Elwood J M, Whitehead S M, Davison J, Stewart M, Galt M
Department of Community Medicine and Epidemiology, University of Nottingham, UK.
Int J Epidemiol. 1990 Dec;19(4):801-10. doi: 10.1093/ije/19.4.801.
In a case-control study in the Midlands of England, 195 subjects with superficial spreading or nodular melanoma were compared to age- and sex-matched controls chosen from all inpatients or outpatients in hospitals serving the defined source population. Significant increases in melanoma risk, after adjustment for other factors, were seen in association with total naevi on the arms (odds ratio (OR), for 15+ naevi compared to none = 3.8), intense freckling as an adult (OR = 6.2), and as a child (OR = 6.0), and higher social class (OR = 2.4). Positive single factor associations were also seen with light or red hair colour, tendency to sunburn easily, and a history of sunburn at ages 8-12, although these were not significant when adjusted for the other factors. No significant effect was seen with naevi greater than 6 mm, or with raised naevi, when adjusted for total number of naevi. Total arm naevi and density of freckling had independent effects, consistent with a multiplicative effect, the OR in those with 10+ naevi and heavy freckling being 20.8. The risk associated with red hair was independent of naevi, but associated with freckling. The strongest association with sunburn history was seen with a history of sunburn in childhood, with sunburn at later times, having smaller effects, or none. These results shows that freckling and social class as well as naevi are strong and independent risk indicators for melanoma. These associations were generally consistent by type of melanoma, sex, age, and extent of regular exposure of the body site affected, although the social class gradient was observed neither for nodular melanoma nor for melanomas occurring on the most exposed body sites.
在英格兰中部地区进行的一项病例对照研究中，将195例患有浅表扩散型或结节型黑色素瘤的患者与从服务于特定源人群的医院所有住院患者或门诊患者中选取的年龄和性别匹配的对照组进行比较。在调整其他因素后，发现手臂上的痣总数（15颗及以上痣与无痣相比的优势比（OR）=3.8）、成年时的密集雀斑（OR = 6.2）、儿童时的密集雀斑（OR = 6.0）以及较高的社会阶层（OR = 2.4）与黑色素瘤风险显著增加相关。还发现浅色或红色头发颜色、容易晒伤的倾向以及8至12岁时有晒伤史与黑色素瘤存在单因素正相关，尽管在调整其他因素后这些因素并不显著。在调整痣的总数后，对于直径大于6毫米的痣或隆起的痣未发现显著影响。手臂上痣的总数和雀斑密度具有独立作用，符合相乘效应，有10颗及以上痣且雀斑密集者的OR为20.8。与红发相关的风险独立于痣，但与雀斑相关。与晒伤史关联最强的是儿童时期有晒伤史，后期晒伤的影响较小或无影响。这些结果表明，雀斑、社会阶层以及痣是黑色素瘤的强大且独立的风险指标。这些关联在黑色素瘤类型、性别、年龄以及受影响身体部位的定期暴露程度方面总体上是一致的，尽管对于结节型黑色素瘤以及在最暴露身体部位发生的黑色素瘤均未观察到社会阶层梯度。
