Channing Laboratory, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Eur Acad Dermatol Venereol. 2013 May;27(5):565-70. doi: 10.1111/j.1468-3083.2012.04483.x. Epub 2012 Feb 24.
Non-melanoma skin cancer (NMSC) is the most common cancer in the US, and having multiple lesions conveys substantial cost and morbidity for the individual involved. Although there are data available on risk factors for NMSC, there are currently few studies that identify specific risk factors for development of multiple NMSCs. We evaluated host risk factors for multiple NMSCs among men (Health Professionals Follow-up Study) and women (Nurses' Health Study). Compared with individuals with a single NMSC, having greater number of sunburns was a risk factor for developing ≥ 2 NMSCs [≥ 10 sunburns, cumulative relative risk (RR) = 1.21, 95% confidence interval (CI): 1.07-1.36] and a higher risk of developing ≥ 11 NMSCs (≥10 sunburns, RR = 2.33, 95% CI: 1.57-3.46). Inability-to-tan was associated with risk of developing ≥ 2 NMSCs (cumulative RR = 1.29, 95% CI: 1.18-1.40) and a higher risk of developing ≥ 11 NMSCs (RR = 1.91, 95% CI: 1.50-2.43). Men had an increased risk of developing ≥ 2 NMSCs (cumulative RR = 1.53, 95% CI: 1.40-1.66). Risk of developing 2-4, 5-10 and ≥11 NMSCs increased with age. Other risk factors for developing ≥ 2 NMSCs included red natural hair colour (cumulative RR = 1.23, 95% CI: 1.07-1.42), family history of melanoma (cumulative RR = 1.15, 95% CI: 1.03-1.28), and having ≥ 6 nevi on the left arm (cumulative RR = 1.22, 95% CI: 1.07-1.40). In conclusion, physicians caring for individuals with incident NMSCs may consider paying special attention to those at highest risk for developing additional tumours, especially males and those with a history of ≥ 10 lifetime sunburns, by performing routine full skin examinations and counselling for aggressive photoprotection.
非黑素瘤皮肤癌 (NMSC) 是美国最常见的癌症，个体患者患有多种病变会带来巨大的经济和发病负担。尽管已有关于 NMSC 风险因素的数据，但目前很少有研究确定多种 NMSC 发病的具体风险因素。我们评估了男性（健康专业人员随访研究）和女性（护士健康研究）中 NMSC 多发的宿主风险因素。与患有单一 NMSC 的个体相比，晒伤次数较多是发生≥2 个 NMSC 的危险因素[≥10 次晒伤，累积相对风险 (RR) = 1.21，95%置信区间 (CI)：1.07-1.36]，发生≥11 个 NMSC 的风险更高（≥10 次晒伤，RR = 2.33，95%CI：1.57-3.46）。无法晒黑与发生≥2 个 NMSC 的风险相关（累积 RR = 1.29，95%CI：1.18-1.40），发生≥11 个 NMSC 的风险更高（RR = 1.91，95%CI：1.50-2.43）。男性发生≥2 个 NMSC 的风险增加（累积 RR = 1.53，95%CI：1.40-1.66）。发生 2-4 个、5-10 个和≥11 个 NMSC 的风险随年龄增长而增加。发生≥2 个 NMSC 的其他危险因素包括红天然发色（累积 RR = 1.23，95%CI：1.07-1.42）、黑素瘤家族史（累积 RR = 1.15，95%CI：1.03-1.28）和左手臂上有≥6 个痣（累积 RR = 1.22，95%CI：1.07-1.40）。总之，治疗新发 NMSC 患者的医生可能会考虑特别关注那些发生额外肿瘤风险最高的患者，尤其是男性和那些有≥10 次一生中晒伤史的患者，通过进行常规全面皮肤检查和积极的防晒咨询来实现。
