revious studies have shown population-specific differences in pigmentation phenotype between males and females regarding phototype, tanning ability, and eye color. [1][2][3][4][5] Recently, a Spanish group described a stronger effect of melanocortin-1-receptor (MC1R) variants on skin phototype in females compared with males 6 : in females, MC1R variants were associated with lower phototypes compared with male carriers of the same variants. This finding is of interest because MC1R is known to be highly polymorphic-with more than 80 variants described-and is the main regulator of pigmentation phenotype, including hair color, skin pigmentation, and sun sensitivity at the same time. [7][8][9][10] Activation and subsequent signaling of this G-protein coupled receptor result in 2 different types of melanin: the lighter, yellowreddish pheomelanin and the darker, brown to black eumelanin. The ratio of eumelanin and pheomelanin is determined by the variants an individual carries and results in particular phenotypes. Variants that were found to be associated with red hair and fair skin were classified as "R" (high-risk) and "r" (lowrisk) variants. These variants also have been well described as being associated with melanoma risk, which is plausible owing to less effective protection of pheomelanin against UV radiation 7,8,10-12 as well as pro-oxidant properties. Only recently, MC1R red hair variants were associated with melanoma, even independent of sun exposure. 13 Differences between the sexes do not affect only skin pigmentation. There are also differences in age at onset, incidence rates, site of tumor occurrence, and survival between male and female patients with melanoma. [14][15][16][17][18][19] Despite these well-acknowledged differences, an explanation for those differences is still missing. It thus seems of particular interest to elucidate the role of genetic risk factors (eg, MC1R) and melanoma risk in males and females separately to better understand possible underlying sex-dependent differences in mela-IMPORTANCE Recently, the red hair variants of MC1R were found to contribute differently to pigmentation phenotype in males and females.OBJECTIVE To investigate the role of these variants in melanoma risk in males and females separately because carriers of the red hair variants of MC1R are at increased risk of melanoma.
DESIGN, SETTING, AND PARTICIPANTSIn this hospital-based, case-control study, we evaluated the effect of MC1R and melanoma risk for males and females separately by performing multivariate logistic regression analyses.
MAIN OUTCOMES AND MEASURES Association of MC1R variants and melanoma risk in males and females.RESULTS A total of 905 females (473 melanoma cases, 432 controls) and 886 males (518 melanoma cases, 368 controls) were included in the analyses. The mean (SD) age of the study population was 59.2 (15.6). In females, carrying any MC1R red hair variants remained an independent risk factor of melanoma in a multivariable analysis (adjusted odds ratio [OR], 2.19 [95% CI, 1.60-2.99]), whereas in...