Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
Melanoma Res. 2012 Feb;22(1):86-91. doi: 10.1097/CMR.0b013e32834ec02f.
The objective of this study was to investigate the risk factors for melanoma on the arms and legs in comparison with well-known risk factors for trunk melanoma. The study was a population-based case-control study of 77 individuals with limb (25 arm; 52 leg) and 86 with trunk melanoma, who were representative of all the individuals newly-diagnosed with primary limb melanomas in Queensland during 1979-1980 and 232 controls. A single physician interviewed and examined all individuals and assessed complexion type, sun exposure history and other potential risk factors and clinical features. After multivariate analysis, the strongest risk factor for both limb and trunk melanomas was the presence of more than 10 naevi on the arm (odds ratio limb melanoma=41.4, 95% confidence interval 10.4-164), though on histology, a preexisting naevus was more strongly associated with trunk than limb melanoma (P<0.004). Associations with blonde/light brown hair, propensity to freckle and sunburn were similar for melanoma on both sites. A lifetime history of painful sunburns significantly raised the risk of trunk but not limb melanoma, whereas solar keratoses on the arm or face were more strongly associated with limb than with trunk melanoma (marginally significant, P(homogeneity)=0.056). High ambient solar ultraviolet radiation in adolescence was also a stronger risk factor for limb than for trunk melanoma. In conclusion, this population-based investigation into specific differences in causes of limb versus melanomas of other sites suggests that the risk factor profile is intermediate between the profiles for head/neck melanoma (mostly cumulative sun damage) and for trunk melanomas (most strongly related to naevi).
本研究旨在探讨四肢（25 例手臂；52 例腿部）与躯干黑素瘤相比，发生黑素瘤的风险因素。这是一项基于人群的病例对照研究，共纳入 77 例四肢（25 例手臂；52 例腿部）黑素瘤患者和 86 例躯干黑素瘤患者，他们均代表 1979-1980 年昆士兰州新诊断的原发性肢体黑素瘤患者的全部人群，且纳入了 232 名对照者。一位医生对所有参与者进行了访谈和检查，评估肤色类型、日照史和其他潜在的风险因素及临床特征。多变量分析后发现，手臂上有超过 10 个痣是四肢和躯干黑素瘤的最强风险因素（肢部黑素瘤的比值比=41.4，95%置信区间 10.4-164），尽管在组织学上，预先存在的痣与躯干黑素瘤的关系比与肢部黑素瘤的关系更密切（P<0.004）。发生在两个部位的黑素瘤与金发/浅棕色头发、雀斑易感性和晒伤之间的关联相似。一生中曾有过严重晒伤史会显著增加发生躯干黑素瘤的风险，但不会增加发生肢部黑素瘤的风险，而手臂或面部的日光性角化病与肢部黑素瘤的相关性比与躯干黑素瘤的相关性更强（边缘显著，P（同质性）=0.056）。青少年时期环境中高水平的太阳紫外线辐射也是发生肢部黑素瘤的风险因素，而不是躯干黑素瘤。总之，这项针对特定部位（如四肢）黑素瘤病因差异的人群研究表明，风险因素谱位于头颈部黑素瘤（主要与累积性日光损伤有关）和躯干黑素瘤（与痣的相关性最强）之间。
