Elsevier

European Journal of Cancer

Volume 41, Issue 14, September 2005, Pages 2040-2059
European Journal of Cancer

Review
Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors

https://doi.org/10.1016/j.ejca.2005.03.034Get rights and content

Abstract

A systematic meta-analysis of observational studies of melanoma and family history, actinic damage and phenotypic factors was conducted as part of a comprehensive meta-analysis of all major risk factors for melanoma. Following a systematic literature search, relative risks were extracted from 60 studies published before September 2002. Fixed and random effects models were used to obtain pooled estimates for family history (RRĀ =Ā 1.74, 1.41ā€“2.14), skin type (I vs. IV: RRĀ =Ā 2.09, 1.67ā€“2.58), high density of freckles (RRĀ =Ā 2.10, 1.80ā€“2.45), skin colour (Fair vs. Dark: RRĀ =Ā 2.06, 1.68ā€“2.52), eye colour (Blue vs. Dark: RRĀ =Ā 1.47, 1.28ā€“1.69) and hair colour (Red vs. Dark: RRĀ =Ā 3.64, 2.56ā€“5.37), pre-malignant and skin cancer lesions (RRĀ =Ā 4.28, 2.80ā€“6.55) and actinic damage indicators (RRĀ =Ā 2.02, 1.24ā€“3.29). Sub-group analysis and meta-regression were carried out to explore sources of between-study variation and bias. Sensitivity analyses investigated reliability of results and publication bias. Latitude and adjustment for phenotype were two study characteristics that significantly influenced the estimates.

Introduction

This is the third and last part of a systematic meta-analysis on all published studies until September 30, 2002. All main risk factors for melanoma were investigated and results on naevi and sun exposure were published in previous papers 1, 2. In the present work, family history, actinic damage indicators and the remaining phenotypic factors were considered.

At this time, family history is considered one of the most important risk factors for cutaneous malignant melanoma and researches into potential melanoma susceptibility genes are ongoing [3]. Approximately 8ā€“12% of melanoma patients have a family history [4].

Cutaneous lesions, which may be considered indicators of acute and chronic exposure to UV radiations, were included as photodamage indicators. Actinic keratoses are also called solar keratoses because they indicate that sun damage has occurred. They are precursors of skin carcinomas, which means they can be the first morphological step in the development of skin cancer. It is estimated that up to 10% of active lesions will take the next step and progress to squamous cell carcinoma. In particular we analysed solar lentigo, actinic keratosis, solar elastosis and presence of skin carcinoma.

Several phenotypic characteristics were also analysed (hair colour, eye colour, skin colour, presence of freckles and photo-type), trying to investigate interrelationships and associations with the evaluation of adjustment for reciprocal effect.

Most of the evidence relevant to these factors comes from observational studies in humans, and most of these studies were case-control. Several methodological problems may bias the association between these risk factors and melanoma risk. A deep exploration of heterogeneity between study and possible sources of bias has been carried out searching for significant differences by study features, definitions adopted, characteristics of the populations and of the types of analyses.

Section snippets

Definition of outcome and exposures

The outcome of this systematic meta-analysis was histologically confirmed melanoma.

Selection of articles

Data searches were conducted on Medline (National Library of Medicine, Bethesda USA), using the PubMed interrogation interface, and EMBASE (Elsevier Science, Amsterdam, Holland) using OVID, as in the meta-analysis on naevi count [1]. The reference lists of the retrieved articles and preceding reviews 14, 15 on the topic were also checked. No language or time restrictions were applied.

Primary inclusion criteria, developed for the selection of all relevant articles, consider original independent

Discussion

In the two previous meta-analyses 1, 2, naevi counts and sun exposure experiences have been investigated with all heterogeneity factors. This meta-analysis considered the remaining important risk factors for melanoma. It was decided to avoid the evaluation of risk factors mentioned in certain publications where highly contradictory evidence of an effect was reported, such as sunscreen [56] and oral contraceptives 57, 58. These two risk factors were investigated in two recently published

Conflict of interest statement

The authors have no conflict of interest to disclose.

Acknowledgement

It is a pleasure to acknowledge that his work was conducted within the framework of support of Italian Ministry for University and Scientific and Technological Research (MURST) (ā€œMinistero Istruzione Universit Ć” e Ricercaā€), as part of the project ā€œPNR per le Tecnologie in oncologia. Tema 2 1998: Sviluppo di metodologie innovative per la prevenzione (primaria e secondaria) delle neoplasieā€, Grant No. 66002 received by the Laboratory of Clinical Epidemiology of ā€œIstituto Dermopatico

References (113)

  • E.A. Holly

    A number of melanocytic nevi as a major risk factor for malignant melanoma

    J Am Acad Dermatol

    (1987)
  • R. Zanetti et al.

    Cutaneous melanoma and sunburns in childhood in a southern European population

    Eur J Cancer

    (1992)
  • C. Garbe et al.

    Risk factors for developing cutaneous melanoma and criteria for identifying persons at risk: multicenter case-control study of the Central Malignant Melanoma Registry of the German Dermatological Society

    J Invest Dermatol

    (1994)
  • C.B. Begg et al.

    Familial aggregation of melanoma risks in a large population-based sample of melanoma cases

    Cancer Causes Control

    (2004)
  • J.E. Manson et al.

