RISK-FACTORS FOR CHILDHOOD MELANOMA IN QUEENSLAND, AUSTRALIA

The causes of cutaneous melanoma among children under 15 years are lar gely unknown. We report the findings of an epidemiological study of ch ildhood melanoma in Queensland, Australia, which has the highest incid ence rates in the world, All 61 cases of melanoma in children less tha n 15 years notified to the Queensland Cancer Registry 1987-1994 were e ligible to participate in a population-based, case-control study, Data were collected through structured, face-to-face interviews with paren ts and skin examinations of the 52 participating cases and 156 age- an d sex-matched controls, The strongest determinants of melanoma risk fo und among Queensland children were constitutional factors, including t he presence of more than 10 naevi greater than 5 mm in diameter (RR 9. 9, 95% CI 2.5-38.9), heavy facial freckling (RR 6.4, 95% CI 1.9-21.6), an inability to tan on exposure to the sun (RR 8.8, 95% CI 2.1-36.2) and a family history of melanoma (RR 4.2, 95% CI 1.9-9.3), These facto rs remained significantly associated with melanoma after adjusting for other risk factors. No measures of acute or chronic exposure to solar UV radiation were associated with childhood melanoma in our study. Es tablished risk factors, including giant congenital naevi and xeroderma pigmentosum, were not present among any of the children in the study. Melanoma in childhood appears to have similar epidemiologic character istics to the adult form of the disease, being associated with a clust er of phenotypic attributes indicating cutaneous sensitivity to the ef fects of sun exposure. Our findings support the contention that childh ood melanoma occurs in susceptible individuals with a low threshold fo r pigment cell tumorigenesis. From a public-health perspective, childr en at elevated risk for melanoma can be identified on the basis of phe notype and family history. (C) 1997 Wiley-Liss, Inc.