Sabine Krüger

Markers and Relative Risk in a German Population for Developing Malignant Melanoma

ABSTRACT: The relationship between cutaneous malignant melanoma (MM) and possible risk factors was assessed in a case‐controlled study. Two hundred patients and 200 non‐melanoma controls of German origin matched for age and sex were interviewed and examined for pigmented moles and pigmentation characteristics. In patients with MM significantly more melanocytic nevi ≥ 2 mm (MCN) were found (mean, 53 MCN) compared to control cases (mean, 18 MCN). For persons with >60 MCN the relative risk (RR) for developing MM increased 15 times compared to ≤ MCN. Additional independent markers for an increased risk were presence of atypical MCN (RR = 7 vs. none) found in 45% of patients and in 5% of the control group, moderate to large numbers of actinic lentigines (RR = 6.2 vs. none), and lack of tanning as well as a tendency to sunburn (skin type I; RR = 2.2 vs. skin type IV) No significant correlation was found between the relative risk for MM and hair color, eye color, duration of free time sun exposure and number of sunburns. Individuals with permanent outdoor profession and sun exposure, however, showed a clearly increased relative risk for developing MM.

Epidemiologic evidence for the role of melanocytic nevi as risk markers and direct precursors of cutaneous malignant melanoma: Results of a case control study in melanoma patients and nonmelanoma control subjects

BACKGROUND Melanocytic nevi (MN) are markers of melanoma risk, but their potential role as precursors of cutaneous malignant melanoma (CMM) is still controversial. OBJECTIVE The overall and site-specific relative risk (RR) of developing CMM was evaluated according to site-specific MN counts. METHODS MN prevalence by anatomic site and by age was compared in 200 CMM patients and in 200 nonmelanoma control subjects; RRs were calculated. RESULTS In CMM patients both MN and CMM were mainly found on the legs in women and on the posterior trunk in men, whereas in the control subjects most MN were found on the arms. MN counts on the trunk in men and on the legs in women were best predictors of the overall CMM risk (RR: 33-fold and 15-fold, respectively, for greater than 20 vs up to 4 MN). For both genders combined, the RR for CMM developing on the trunk and legs (predominant CMM locations) was best predicted by MN counts in the respective body region (RR: 24-fold and 27-fold, respectively). MN prevalence peaked in the fourth to fifth decade of life and most CMM were diagnosed during the fifth and sixth decades. CONCLUSION The site-specificity of melanoma risk found for high MN counts on the trunk and the legs and the close similarities in age distribution suggest that the role of MN as direct precursors of CMM has been underestimated and exceeds the number of histologically evident MN associated with CMM.

The German Melanoma Registry and Environmental Risk Factors Implied

There is no nationwide, population-based cancer registry in the Federal Republic of Germany (FRG). Only the cancer registry of the federal state of Saarland, a region with about 1 000 000 inhabitants bordering on France, has reliably documented the incidence of malignant melanoma in western Germany. The annual incidence of melanoma registered for this region in the mid-1980s was 6/10 0000 inhabitants for both sexes (age-adjusted for the European standard population) (Garbe et al. 1986). The increase in the incidence of melanoma in the 1970s documented by the Saarland cancer registry suggested that the incidence would double every 15 years (Garbe et al. 1986). This rate of increase is in good agreement with data from the two internationally longest existing cancer registries in Denmark and Connecticut (USA) (Houghton et al. 1980). However, the question arises whether the data from the Saarland cancer registry and the melanoma incidence derived from this more rural area are representative for the entire FRG. Another drawback of the Saarland cancer registry is that only the diagnoses were registered, without detailed information on histologic subtypes and other histologic or prognostic parameters and without documentation of possible risk factors for developing melanoma.