A pooled analysis of melanocytic nevus phenotype and the risk of cutaneous melanoma at different latitudes

Abstract

An abnormal nevus phenotype is associated with an increased risk of melanoma. We report a pooled analysis conducted using individual nevus data from 15 case-control studies (5,421 melanoma cases and 6,966 controls). The aims were to quantify the risk better and to determine whether relative risk is varied by latitude. Bayesian unconditional logistic random coefficients models were employed to study the risk associated with nevus characteristics. Participants with whole body nevus counts in the highest of 4 population-based categories had a greatly increased risk of melanoma compared with those in the lowest category (pooled odds ratio (pOR) 6.9 (95% confidence interval (CI): 4.4, 11.2) for those aged<50 years and pOR 5.1 (95% CI: 3.6, 7.5) for those aged>or=50). The pOR for presence compared with absence of any clinically atypical nevi was 4.0 (95% CI: 2.8, 5.8). The pORs for 1-2 and >or=3 large nevi on the body compared with none were 2.9 (95% CI: 1.9, 4.3) and 7.1 (95% CI: 4.7, 11.6), respectively. The relative heterogeneities among studies were small for most measures of nevus phenotype, except for the analysis of nevus counts on the arms, which may have been due to methodological differences among studies. The pooled analysis also suggested that an abnormal nevus phenotype is associated most with melanomas on intermittently sun-exposed sites. The presence of increased numbers of nevi, large nevi and clinically atypical nevi on the body are robust risk factors for melanoma showing little variation in relative risk among studies performed at different latitudes.

Figure 1

Forest plot of the association between the highest body naevus category and melanoma risks in (a) age < 50 subgroup, and (b) age ≥ 50 subgroup, and the highest arm naevus counts category and melanoma risks in (c) age < 50 subgroup, and (d) age ≥ 50 subgroup. Each line represents results from an individual study with the width of the horizontal line indicating the 95% Bayesian confidence intervals, and the squared box indicating the study-specific OR for the highest naevus count category (‘High’). Pooled ORs and 95% Bayesian confidence intervals are represented by grey diamonds.

Figure 2

Forest plot of the association between the number of palpable naevi on arms (a) 1–2 versus none, (b) ≥3 versus none and melanoma risks, and the number of large naevi on the whole body (c) 1–2 versus none, (d) ≥3 versus none and melanoma risks. Each line represents results from an individual study with the width of the horizontal line indicating the 95% Bayesian confidence intervals, and the squared box indicating the study-specific OR. Pooled ORs and 95% Bayesian confidence intervals are represented by grey diamond