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Dysplastic Nevi in Association with Multiple Primary Melanoma

The Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06510 [L. T-E., P. L. H.]; the Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania [P. H. D.]; the Department of Medicine, University of Pittsburgh, and the Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213 [M. S. E., J. M. K.]; and Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06510 [R. L. B.]

Risk factors for multiple primary cutaneous melanoma were evaluated in a case-control study. Eight cases of multiple primary melanoma were matched on sex, age, and education to 24 first primary melanoma controls. Risk factors examined in the analysis included pigmentary characteristics, history of sun exposure, and nevi. The importance of histologically dysplastic nevi (DN) and clinically atypical nevi was of particular interest. Single-factor conditional logistic regression analysis showed that first primary melanoma patients with histological DN are at increased risk for a second primary (odds ratio, 6.2; 95% confidence interval, 1.2–33.4). Patients with two or more clinically atypical nevi also have elevated risk for a second primary (odds ratio, 8.8; 95% confidence interval, 1.0–80.7). Two-factor logistic models were used to evaluate the effect of histological DN while controlling single for all other variables as potential confounders. Odds ratios for the association of histological DN varied from 6.1 to 10.4 when adjusting singly for pigmentary and sun exposure variables. In the two-factor model that included histological and clinical DN, both variables retained marginally significant statistical association with primary melanoma. These results suggest that DN is a marker of increased risk for multiple primary melanoma and suggest that melanoma patients with evidence of DN should be followed closely for the development of additional primaries.

¹ To whom requests for reprints should be addressed, at Division of Medical Oncology, Pittsburgh Cancer Institute, 230 Lothrop Street, Pittsburgh, PA 15213.

Received 7/ 8/87. Revised 11/11/87. Accepted 11/12/87.

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