Paolino Giovanni, Moliterni Elisa, Didona Dario, Garelli Valentina, Corsetti Paola, Lopez Teresa, Richetta Antonio Giovanni, Cantisani Carmen, Bottoni Ugo, Calvieri Stefano
Dermatologic Clinic, La Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy,
Med Oncol. 2015 Jan;32(1):451. doi: 10.1007/s12032-014-0451-4. Epub 2014 Dec 17.
Intermittent sun exposure and sunburns are strongly related to the development of melanoma (MM); however, MM can also arise in non-sun exposed areas, where other biological pathways may cause the disease, with different outcomes. At the same time, evidences of serum levels of vitamin D in melanoma patients according to sun-exposed or not-sun-exposed areas are still lacking, especially if compared with the percentage of BRAF mutation. We performed a retrospective analysis with patients registered in our electronic database and an observational study in patients with a recent diagnosis of MM. Performing Kaplan-Meier product and log-rank test, median disease-free survival was 78 months in non-shield-sites (NST-MM) patients and 20.5 months in shield-sites (ST-MM) patients (p < 0.0001); also in the long term, a better behavior was observed for NST-MM (80 vs. 42 months; p < 0.0001). Among 87 melanoma patients with a recent history of MM (≤30 days), we found that ST-MM patients showed lower values of vitamin D compared with NST-MM patients. Regarding BRAF status, a BRAF mutation was present in 13 % of ST-MM and in 41 % of NST-MM. Performing Mc-Nemar test, we found a statistical significant correlation between low serum levels of vitamin D in ST-MM and low percentage of BRAF mutation (p = 0.03), as well as between serum levels of vitamin D and high percentage of BRAF mutation in NST-MM (p < 0.001). All these aspects confirm that in ST-MM, other pathways play pivotal points, if compared with NST-MM.
间歇性阳光照射和晒伤与黑色素瘤（MM）的发生密切相关；然而，MM也可能出现在非阳光暴露区域，在这些区域其他生物学途径可能导致该病，且预后不同。同时，关于黑色素瘤患者血清维生素D水平与阳光暴露或非阳光暴露区域关系的证据仍然不足，尤其是与BRAF突变百分比相比时。我们对电子数据库中登记的患者进行了回顾性分析，并对近期诊断为MM的患者进行了观察性研究。通过Kaplan-Meier乘积法和对数秩检验，非遮挡部位（NST-MM）患者的无病生存期中位数为78个月，遮挡部位（ST-MM）患者为20.5个月（p<0.0001）；从长期来看，NST-MM患者的表现也更好（80个月对42个月；p<0.0001）。在87例近期有MM病史（≤30天）的黑色素瘤患者中，我们发现ST-MM患者的维生素D值低于NST-MM患者。关于BRAF状态，13%的ST-MM患者和41%的NST-MM患者存在BRAF突变。通过Mc-Nemar检验，我们发现ST-MM患者血清维生素D水平低与BRAF突变百分比低之间存在统计学显著相关性（p=0.03），以及NST-MM患者血清维生素D水平与BRAF突变百分比高之间存在相关性（p<0.001）。所有这些方面都证实，与NST-MM相比，在ST-MM中其他途径起着关键作用。
