Whiteman David C, Stickley Mark, Watt Peter, Hughes Maria Celia, Davis Marcia B, Green Adèle C
Division of Population Studies and Human Genetics, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Queensland 4029 Australia; e-mail:
J Clin Oncol. 2006 Jul 1;24(19):3172-7. doi: 10.1200/JCO.2006.06.1325.
Sunlight is the principal environmental risk factor for cutaneous melanoma. A current hypothesis postulates that the role of sunlight in causing melanoma differs according to anatomic site. We tested this hypothesis in a population-based case-case comparative study of melanoma patients.
Patients were sampled from the Queensland cancer registry in three groups: superficial spreading or nodular melanomas of the trunk (n = 154), of the head and neck (HN; n = 76), and lentigo maligna (LM) and lentigo maligna melanoma (LMM; for both LM and LMM, n = 76). Data were collected on school-age sun exposure and occupational and recreational sun exposure in adulthood. Odds ratios (OR) and 95% CIs were calculated using polytomous logistic regression.
HN melanoma patients were substantially more likely than trunk patients to have higher levels of sun exposure in adulthood (OR, 2.43; 95% CI, 0.98 to 5.99) and specifically, higher levels of occupational exposure (OR, 3.25; 95% CI, 1.32 to 8.00), but lower levels of recreational sun exposure (OR, 0.50; 95% CI, 0.21 to 1.19). LM and LMM patients reported higher occupational exposure and lower recreational sun exposure than trunk melanoma patients, although this was not significant. We found no significant differences between the groups for school-age sun exposures.
Melanomas developing at different body sites are associated with distinct patterns of sun exposure. Melanomas of the head and neck are associated with chronic patterns of sun exposure whereas trunk melanomas are associated with intermittent patterns of sun exposure, supporting the hypothesis that melanomas may arise through divergent causal pathways.
阳光是皮肤黑色素瘤主要的环境风险因素。当前一种假说认为，阳光在引发黑色素瘤方面的作用因解剖部位而异。我们在一项基于人群的黑色素瘤患者病例 - 病例对照研究中对这一假说进行了验证。
从昆士兰癌症登记处选取患者，分为三组：躯干浅表扩散型或结节型黑色素瘤患者（n = 154）、头颈部（HN）黑色素瘤患者（n = 76）、恶性雀斑样痣（LM）和恶性雀斑样痣黑色素瘤（LMM；LM和LMM患者共n = 76）。收集了关于学龄期阳光暴露以及成年期职业和娱乐性阳光暴露的数据。使用多分类逻辑回归计算优势比（OR）和95%置信区间（CI）。
HN黑色素瘤患者比躯干黑色素瘤患者在成年期有更高阳光暴露水平的可能性显著更高（OR，2.43；95% CI，0.98至5.99），具体而言，职业暴露水平更高（OR，3.25；95% CI，1.32至8.00），但娱乐性阳光暴露水平较低（OR，0.50；95% CI，0.21至1.19）。LM和LMM患者报告的职业暴露高于躯干黑色素瘤患者，娱乐性阳光暴露低于躯干黑色素瘤患者，尽管差异不显著。我们发现各组在学龄期阳光暴露方面无显著差异。
不同身体部位发生的黑色素瘤与不同的阳光暴露模式相关。头颈部黑色素瘤与长期阳光暴露模式相关，而躯干黑色素瘤与间歇性阳光暴露模式相关，支持黑色素瘤可能通过不同因果途径产生的假说。
