A recent report from Koomen and colleagues in the Annals of Oncology  has reopened the discussion on the association between the development of cutaneous melanoma (CM) and hormones.
The paper reports on a case–control study conducted in the Netherlands using two databases: PHARMO, a pharmacy database recording all prescriptions on an individual basis, and PALGA, the Dutch nationwide registry of histo- and cytopathology. The authors linked both databases for the use of oral contraception and hormone replacement therapy (HRT) (for at least 6 months) and a diagnosis of primary cutaneous melanoma. Inclusion criteria were women ≥ 18 years, complete records for the 3 years before CM diagnosis, and diagnosis of CM between 1991 and 2004. From 2053 female subjects with a CM diagnosis, 778 cases were included and matched with 4072 controls on age and geographical region. The mean ages of cases and controls were 53.6 and 54.6 years, respectively. Estrogens were used by 25.8% of the cases and 19.7% of the controls; dividing the data by use of oral contraceptives or HRT, oral contraceptives were used by 21.5% of the cases and 17.7% of the controls, and HRT was used by 4.2% of the cases and 2% of the controls.
CM risk was significantly associated with estrogen use (adjusted odds ratio (OR) 1.42; 95% confidence interval (CI) 1.19–1.69). This effect was cumulative dose-dependent (p trend < 0.001). CM risk was also significantly associated with the use of HRT (OR 2.08; 95% CI 1.37–3.14) and oral contraceptives (OR 1.28; 95% CI 1.06–1.54).
Unité de Gynécologie Endocrinienne, Hôpital Hôtel-Dieu, Université Paris Descartes, Paris, France
Service de Dermatologie , Hôpital Cochin, Université Paris Descartes, Paris, France
Koomen ER, Joosse A, Herings RM, Casparie MK, Guchelaar HJ, Nijsten T. Estrogens, oral contraceptives and hormonal replacement therapy increase the incidence of cutaneous melanoma: a population-based casecontrol study. Ann Oncol 2009;20:358-64. Published February 2009.
Pfahlberg A, Hassan K, Wille L, Lausen B, Gefeller O. Systematic review of case-control studies: oral contraceptives show no effect on melanoma risk. Public Health Rev 1997;25:309-15.
Karagas MR, Stukel TA, Dykes J, et al. A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use. Br J Cancer 2002;86:1085-92.
Osterlind A, Tucker MA, Stone BJ, Jensen OM. The Danish case-control study of cutaneous malignant melanoma. III. Hormonal and reproductive factors in women. Int J Cancer 1988;42:821-4.
Smith MA, Fine JA, Barnhill RL, Berwick M. Hormonal and reproductive influences and risk of melanoma in women. Int J Epidemiol 1998;27:751-7.
Lea CS, Holly EA, Hartge P, et al. Reproductive risk factors for cutaneous melanoma in women: a case-control study. Am J Epidemiol 2007;165:505-13.
Karagas MR, Zens MS, Stukel TA, et al. Pregnancy history and incidence in melanoma in women : a pooled analysis . Cancer Causes Control 2006;17:11-19.
de Giorgi V, Mavilia C, Massi D, et al. Estrogen receptor expression in cutaneous melanoma: a real-time reverse transcriptase-polymerase chain reaction and immunohistochemical study. Arch Dermatol 2009;145:30-6.
Asqari MM, Marati SS, White E, et al. A large cohort study of nonsteroidal anti-inflammatory drug use and melanoma incidence. J Natl Cancer Inst 2008;100:967-71.