CORRESPONDENCE

Re: A Prospective Study of Pigmentation, Sun Exposure, and Risk of Cutaneous Malignant Melanoma in Women

Mathieu Boniol, Philippe Autier, Jean-François Doré

Affiliations of authors: Division of Epidemiology, University of Minnesota, Minneapolis (DL, CS); Dermatoepidemiology Unit, Department of Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital and Brown University, Providence (MAW); Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (MB).

Correspondence to: DeAnn Lazovich, PhD, Division of Epidemiology, University of Minnesota, 1300 S. 2nd Ave., #300, Minneapolis, MN 55454 (e-mail: lazovich{at}epi.umn.edu)

Results of the prospective cohort study of host and environmental factors and risk of cutaneous melanoma recently reported by Veierød et al. (1) not only suggest that solarium use is a risk factor for melanoma but may also provide evidence in support of current hypotheses of melanoma etiology. On the one hand, it has been suggested that sun exposure and host susceptibility factors play different roles in the etiology of melanoma depending on the age at which an individual develops melanoma. For example, melanomas that arise in individuals younger than 50 years are preferentially localized to body sites that are the most likely to be intermittently exposed to sunlight (i.e., the trunk and legs) and are the superficial spreading type, whereas melanomas that arise in individuals older than 50 years are frequently located on body surfaces that are chronically exposed to sunlight (i.e., the face and neck) and are of the lentigo maligna type, which are widely accepted as being caused by chronic sunlight exposure (2). Host susceptibility factors are likely to promote the development of melanoma at an earlier age. For example, the median age at diagnosis of invasive melanoma is 11–16 years younger for members of families prone to cutaneous malignant melanoma or dysplastic nevus syndrome than it is for sporadic melanomas (3). Furthermore, pigmentation factors (i.e., skin phototype, hair color) are more strongly associated with melanomas that arise in individuals younger than 50 years than those that arise in individuals older than 50 years (4), whereas individual susceptibility to UVB radiation is manifest only in patients younger than 40 years (5). On the other hand, it has recently been postulated that cutaneous melanomas may arise through two pathways: one pathway is associated with melanocyte proliferation and melanocytic nevi, and the other pathway is associated with chronic exposure to sunlight but not with nevi (6).

We hypothesize that individuals who had an initial exposure to UV radiation in childhood and/or adolescence and have high susceptibility to UV radiation will develop melanomas at a relatively young age and typically on the trunk following intermittent UV exposure as an adult. Such a susceptibility to UV radiation could be associated with a high nevus count. By contrast, we hypothesize that individuals without high susceptibility to UV radiation will develop melanomas only after chronic, cumulative UV exposure and, hence, at a more advanced age, on a part of the body that is chronically exposed to sunlight (i.e., head and neck), and that those melanomas will be of the lentigo maligna type and not associated with nevi.

UV exposure via solarium use is typically an intermittent exposure. Thus, it would be of interest to test the hypothesis that melanomas that develop in solarium users are more frequently associated with a higher nevus number than melanomas that develop in nonusers by analyzing the study cohort described by Veierød et al. (1), which included nearly a million person-years of a relatively young population with a complete follow-up and histopathologic confirmation of all incident melanoma cases. We further predict that melanomas in solarium users would be preferentially localized to anatomic sites that are usually intermittently exposed (i.e., the trunk).

Our hypothesis, if confirmed, would have a major public health impact because it predicts that the risk of melanoma associated with solarium use would be greatest among young populations with high individual susceptibility to UV radiation. It would therefore be important to discourage the use of a solarium or any device that emits artificial UV light by people with host susceptibility factors such as melanocytic nevi.

NOTES

Supported by a fellowship from Fondation De France (to MB).

REFERENCES

1 Veierød MB, Weiderpass E, Thorn M, Hansson J, Lund E, Armstrong B, et al. A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women. J Natl Cancer Inst 2003;95:1530–8.[Abstract/Free Full Text]

2 Elwood JM, Gallagher RP. Body site distribution of cutaneous malignant melanoma in relationship to patterns of sun exposure. Int J Cancer 1998;78:276–80.[CrossRef][ISI][Medline]

3 Goldstein AM, Fraser MC, Clark WH Jr, Tucker MA. Age at diagnosis and transmission of invasive melanoma in 23 families with cutaneous malignant melanoma/dysplastic nevi. J Natl Cancer Inst 1994;86:1385–90.[Abstract]

4 Boniol M, Sallin J, Dore JF. Time trends of cutaneous melanoma in Queensland, Australia and Central Europe. Cancer 2002;94:1902–3.[CrossRef][ISI][Medline]

5 Pedeux R, Boniol M, Autier P, Dore JF. Re: DNA repair, dysplastic nevi, and sunlight sensitivity in the development of cutaneous malignant melanoma. J Natl Cancer Inst 2002;94:772–3; author reply 773–4.[Free Full Text]

6 Whiteman DC, Watt P, Purdie DM, Hughes MC, Hayward NK, Green AC. Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma. J Natl Cancer Inst 2003;95:806–12.[Abstract/Free Full Text]



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