Hiatt R A, Fireman B
Prev Med. 1986 Nov;15(6):652-60. doi: 10.1016/0091-7435(86)90070-8.
We investigated the hypothesis that the increased incidence of malignant melanoma at the Lawrence Livermore National Laboratory (LLNL) in California was associated with a difference in medical care received by its employees compared with that received by other residents of the same geographic area. From records of the Kaiser Permanente Medical Care Program, to which about half of the LLNL employees belonged, we confirmed that the incidence of melanoma at the laboratory was 3.2 times that among members served by the Kaiser Permanente medical center in Walnut Creek, a nearby community (95% CI, 1.7-6.0). Rates of biopsy showing junctional, compound, and dermal nevi in men were also higher in the LLNL employees than in the other health-plan members (relative risks, 3.2, 2.4, and 1.3, respectively). When LLNL employees without melanoma were compared with community controls, we found that the employees had substantially more skin biopsies. Although the excess number of skin biopsies existed among LLNL employees before publicity about the problem, this excess increased after the publicity. Exposure to some environmental agent(s) or personal risk factors may have caused clinically suspicious pigmented lesions that required LLNL employees to have more skin biopsies. On the other hand, awareness of the laboratory's excess melanoma incidence may have increased physicians' propensity to obtain biopsy specimens of pigmented lesions.
加利福尼亚州劳伦斯利弗莫尔国家实验室（LLNL）恶性黑色素瘤发病率的增加，与其员工所接受的医疗护理与同一地理区域其他居民所接受的医疗护理存在差异有关。从凯泽永久医疗保健计划的记录中（约一半的LLNL员工属于该计划），我们证实该实验室黑色素瘤的发病率是附近社区核桃溪市凯泽永久医疗中心服务的成员发病率的3.2倍（95%可信区间，1.7 - 6.0）。LLNL员工中男性显示交界痣、混合痣和皮内痣的活检率也高于其他健康计划成员（相对风险分别为3.2、2.4和1.3）。当将没有患黑色素瘤的LLNL员工与社区对照组进行比较时，我们发现员工进行的皮肤活检显著更多。尽管在关于这个问题的宣传之前，LLNL员工中就存在皮肤活检数量过多的情况，但宣传之后这种过量情况有所增加。接触某些环境因素或个人风险因素可能导致了临床上可疑的色素沉着病变，这使得LLNL员工需要进行更多的皮肤活检。另一方面，对该实验室黑色素瘤发病率过高的认识可能增加了医生获取色素沉着病变活检标本的倾向。
