Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
J Eur Acad Dermatol Venereol. 2019 Oct;33(10):1874-1885. doi: 10.1111/jdv.15680. Epub 2019 Jun 7.
People at high risk of developing melanoma are usually identified by pigmentary and naevus phenotypes.
We examined whether associations of these phenotypes with melanoma risk differed by ambient sun exposure or participant characteristics in two population-based, case-control studies with comparable ancestry but different ambient sun exposure.
Data were analysed from 616 cases and 496 controls from the Australian Melanoma Family Study and 2012 cases and 504 controls from the Leeds (UK) case-control study. Questionnaire, interview and dermatological skin examination data were collected using the same measurement protocols. Relative risks were estimated as odds ratios using unconditional logistic regression, adjusted for potential confounders.
Hair and skin colour were the strongest pigmentary phenotype risk factors. All associations of pigmentary phenotype with melanoma risk were similar across countries. The median number of clinically assessed naevi was approximately three times higher in Australia than Leeds, but the relative risks for melanoma associated with each additional common or dysplastic naevus were higher for Leeds than Australia, especially for naevi on the upper and lower limbs. Higher naevus counts on the head and neck were associated with a stronger relative risk for melanoma for women than men. The two countries had similar relative risks for melanoma based on self-reported naevus density categories, but personal perceptions of naevus number differed by country. There was no consistent evidence of interactions between phenotypes on risk.
Classifying people at high risk of melanoma based on their number of naevi should ideally take into account their country of residence, type of counts (clinical or self-reported), body site on which the naevus counts are measured and sex. The presence of naevi may be a stronger indicator of a genetic predisposition in the UK than in Australia based on less opportunity for sun exposure to influence naevus development.
通常通过色素和痣表型来识别易患黑色素瘤的人群。
我们在两个基于人群的病例对照研究中检查了这些表型与黑色素瘤风险的关联是否因环境阳光暴露或参与者特征而异，这两个研究具有相似的祖源但环境阳光暴露不同。
使用相同的测量方案，从澳大利亚黑色素瘤家族研究中的 616 例病例和 496 例对照以及利兹（英国）病例对照研究中的 2012 例病例和 504 例对照中分析数据。通过使用无条件逻辑回归，调整潜在混杂因素，使用优势比（OR）来估计相对风险。
头发和肤色是最强的色素表型危险因素。色素表型与黑色素瘤风险的所有关联在各国之间均相似。澳大利亚的临床评估痣数中位数约为利兹的三倍，但与每个额外常见或发育不良痣相关的黑色素瘤相对风险在利兹高于澳大利亚，尤其是在上肢和下肢的痣。头部和颈部的痣数量越多，女性发生黑色素瘤的相对风险越高。两国基于自我报告的痣密度类别，黑色素瘤的相对风险相似，但对痣数量的个人看法因国家而异。没有证据表明表型之间存在风险的相互作用。
基于痣的数量对黑色素瘤高风险人群进行分类，理想情况下应考虑到他们的居住国家、计数类型（临床或自我报告）、进行痣计数的身体部位以及性别。基于英国比澳大利亚阳光暴露机会较少，对痣发育的影响较小，痣的存在可能是遗传易感性的更强指标。
