Elwood J M, Gallagher R P, Hill G B, Spinelli J J, Pearson J C, Threlfall W
Br Med J (Clin Res Ed). 1984 Jan 14;288(6411):99-102. doi: 10.1136/bmj.288.6411.99.
Between 1 April 1979 and 31 March 1981, 904 residents of the four western provinces of Canada (population 6.5 million), were diagnosed as suffering from primary cutaneous malignant melanoma. Of 801 patients aged 20-79 years, 665 (83%) were interviewed along with control subjects chosen at random from the general population and matched for age, sex, and province. After exclusion of 70 subjects with lentigo maligna or acral lentiginous melanoma, comparisons of the 595 case-control pairs showed that light hair, skin, and eye colour, a history of heavy freckling in adolescence, and a tendency to burn readily and tan poorly in the sun were significant risk factors for melanoma. The strongest primary associations were with blond hair (relative risk 7.1 compared with black hair), light colour of unexposed skin (relative risk 2.4), and severe freckling (relative risk 2.1). These associations were independent of ethnic origin and of recorded amount of exposure to the sun and were somewhat stronger for superficial spreading than for nodular melanoma. This study is the largest and most detailed of an incident series of melanomas to be published to date. The results were consistent with other studies reporting associations between melanoma and poor tanning ability, a tendency to burn easily, and a history of sunburn and showed that light hair colour was the strongest risk factor for the disease.
1979年4月1日至1981年3月31日期间，加拿大西部四个省份（人口650万）的904名居民被诊断患有原发性皮肤恶性黑色素瘤。在801名年龄在20至79岁之间的患者中，665名（83%）接受了访谈，同时从普通人群中随机选取对照对象，并按照年龄、性别和省份进行匹配。在排除70名患有恶性雀斑样痣或肢端雀斑样黑色素瘤的受试者后，对595例对照配对进行比较，结果显示浅色头发、皮肤和眼睛颜色、青春期重度雀斑病史以及在阳光下容易晒伤且不易晒黑的倾向是黑色素瘤的重要危险因素。最强的主要关联是与金色头发（与黑色头发相比，相对风险为7.1）、未暴露皮肤的浅色（相对风险为2.4）以及重度雀斑（相对风险为2.1）。这些关联与种族起源以及记录的日照暴露量无关，并且对于浅表扩散型黑色素瘤而言，关联程度略强于结节型黑色素瘤。这项研究是迄今为止已发表的黑色素瘤发病系列中规模最大、最详细的一项。研究结果与其他报道黑色素瘤与晒黑能力差、容易晒伤的倾向以及晒伤病史之间关联的研究一致，并且表明浅色头发是该疾病最强的危险因素。
