The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
Melanoma Institute Australia.
Br J Dermatol. 2024 Jan 23;190(2):174-183. doi: 10.1093/bjd/ljad275.
Compared with the general population, people with a previous melanoma are at increased risk of developing another primary melanoma. Understanding the risk factors associated with multiple primary melanomas can inform patient education and tailored surveillance.
To examine the risk factors for subsequent primary melanoma in people with a previous melanoma, by conducting a systematic review and meta-analysis of the available data.
A systematic literature search was conducted in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase and MEDLINE. Studies that reported a risk estimate or raw frequencies and conducted between 1982 and August 2022 were included. Adjusted risk estimates were prioritized over univariable risk estimates. PRISMA reporting guidelines were followed. Random effects meta-analysis was conducted to derive pooled estimates. Quality assessment was conducted by two researchers using the Newcastle-Ottawa scale. GRADE was used to rate the certainty and quality of the evidence.
Data from 27 studies involving 413 181 participants were pooled and analysed. Risk factors assessed included age and sex, environmental, lifestyle, phenotypic, genetic and histopathological factors, and there was wide variation in how they were categorized and analysed. Independent risk factors identified from pooled analyses included male sex [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.40-1.53], increasing age per 10 years (HR 1.19, 95% CI 1.14-1.24), light skin colour (HR 1.44, 95% CI 1.23-1.70), family history [odds ratio (OR) 1.79, 95% CI 1.25-2.56], CDKN2A mutation (OR 5.29, 95% CI 2.70-10.37), a high or moderate naevus count [OR 2.63 (95% CI 1.61-4.30) and OR 1.64 (95% CI 1.07-2.51), respectively], one or more atypical naevi (OR 3.01, 95% CI 1.52-5.97), first lesions occurring on the head or neck, lentigo maligna subtype (HR 1.16, 95% CI 1.15-1.17), other subtype (HR 1.14, 95% CI 1.03-1.27) and inadequate sun protection (HR 1.85, 95% CI 0.98-3.50). Based on the GRADE criteria, there was high to very low confidence in the pooled effect estimates.
This meta-analysis identified several consistent, independent risk factors for the development of subsequent primary melanoma. These findings will help stratify the risk of subsequent melanoma, tailor skin-check schedules and inform patient education.
与一般人群相比，患有黑色素瘤的人发生另一种原发性黑色素瘤的风险增加。了解与多发性原发性黑色素瘤相关的风险因素可以为患者教育和量身定制的监测提供信息。
通过对现有数据进行系统回顾和荟萃分析，探讨既往黑色素瘤患者发生后续原发性黑色素瘤的风险因素。
在 CINAHL、Cochrane 对照试验中心注册库（CENTRAL）、Embase 和 MEDLINE 中进行系统文献检索。纳入报告风险估计值或原始频率并于 1982 年至 2022 年 8 月间进行的研究。优先考虑调整后的风险估计值而不是单变量风险估计值。遵循 PRISMA 报告指南。采用随机效应荟萃分析得出汇总估计值。两位研究者使用纽卡斯尔-渥太华量表进行质量评估。使用 GRADE 评估证据的确定性和质量。
汇总并分析了来自 27 项研究、涉及 413181 名参与者的数据。评估的风险因素包括年龄和性别、环境、生活方式、表型、遗传和组织病理学因素，这些因素的分类和分析存在很大差异。荟萃分析确定的独立风险因素包括男性（风险比 [HR] 1.46，95%置信区间 [CI] 1.40-1.53）、每增加 10 岁（HR 1.19，95% CI 1.14-1.24）、浅色皮肤（HR 1.44，95% CI 1.23-1.70）、家族史（比值比 [OR] 1.79，95% CI 1.25-2.56）、CDKN2A 突变（OR 5.29，95% CI 2.70-10.37）、高或中度痣计数（OR 2.63 [95% CI 1.61-4.30] 和 OR 1.64 [95% CI 1.07-2.51]）、一个或多个不典型痣（OR 3.01，95% CI 1.52-5.97）、首次发病于头颈部、恶性雀斑样痣型（HR 1.16，95% CI 1.15-1.17）、其他型（HR 1.14，95% CI 1.03-1.27）和防晒不足（HR 1.85，95% CI 0.98-3.50）。根据 GRADE 标准，汇总效应估计的置信度很高至极低。
本荟萃分析确定了几个一致的、独立的后续原发性黑色素瘤发生风险因素。这些发现将有助于分层评估后续黑色素瘤的风险，调整皮肤检查计划，并为患者教育提供信息。
