Primary tumor sites in relation to ultraviolet radiation exposure and skin visibility correlate with survival in cutaneous melanoma

Abstract

The prognostic value of detailed anatomic site and ultraviolet radiation (UVR) exposure patterns has not been fully determined in cutaneous melanoma. Thus, we reviewed medical records for detailed site in a population-based retrospective Swedish patient cohort diagnosed with primary invasive melanoma 1976-2003 (n = 5,973). We followed the patients from date of diagnosis until death, emigration or December 31 2013, and evaluated melanoma-specific survival by subsite in a multivariable regression model adjusting for established prognostic factors. We found that melanoma on chronic UVR exposure sites (face, dorsum of hands; adjusted HR 0.6; CI 0.4-0.7) and moderately intermittent UVR sites (lateral arms, lower legs, dorsum of feet; HR 0.7; CI 0.6-0.8) were associated with a favorable prognosis compared with highly intermittent sites (chest, back, neck, shoulders and thighs). Further, melanoma on poorly visible skin sites upon self-examination (scalp, retroauricular area, back, posterior upper arms and thighs, buttocks, pubic area; HR 1.3; CI 1.1-1.5) had a worse prognosis than those on easily visible sites (face, chest, abdomen, anterior upper arms and thighs, lower arms and legs, dorsum of hands and feet, palms). In conclusion, highly intermittent UVR exposure sites and poor skin visibility presumably correlate with reduced melanoma survival, independent of established tumor characteristics. A limitation of the study was the lack of information on actual individual UVR exposure.

Ultraviolet light and melanoma

“…There is a need to understand whether molecularly defined subtypes are associated with specific biological mechanisms of disease, and particularly whether environmental UVR contributes differentially to the different types, to enable stratification of patients for appropriate therapy and to provide accurate sun safety advice. Epidemiological studies suggest that different patterns and extent of sun exposure, are associated with different driver mutations in melanoma and, potentially, different rates of survival . Chronic exposure to UVR is highly correlated with mutational load within the epidermis , and recent data suggest that patients with melanomas with a higher mutation burden are more likely to respond to novel immunotherapies .…”

Public Interest in a Potentially Harmful, Non–Evidence-Based “Wellness” Practice: Cross-Sectional Analysis of Perineum Sunning

“…Short-term effects are sunburn (ranging from solar erythema to vesiculation/bullae formation) and tanning. Long-term effects include photoaging and UV-induced tumor formation [ 9 , 10 ]. It is well known that UV exposure is the most obvious risk factor for cutaneous malignancies such as melanoma, basal cell carcinoma, and squamous cell carcinoma [ 11 ].…”

“…It is well known that UV exposure is the most obvious risk factor for cutaneous malignancies such as melanoma, basal cell carcinoma, and squamous cell carcinoma [ 11 ]. To make matters worse, melanomas in less visible areas, such as the buttocks and perineum, have worse prognosis independent of tumor characteristics and visibility on self-skin examinations [ 10 ]. Furthermore, perineum skin is still vulnerable to risk of sunburn and, over time, cancer formation.…”

A Review of Exogenous Factors Implicated in the Induction of Cutaneous Melanoma

“…Additional confusion arises from clinical research suggesting that "sun exposure" in light skinned individuals "prone to tanning" (phototype II --"unexposed skin is white, Blue, hazel or brown eyes Red, blonde or brown hair, European/Scandinavian, phototype III --"Unexposed skin is fair, Brown eyes, Dark hair, Southern or Central European") may actually be protective against the incidence of melanoma. 48,49 The link between UVR exposure and realized UVR exposure is mediated by absorption ability, specifically relative concentrations of pheomelanin and eumelanin. Pheomelanin and eumelanin are melanin subtypes linked to differential expression of the melanocortin-1 receptor (MC1R).…”