Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi

Department of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy.
European Journal of Cancer (Impact Factor: 4.82). 02/2005; 41(1):28-44. DOI: 10.1016/j.ejca.2004.10.015
Source: PubMed

ABSTRACT A systematic meta-analysis of observational studies of melanoma and one of the most important risk factors, the number of naevi, was conducted in order to clarify aspects of the aetiology of this disease. Following a systematic literature search, relative risks (RRs) were extracted from 46 studies published before September 2002. Dose-response random effects models were used to obtain pooled estimates. Sub-group analysis and meta-regression were carried out to explore sources of between-study variation and bias. Sensitivity analyses investigated the reliability of the results and any publication bias. Number of common naevi was confirmed an important risk factor with a substantially increased risk associated with the presence of 101-120 naevi compared with <15 (pooled Relative Risk (RR) = 6.89; 95% Confidential Interval (CI): 4.63, 10.25) as was the number of atypical naevi (RR = 6.36 95%; CI: 3.80, 10.33; for 5 versus 0). The type of study and source of cases and controls were two study characteristics that significantly influenced the estimates. Case-control studies, in particular when the hospital was the source for cases or controls, appeared to present much lower and more precise estimates than cohort studies.

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Available from: Sara Gandini, Aug 26, 2015
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    • "As such, an accurate count can be performed by either the GP or the dermatologist, and an approximate count might even be carried out by the patient as selfscreening (Quéreux et al., 2011). Third, in our study involving a relatively large sample size of patients, the rule was predictive of a high TNC, which is one of the strongest risk factors for melanoma (Fig. 2) (Holman and Armstrong, 1984; Grob et al., 1990; Garbe et al., 1994; Gandini et al., 2005; Rhodes, 2006; MacKie et al., 2009; Stratigos and Katsambas, 2009). "
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    ABSTRACT: Patients with a high total nevus count (TNC) merit a total-body examination, but a simple strategy to identify these high-risk individuals is essentially missing. The aim of this study was to investigate the correlation between the number of melanocytic nevi on both arms and the TNC, and to evaluate patient variables that may have an effect on this association. In this multicenter, cross-sectional study, 2175 patients were examined and the mean number of arm nevi in relation to TNC was calculated. A mean value of fewer than 10 arm nevi was found in patients with TNC lower than 51 and a mean value of greater than 19 arm nevi was scored in patients with TNC greater than 50. These values remained unchanged after adjustment for various patient variables. In relation to TNC greater than 50, the presence of 20 or more arm nevi had specificity and negative predictive values of 95.2 and 89.6%, respectively. The sensitivity was 65.5% in patients younger than 50 years of age and 37.5% in the older age group. The number of arm nevi was significantly higher in individuals with a history of melanoma and in those with a melanoma detected during the study period. The presence of 20 or more nevi on the arms is an independent predictor of a high TNC and risk of melanoma. This sign thus represents a simple and rapid screening tool for either the primary care physician or the dermatologist to help identify high-risk patients.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 09/2014; 23(5):458-63. DOI:10.1097/CEJ.0000000000000053 · 2.76 Impact Factor
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    • "Patients were classified according to light or non-light skin color, light (blue/green) or dark (brown/black) eye color and light (red/blond) or dark (brown/ black) natural hair color. The numbers of nevi over the entire skin surface of patients were classified as none (0), few (1–20), moderate (21–50), and many (>50) [42]. Freckles were classified as none/few (limited to a single body part) and moderate/many (more than two body areas) [43]. "
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    ABSTRACT: The P53 Arg72Pro, MDM2 c.+309T>G, BAX c.-248G>A, and BCL2 c.-717C>A polymorphisms have variable roles in the apoptosis pathways. To clarify the roles of these polymorphisms in the risk for cutaneous melanoma (CM). Genomic DNA of 200 CM patients and 215 controls was analyzed by PCR-RFLP. In women, the frequencies of BAX GG (83.0% vs. 71.0%, P=0.04), BCL2 AA (32.0% vs. 15.0%, P=0.003), P53 ArgArg plus BAX GG (84.9% vs. 63.2%, P=0.01), P53 ArgArg plus BCL2 AA (37.0% vs. 13.1%, P=0.003), BAX GG plus BCL2 AA (70.3% vs. 33.3%, P=0.001), MDM2 GG plus BAX GG plus BCL2 AA (27.3% vs. 3.7%, P=0.03), and P53 ArgArg plus MDM2 GG plus BAX GG plus BCL2 AA (33.3% vs. 5.6%, P=0.04) genotypes were higher in patients than in controls. Female carriers of the respective genotypes were under 1.98 (95% CI: 1.01-3.91), 2.87 (95% CI: 1.43-5.77), 3.48 (95% CI: 1.34-9.04), 4.23 (95% CI: 1.63-10.96), 6.04 (95% CI: 2.10-17.37), 25.61 (95% CI: 1.29-507.24), and 25.69 (95% CI: 1.11-593.59)-fold increased risks for CM than others, respectively. In men, the frequencies of BCL2 CA+AA (83.0% vs. 67.6%, P=0.01) and MDM2 TG+GG plus BCL2 CA+AA (94.2% vs. 68.3%, P=0.003) genotypes were higher in patients than in controls. Male carriers of the respective genotypes were under 2.43 (95% CI: 1.23-4.82) and 9.22 (95% CI: 2.16-39.31)-fold increased CM risks than others, respectively. The data suggest for the first time that P53 Arg72Pro, MDM2 c.+309T>G, BAX c.-248G>A, and BCL2 c.-717C>A polymorphisms, enrolled in apoptosis pathways, constitute distinct determinants of CM in women and men.
    Journal of dermatological science 01/2014; DOI:10.1016/j.jdermsci.2013.12.010 · 3.34 Impact Factor
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    • "Fair skin subjects are more likely to get melanomas compared to darker skin types and this may be the strongest piece of evidence linking UV sensitivity with melanoma from epidemiology studies. However, the risk associated with sunburns and fair skin is small with risk factors in the order of 1.5–2 compared to relative risks of 5–30 for multiple atypical naevi without or with family of melanoma respectively [12] [13]. "
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    ABSTRACT: There are many observations regarding the behaviour of melanoma which points away from sunshine as the main cause of this tumour. Incidence data shows that the increase is mostly seen for thin melanomas which cannot be attributed to sun exposure but increasing screening over the last 20years. Melanoma behaves in a similar fashion all over the world regarding age of onset, gender differences and histological subtypes. An excess of naevi is the strongest risk factor for melanoma and their appearance and involution throughout life, and the differences in naevus distribution according to gender is giving us a lot of clues about melanoma biology. Melanoma like all cancers is a complex disease with the involvement of many common and low penetrance genes many of them involved in pigmentation and naevogenesis but these only explain a very small portion of melanoma susceptibility. Genes involved in melanocyte differentiation early on in embryogenesis are also becoming relevant for melanoma initiation and progression. Reduced senescence and longevity as well as body weight and energy expenditure are also relevant for melanoma susceptibility. These observations with links between melanoma and non-sun related phenotypes as well as gene discoveries should help to assess the relative contribution of genetic and environmental factors in its causation.
    Medical Hypotheses 06/2013; 81(5). DOI:10.1016/j.mehy.2013.05.031 · 1.07 Impact Factor
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