Bain C, Colditz G A, Willett W C, Stampfer M J, Green A, Bronstein B R, Mihm M C, Rosner B, Hennekens C H, Speizer F E
Channing Laboratory, Harvard Medical School, Boston, MA 02115.
Am J Epidemiol. 1988 Apr;127(4):703-12. doi: 10.1093/oxfordjournals.aje.a114851.
The relation of the presence of moles (nevi) on all four limbs to risk of cutaneous malignant melanoma was explored among 98 incident cases aged 32-59 years at diagnosis and 190 age-matched controls drawn from the Nurses' Health Study, a prospective cohort of female nurses in the United States. Cases diagnosed during follow-up from 1976 to 1982 were included in this study. Participants reported counts of all moles and raised moles alone on postal questionnaires. Distributions of moles were similar for right and left sides on upper and lower limbs for cases and controls. Counts declined with increasing age for all women, from a median of 15 for the youngest tertile of controls (aged 36-46 years) to three for the oldest (aged 54-62 years). Cases had more moles than did controls (medians of 23 and 9, respectively, for total moles on all four limbs): The presence of any mole on a limb gave relative risks for melanoma ranging from 2.2 (95% confidence interval (CI) = 1.2-4.0) for one or more moles on an arm to 2.9 (95% CI = 1.6-5.3) for one or more moles on the lower limb. For raised moles, relative risks were 1.7 (95% CI = 1.0-2.7) for arm, 2.1 (95% CI = 1.3-3.5) for lower limb, and 3.5 (95% CI = 2.0-6.3) for leg (below knee). The highest site-specific risk (i.e., for any moles on the same limb as the melanoma vs. no moles on that limb) was for moles on the lower limb (relative risk = 5.0 (95% CI = 1.8-13.5)). There were positive and significant trends in overall and site-specific risk with increasing numbers of moles on all limbs when absolute mole counts were considered, e.g., for total moles on all four limbs combined, chi for trend = 4.0, one-sided p less than 0.001, with relative risk for more than 100 moles versus none of 6.0. Inclusion of sun exposure and other constitutional factors in logistic regression analyses did not alter these observed relations between the presence of moles and risk of melanoma.
在美国护士健康研究（一项针对美国女性护士的前瞻性队列研究）中，对98例诊断时年龄在32 - 59岁的皮肤恶性黑色素瘤新发病例和190名年龄匹配的对照者，探讨了四肢痣（黑素细胞痣）的存在与皮肤恶性黑色素瘤风险之间的关系。本研究纳入了1976年至1982年随访期间诊断出的病例。参与者通过邮政问卷报告所有痣以及仅凸起痣的数量。病例组和对照组上下肢左右两侧痣的分布相似。所有女性的痣数量均随年龄增长而减少，对照组最年轻三分位数（年龄36 - 46岁）的中位数为15个，最年长三分位数（年龄54 - 62岁）为3个。病例组的痣比对照组多（四肢所有痣的总数中位数分别为23个和9个）：肢体上有任何一个痣，黑色素瘤的相对风险范围为：手臂上有一个或多个痣时为2.2（95%置信区间（CI）= 1.2 - 4.0），下肢为2.9（9５% CI = 1.6 - 5.3）。对于凸起痣，手臂的相对风险为1.7（95% CI = 1.0 - 2.7），下肢为2.1（95% CI = 1.3 - 3.5），小腿（膝盖以下）为3.5（95% CI = 2.0 - 6.3）。特定部位的最高风险（即与黑色素瘤在同一肢体上有任何痣与该肢体无痣相比）是下肢的痣（相对风险 = 5.0（95% CI = 1.8 - 13.5））。当考虑痣的绝对数量时，所有肢体上痣的数量增加，总体和特定部位的风险呈正且显著的趋势，例如，对于四肢所有痣的总数，趋势检验卡方值 = 4.0，单侧p值小于0.001，有超过100个痣相对于没有痣的相对风险为6.0。在逻辑回归分析中纳入阳光暴露和其他体质因素并未改变观察到的痣的存在与黑色素瘤风险之间的这些关系。
