Elwood J M
Department of Community Medicine and Epidemiology, Queen's Medical Centre, Nottingham, U.K.
J Invest Dermatol. 1989 May;92(5 Suppl):214S-221S. doi: 10.1111/1523-1747.ep13075569.
In white populations living at moderate or low latitudes, melanoma has become one of the most common tumors in young adults. Epidemiologic studies show a complex association with sun exposure. Risk is related positively to the levels of exposure typical of the place of residence, and also to personally controlled exposure, with the maximum risk being related to acute intermittent exposure. Risk also varies with pigmentation, family history of melanoma, and the presence of benign and of dysplastic nevi. The following methods of control of melanoma in such populations are discussed: the most effective methods depend on early diagnosis; primary prevention appears difficult and requires evaluation; identification of very high-risk subjects on the basis of family history and dysplastic nevi will affect only a very small proportion of melanomas; the use of simpler methods to identify high-risk subjects is explored. In Japan, melanoma is comparatively rare, but increasing as rapidly as elsewhere. The incidence rate of acral lentiginous melanoma appears similar to that in whites, comprising a large proportion of melanoma in Japan. Control programs cannot be designed rationally, since basic information on the occurrence, presentation, and survival of melanoma in Japan is lacking. Some specific research questions are suggested.
在生活在中低纬度地区的白人人群中，黑色素瘤已成为年轻成年人中最常见的肿瘤之一。流行病学研究表明，它与阳光照射之间存在复杂的关联。风险与居住地典型的暴露水平呈正相关，也与个人可控的暴露相关，最大风险与急性间歇性暴露有关。风险还因色素沉着、黑色素瘤家族史以及良性和发育异常痣的存在而有所不同。本文讨论了在这类人群中控制黑色素瘤的以下方法：最有效的方法取决于早期诊断；一级预防似乎很困难且需要评估；根据家族史和发育异常痣来识别极高风险个体仅能影响极小一部分黑色素瘤病例；探讨了使用更简单的方法来识别高风险个体。在日本，黑色素瘤相对少见，但发病率增长速度与其他地方一样快。肢端雀斑样痣黑色素瘤的发病率似乎与白人相似，在日本黑色素瘤中占很大比例。由于缺乏关于日本黑色素瘤的发生、表现和生存率的基本信息，无法合理设计控制方案。本文提出了一些具体的研究问题。
