Risk Factors for Malignant Melanoma in White and Non-White/Non–African American Populations: The Multiethnic Cohort

Abstract

It is unknown whether the established risk factors for malignant melanoma in whites influence malignant melanoma risk in non-whites. We examined the risk factors for melanoma among 39,325 whites and 101,229 non-whites/multiracials (Japanese American [47.5%], Latino American [34.8%], Native Hawaiian [2.1%] and multiracial [15.6%], excluding African Americans) in the Multiethnic Cohort study. With an average follow-up of 12.7 years, 581 invasive malignant melanoma (IMM) and 412 melanoma in situ (MIS) cases were identified, of which 107 (IMM) and 74 (MIS) were among non-whites/multiracials. The relative risks (RRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards models using days from cohort entry as the underlying time variable. Among non-white/multiracial males, location of IMM tumors differed from those of white males (p<0.001); and non-white/multiracial females were more likely to be diagnosed with later stage of disease (p<0.001). After adjusting for potential confounders, age at cohort entry, male sex, higher education, and sunburn susceptibility phenotypes were associated with an increased risk of invasive malignant melanoma in non-whites/multiracials (p<0.05). The risk estimates for age at cohort entry and lighter hair and eye color were greater in non-whites/multiracials than in whites (p-heterogeneity=0.062, 0.016, and 0.005, respectively). For MIS risk, RRs between whites and non-whites/multiracials also differed for study location and education (p-heterogeneity ≤ 0.015). In conclusion, similar to whites, age at cohort entry, male sex, and susceptibility to sunburn phenotypes may be predictive of malignant melanoma risk in non-white populations excluding African-Americans.

Socioeconomic and lifestyle factors and melanoma: a systematic review

“…While SES has an established relationship with melanoma, three U.S. studies and two international studies provide grade B evidence that high SES and melanoma incidence may be unrelated . An Australian study published in 2011 notes that areas of disadvantage had higher incidence of melanoma among women only .…”

“…[8][9][10][11][15][16][17][18][19][20][21][22]24,25,[27][28][29][30][31][32][33][34]37 While SES has an established relationship with melanoma, three U.S. studies and two international studies provide grade B evidence that high SES and melanoma incidence may be unrelated. 12,14,23,39,40 An Australian study published in 2011 notes that areas of disadvantage had higher incidence of melanoma among women only. 13 Of note, a Canadian study from 2007 observed that higher SES populations have higher incidence; however, rural environments also have higher incidence.…”

Evolved adaptation to low ultraviolet radiation may be the main cause of malignant melanoma independent of high ultraviolet radiation levels

“…6. The C43 incidence rates vary between geographical areas, with the highest rates in Europe [33,51,62] and in countries with the greatest proportion of European descendants [6,11,[63][64][65]. Therefore, we have constructed the following two further variables concerning populations of European origin/ descendants.…”

Dermatology in the North American Indian/Alaska Native population

“…11,17,18 A limited number of studies have confirmed some of these risk factors in non-white populations. 16,17 Risk factors for melanoma have not been explored in the AIAN population specifically, although possible risk factors may be gleaned from previous studies. Wu et al showed that rates of melanoma increased with age and were higher for males in the AIAN population, as for all other racial groups.…”