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JNCI Journal of the National Cancer Institute 2003 95(23):1801-1802; doi:10.1093/jnci/djg128
© 2003 by Oxford University Press
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© 2003 Oxford University Press

CORRESPONDENCE

RESPONSE: Re: Melanocytic Nevi, Solar Keratoses, and Divergent Pathways to Cutaneous Melanoma

David C. Whiteman, Peter Watt, David M. Purdie, Maria Celia Hughes, Nicholas K. Hayward, Adèle C. Green

Affiliation of authors: Division of Population Studies and Human Genetics, Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Brisbane, Queensland, Australia.

Correspondence to: David C. Whiteman, MBBS, PhD, Division of Population Studies and Human Genetics, Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia (e-mail: daveW{at}qimr.edu.au)

We note with interest the findings of Carli and Palli, which replicate our observations (1) that patients with melanomas of the head and neck were older and were statistically significantly less likely to have numerous nevi than patients with truncal melanoma. Patients in this Italian study were not originally selected with the specific intention of testing the divergent pathway hypothesis; nevertheless, particular aspects of the study design serve to strengthen our belief that the observed effects are real. For example, all nevus counts were performed by dermatologists trained in the recognition of pigmented skin lesions. Moreover, given that this analysis was conceived and conducted long after data collection was completed, it is unlikely that nevus counts of patients were biased by the dermatologists awareness of the sites of melanomas. The investigators also adjusted for the effects of age and sex on melanoma risk, thereby reducing the likelihood that confounding could explain their findings.

These observations therefore lend support to the notion that cutaneous melanomas at different body sites may arise through different causal pathways. We await further testing of the divergent pathway hypothesis through epidemiologic and experimental studies.

REFERENCE

1 Whiteman DC, Watt P, Purdie DM, Hughes MC, Hayward NK, Green AC. Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma. J Natl Cancer Inst 2003;95:806–12.[Abstract/Free Full Text]


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Related Correspondence

Re: Melanocytic Nevi, Solar Keratoses, and Divergent Pathways to Cutaneous Melanoma
Paolo Carli and Domenico Palli
J Natl Cancer Inst 2003 95: 1801. [Extract] [Full Text] [PDF]




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