Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
J Am Acad Dermatol. 2019 Jan;80(1):139-148.e4. doi: 10.1016/j.jaad.2018.06.068.
Melanoma survivors are at high risk of further primary melanomas.
To assess sun behavior after melanoma diagnosis and in relation to further primary melanomas.
We applied repeated measures latent class analysis to reported primary prevention behavior at time of diagnosis and every 6 months for 2 years after diagnosis in patients with clinical stage IB or II melanoma. Correlates of behavior trajectories and risk of subsequent primaries were determined by using multivariable logistic and Cox regression analyses, respectively.
Among the 448 male and 341 female patients, sunscreen use fell into 3 trajectories: stable never-use (26% of males and 12% of females), stable sometimes-use (35% of males and 29% of females), and increased to often-use (39% of males and 59% of females). Most reduced their weekend sun exposure, but in 82% of males and 69% of females it remained increased. Males, smokers, the less educated, those who tanned, and those not self-checking their skin were more likely to have trajectories of inadequate protection. Patients with a history of melanoma before the study doubled their risk of another primary melanoma in the next 2 years if sunscreen use in that time was inadequate (hazard ratio, 2.45; 95% confidence interval, 1.00-6.06).
Patient-reported data are susceptible to recall bias.
Our results may assist clinicians in identifying patients not using adequate sun protection and providing information for patient counseling.
黑色素瘤幸存者有很高的罹患进一步原发性黑色素瘤的风险。
评估黑色素瘤诊断后的日晒行为与进一步原发性黑色素瘤之间的关系。
我们应用重复测量潜在类别分析，对临床分期 IB 或 II 期黑色素瘤患者在诊断时以及诊断后每 6 个月进行 2 年的原发性预防行为进行报告。使用多变量逻辑回归和 Cox 回归分析分别确定行为轨迹的相关性和随后原发性疾病的风险。
在 448 名男性和 341 名女性患者中，防晒霜的使用分为 3 种轨迹：稳定从不使用（26%的男性和 12%的女性）、稳定偶尔使用（35%的男性和 29%的女性）和增加至经常使用（39%的男性和 59%的女性）。大多数人减少了周末的日晒，但 82%的男性和 69%的女性仍增加了日晒。男性、吸烟者、受教育程度较低者、晒黑者和不自查皮肤者更有可能采取保护不足的轨迹。如果在此期间防晒霜使用不足，患有研究前黑色素瘤病史的患者在接下来的 2 年内再次发生原发性黑色素瘤的风险增加一倍（危险比，2.45；95%置信区间，1.00-6.06）。
患者报告的数据易受回忆偏倚的影响。
我们的研究结果可能有助于临床医生识别未使用足够防晒措施的患者，并为患者咨询提供信息。
