95%置信区间[CI]，0.11 - 0.93）。非典型痣的数量与风险增加显著相关（趋势P = 0.004）。与无相比，存在3个或更多非典型痣与多发性原发性黑色素瘤的风险增加4倍以上相关（OR，4.29；95% CI，1.51 - 12.16）。
额外的黑色素瘤发生频率比以前显示的更高。我们的研究证实，非典型痣与多发性原发性黑色素瘤的风险密切相关，但几乎没有证据表明风险受色素沉着特征、日晒时间或良性痣的影响。与水疱性晒伤的负相关可能反映了一个未测量协变量 的影响。
