Green A, McCredie M, Giles G, Jackman L
Epidemiology and Population Health Unit, Queensland, Institute of Medical Research, PO Royal Brisbane Hospital, Australia.
Melanoma Res. 1996 Oct;6(5):387-94. doi: 10.1097/00008390-199610000-00006.
In view of the changing trends in the incidence of melanoma at different body sites and in particular on the limbs, the detailed distributions of over 10,000 invasive melanomas diagnosed on the upper and lower limbs in residents of mainland eastern Australia between 1987 and 1993 were examined. Cancer notifications and histopathology reports from the cancer registries of Queensland, New South Wales and Victoria were searched manually, and subsites when specified were recorded as shoulder, upper arm, forearm, elbow, wrist or hand, and thigh, leg, knee, ankle or foot. On the upper limbs relative tumour densities were highest on the shoulder, approximately equal on the upper arm and forearm and least on the hand in both men and women; on the lower limbs melanomas occurred more than twice as often on the leg than on the thigh or the foot, taking account of surface area. There was a clear inverse gradient of incidence of melanoma with latitude in the three eastern Australian states studied, but little difference between the states or between sexes in distribution of histological type: the majority specified being specified as superficial spreading melanomas. In contrast to predictions based on apparent frequency of sun exposure at subsites on the upper limbs, the relative concentration of melanomas on the shoulder suggests that wearing sleeveless garments outdoors in the sun should be avoided whenever possible. Also, the similar densities of leg and forearm melanomas seems inconsistent with the relative degree of exposure of each and further suggests that women's adoption of ankle-length skirts or trousers, in preference to knee-length skirts would be a worthwhile modern control measure.
鉴于黑色素瘤在不同身体部位尤其是四肢的发病率变化趋势，我们研究了1987年至1993年间澳大利亚东部大陆居民中10000多例上肢和下肢诊断为侵袭性黑色素瘤的详细分布情况。手动检索了昆士兰州、新南威尔士州和维多利亚州癌症登记处的癌症通知和组织病理学报告，并将指定的亚部位记录为肩部、上臂、前臂、肘部、腕部或手部，以及大腿、小腿、膝盖、脚踝或足部。在上肢，男性和女性的相对肿瘤密度在肩部最高，在上臂和前臂大致相等，在手部最低；在下肢，考虑到表面积，小腿上发生黑色素瘤的频率是大腿或足部的两倍多。在所研究的澳大利亚东部三个州，黑色素瘤发病率与纬度呈明显的反向梯度，但在组织学类型分布上，各州之间或男女之间差异不大：大多数被指定为浅表扩散型黑色素瘤。与基于上肢亚部位明显日晒频率的预测相反，肩部黑色素瘤的相对集中表明应尽可能避免在户外阳光下穿着无袖服装。此外，小腿和前臂黑色素瘤的相似密度似乎与各自的相对暴露程度不一致，这进一步表明女性选择穿及踝长裙或长裤而非及膝短裙是一项值得的现代预防措施。
