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Endometriosis History Linked to Increased Melanoma Risk
Patients with a history of endometriosis or uterine fibromas may benefit from annual skin exams.
Previous case-control studies suggested an association between endometriosis and melanoma, but the small number of melanomas threw doubt on the significance of the data. A link between melanoma and another disease is clinically relevant by identifying a particular population in whom close screening is warranted.
Investigators prospectively studied risk for melanoma in 98,995 women teachers (age, 40–65) who were enrolled in the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale study in France between February 1, 1989, and November 30, 1991. These women, who are covered by a national health plan, have been surveyed every 2 years since entry into the cohort. Women who never menstruated (n=30), those with cancers at baseline other than basal cell epithelioma (5516), and those lost to follow-up (1484) were excluded from this analysis, leaving 91,965 subjects.
A total of 363 primary melanomas were identified during a median follow-up of 12 years, with pathology reports available for review in 97.8%. A personal history of endometriosis was significantly associated with the risk for melanoma (relative risk, 1.62), as was history of uterine fibroma (RR, 1.33). However, there was no statistical association between melanoma risk and ovarian cyst, uterine polyp, breast adenoma/fibroadenoma, or breast fibrocystic disease. Endometriosis was significantly associated with red hair, and although fair-complected women and those with blond, red, or chestnut hair were more likely to have melanoma, these characteristics were no longer significant on multivariate analysis. Neither body-mass index nor education level was significantly related to melanoma risk.
The authors speculate that the associated risk derives from an allelic imbalance of tumor-suppressor genes that predisposes to both endometriosis and melanoma. They also hypothesize that the link could represent a hormonal effect, because both diseases occur more frequently in nulliparous and pauciparous women. The researchers found no relation between melanoma risk and use of hormonal therapy.
Comment: Patients with a history of endometriosis had a significantly increased risk for melanoma. Should this finding prompt a more careful screening of such patients? The answer may be yes, because diagnosis of early melanoma is believed to produce a better chance of cure with simple excision. Although the risk in a given individual is statistically increased, it remains relatively low. Nevertheless, it seems reasonable to alert primary care physicians, including gynecologists, to this finding and to conduct annual complete skin examinations in patients with such history.
Published in Journal Watch Dermatology November 21, 2007
Citation(s):
Kvaskoff M et al. Personal history of endometriosis and risk of melanoma in a large prospective cohort of French women. Arch Intern Med 2007 Oct 22; 167:2061.
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