Bataille V, Bishop J A, Sasieni P, Swerdlow A J, Pinney E, Griffiths K, Cuzick J
ICRF Skin Tumour Laboratory, London Hospital Medical College, UK.
Br J Cancer. 1996 Jun;73(12):1605-11. doi: 10.1038/bjc.1996.302.
The atypical mole syndrome (AMS) phenotype, characterised by a large number of common naevi as well as atypical naevi, has been described in families with a genetic susceptibility to melanoma. However, the importance of this phenotype for melanoma in the general population has not been conclusively determined. This study was designed to examine the types and distribution of naevi as well as the prevalence of the AMS phenotype in melanoma patients in England compared with controls. A total of 426 cutaneous melanoma cases (61% of all incident cases) aged 16-75 years were recruited between 1989 and 1993 from the north-east Thames region of the UK and 416 controls from the same age group were recruited over the same period and from the same region. Each subject answered a questionnaire covering demographic details, sun exposure history and other risk factors and underwent a skin examination with total body naevus count performed by a dermatologist. The AMS phenotype was defined using a scoring system. Atypical naevi gave the highest relative risk for cutaneous melanoma, with an odds ratio (OR) of 28.7 (P < 0.0001) for four or more atypical naevi compared with none. Many common naevi were also an important risk factor: the OR for 100 or more naevi 2 mm or above in diameter compared with 0-4 naevi was 7.7 (P < 0.0001). Melanoma was also associated with naevi on sun-exposed sites but also with naevi on non-sun-exposed sites such as the dorsum of the feet, buttocks and anterior scalp. Sixteen per cent of the cases had the AMS phenotype compared with 2% of the controls (OR 10.4, P < 0.0001). The AMS phenotype was more common in males than females (P = 0.008). The odds ratio for the presence of the AMS phenotype was dependent on age, with an odds ratio of 16.1 (95% CI 4.6-57.5) for the presence of the AMS phenotype if aged less than 40 compared with an odds ratio of 6.9 (95% CI 2.9-16.6) if aged 40 or more. The AMS phenotype was strongly predictive of an increased risk of melanoma outside the familial context.
非典型痣综合征（AMS）的表型特征为大量普通痣以及非典型痣，在对黑色素瘤具有遗传易感性的家族中已有描述。然而，该表型对普通人群黑色素瘤的重要性尚未得到最终确定。本研究旨在比较英国黑色素瘤患者与对照组中痣的类型和分布以及AMS表型的患病率。1989年至1993年期间，从英国泰晤士河东北地区招募了426例年龄在16至75岁之间的皮肤黑色素瘤病例（占所有新发病例的61%），并在同一时期从同一地区招募了416名同年龄组的对照。每位受试者回答了一份涵盖人口统计学细节、阳光暴露史和其他危险因素的问卷，并接受了皮肤科医生进行的全身痣计数皮肤检查。AMS表型使用评分系统进行定义。非典型痣对皮肤黑色素瘤的相对风险最高，与无非典型痣相比，四个或更多非典型痣的优势比（OR）为28.7（P < 0.0001）。许多普通痣也是一个重要的危险因素：直径2毫米或以上的100个或更多痣与0至4个痣相比，优势比为7.7（P < 0.0001）。黑色素瘤还与阳光暴露部位的痣有关，但也与非阳光暴露部位如脚背、臀部和头皮前部的痣有关。16%的病例具有AMS表型，而对照组为2%（OR 10.4，P < 0.0001）。AMS表型在男性中比女性更常见（P = 0.008）。AMS表型存在的优势比取决于年龄，年龄小于40岁时AMS表型存在的优势比为16.1（95%CI 4.6 - 57.5），而年龄在40岁或以上时为6.9（95%CI 2.9 - 16.6）。在家族背景之外，AMS表型强烈预示黑色素瘤风险增加。