    The case for a comprehensive national campaign to prevent melanoma and associated mortality

    Epidemiology

    (2000)
  • T.B. Fitzpatrick

    The validity and practicality of sun-reactive skin types I through VI

    Arch Dermatol

    (1988)
  • S. Greenland

    Quantitative methods in the review of epidemiologic literature

    Epidemiol Rev

    (1987)
  • SAS Institute Inc. SAS Windows version (8.02), Cary, NC;...
  • J.B. Copas et al.

    A sensitivity analysis for publication bias in systematic reviews

    Stat Meth Med Res

    (2001)
  • C.B. Begg et al.

    Operating characteristics of a rank correlation test for publication bias

    Biometrics

    (1994)
  • M. Egger et al.

    Bias in meta-analysis detected by a simple, graphical test

    BMJ

    (1997)
  • H.C. van Houwelingen et al.

    Advanced methods in meta-analysis: multivariate approach and meta-regression

    Stat Med

    (2002)
  • Y.T. Chen et al.

    Malignant melanoma risk factors by anatomic site: a case-control study and polychotomous logistic regression analysis

    Int J Cancer

    (1996)
  • D. Ford et al.

    Risk of cutaneous melanoma associated with a family history of the disease. The International Melanoma Analysis Group (IMAGE)

    Int J Cancer

    (1995)
  • J.M. Bliss et al.

    Risk of cutaneous melanoma associated with pigmentation characteristics and freckling: systematic overview of 10 case-control studies. The International Melanoma Analysis Group (IMAGE)

    Int J Cancer

    (1995)
  • D.C. Whiteman et al.

    Risk factors for childhood melanoma in Queensland, Australia

    Int J Cancer

    (1997)
  • P. Youl et al.

    Melanoma in adolescents: a case-control study of risk factors in Queensland, Australia

    Int J Cancer

    (2002)
  • Grob JJ, Stern RS, McKie RM, et al. IARC monographs on the evaluation of carcinogenic risks to humans ā€“ solar and...
  • R. Gallagher et al.

    Sun exposure and the epidemiology of malignant melanoma

  • M. Cockburn et al.

    Determinants of melanoma in a case-control study of twins (United States)

    Cancer Causes Control

    (2001)
  • A. Green et al.

    Common acquired naevi and the risk of malignant melanoma

    Int J Cancer

    (1985)
  • E.A. Holly et al.

    Cutaneous melanoma in women II. Phenotypic characteristics and other host-related factors

    Am J Epidemiol

    (1995)
  • A.J. Swerdlow et al.

    Benign melanocytic naevi as a risk factor for malignant melanoma

    Br Med J (Clin Res Ed)

    (1986)
  • S.D. Walter et al.

    The association of cutaneous malignant melanoma with the use of sunbeds and sunlamps

    Am J Epidemiol

    (1990)
  • S.D. Walter

    Small sample estimation of log odds ratios from logistic regression and fourfold tables

    Stat Med

    (1985)
  • A. Green et al.

    A case-control study of melanomas of the soles and palms (Australia and Scotland)

    Cancer Causes Control

    (1999)
  • D.H. Moore et al.

    Case-control study of malignant melanoma among employees of the Lawrence Livermore National Laboratory

    Am J Ind Med

    (1997)
  • A. Osterlind et al.

    The Danish case-control study of cutaneous malignant melanoma. I. Importance of host factors

    Int J Cancer

    (1988)
  • C.D. Holman et al.

    Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: an analysis separating histogenetic types

    J Natl Cancer Inst

    (1984)
  • A.A. Marghoob et al.

    Risk of cutaneous malignant melanoma in patients with ā€˜classicā€™ atypical-mole syndrome. A case-control study

    Arch Dermatol

    (1994)
  • A.C. Halpern et al.

    Dysplastic nevi as risk markers of sporadic (nonfamilial) melanoma. A case-control study

    Arch Dermatol

    (1991)
  • N. Dubin et al.

    Epidemiology of malignant melanoma: pigmentary traits, ultraviolet radiation, and the identification of high-risk populations

    Recent Results Cancer Res

    (1986)
  • J.M. Elwood

    Malignant melanoma in relation to moles, pigmentation and exposure to fluorescent and other lighting sources

    Br J Cancer

    (1986)
  • L.D. Marrett et al.

    Use of host factors to identify people at high risk for cutaneous malignant melanoma

    CMAJ

    (1992)
  • A.E. Grulich et al.

    Naevi and pigmentary characteristics as risk factors for melanoma in a high-risk population: a case-control study in New South Wales, Australia

    Int J Cancer

    (1996)
  • E. White et al.

    Case-control study of malignant melanoma in Washington State. I. Constitutional factors and sun exposure

    Am J Epidemiol

    (1994)
  • R.P. Gallagher et al.

    Risk factor for cutaneous malignant melanoma in the Western Canada Melanoma Study

    Recent Results Cancer Res

    (1986)
  • J.M. Elwood et al.

    Malignant melanoma in England: risks associated with naevi, freckles, social class, hair colour, and sunburn

    Int J Epidemiol

    (1990)
  • A. Pfahlberg et al.

    Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma

    Br J Dermatol

    (2001)
  • A.R. Shors et al.

    Melanoma risk in relation to height, weight, and exercise (United States)

    Cancer Causes Control

    (2001)
  • Cited by (0)

    View full text