Kwa Michael, Ravi Manisha, Elhage Kareem, Schultz Lonni, Lim Henry W
Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA.
Department of Dermatology, Boston University, Boston, Massachusetts, USA.
J Eur Acad Dermatol Venereol. 2025 Jul;39(7):1239-1253. doi: 10.1111/jdv.20316. Epub 2024 Sep 4.
Within the last two decades, no studies have comprehensively reviewed the risk of varying types of ultraviolet (UV) exposure on melanoma in fairer skinned individuals. Our research objective was to determine whether or not there was a change in the risk of UV exposure with development of melanoma in Fitzpatrick skin types I-IV based on more recent data over the past 20 years. We performed a systematic review from January 2002 to December 2021 analysing UV exposure and melanoma risk in Fitzpatrick type I-IV individuals. Out of 19,852 studies, 26 met inclusion criteria. Data spanned subjects from national and multinational cohorts (USA, Europe, Australia, Asia and South America). Twenty studies (77%, 20/26) identified a significant association between UV exposure and melanoma incidence. Sunburn was the most commonly assessed risk factor. Sunburn studies encompassed 3417 melanoma and found positive significant odds ratios (OR [95% CI]) in 11 out of 13 studies, ranging from 1.23 [1.01-1.49] to 8.48 [4.35-16.54]. Pooled analysis of the risk of melanoma with sunburn history found an unadjusted odds ratio of 1.66 [1.40-1.97] and adjusted odds ratio of 1.23 [1.04-1.46]. Cumulative sun exposure, measured as number of hours of sun exposure or calculated UV flux, was the second most common risk factor, encompassing 913 melanomas with positive significant ORs ranging from 1.1 [1.0-1.2] to 5.2 [2.1-12.5]. For other forms of UV exposure, a majority of studies showed an association with UV index (6/9), outdoor leisure activity (3/3) and left-sided laterality (1/1). Overall, UV exposure should continue to be considered a modifiable risk factor for melanoma in individuals of fairer skin.
在过去二十年中，尚无研究全面综述不同类型紫外线（UV）暴露对皮肤较白个体患黑色素瘤风险的影响。我们的研究目的是根据过去20年的最新数据，确定在菲茨帕特里克皮肤分型I-IV型中，随着黑色素瘤的发生，紫外线暴露风险是否发生变化。我们于2002年1月至2021年12月进行了一项系统综述，分析菲茨帕特里克I-IV型个体的紫外线暴露与黑色素瘤风险。在19852项研究中，26项符合纳入标准。数据涵盖来自国家和跨国队列（美国、欧洲、澳大利亚、亚洲和南美洲）的受试者。20项研究（77%，20/26）确定紫外线暴露与黑色素瘤发病率之间存在显著关联。晒伤是最常评估的风险因素。晒伤研究涉及3417例黑色素瘤，13项研究中有11项发现显著的阳性比值比（OR [95% CI]），范围从1.23 [1.01-1.49]到8.48 [4.35-16.54]。对有晒伤史的黑色素瘤风险进行汇总分析，发现未调整的比值比为1.66 [1.40-1.97]，调整后的比值比为1.23 [1.04-1.46]。累积日照量，以日照小时数或计算出的紫外线通量衡量，是第二常见的风险因素，涉及913例黑色素瘤，阳性显著OR范围从1.1 [1.0-1.2]到5.2 [2.1-12.5]。对于其他形式的紫外线暴露，大多数研究显示与紫外线指数（6/9）、户外休闲活动（3/3）和左侧偏侧性（1/1）有关联。总体而言，紫外线暴露应继续被视为皮肤较白个体患黑色素瘤的一个可改变的风险因素。
