RISK OF CUTANEOUS MELANOMA IN A COHORT OF INFERTILE WOMEN

We assessed the risk of cutaneous malignant melanoma associated with t he presence of ovulatory abnormalities and with the use of ovulation-i nducing agents (such as clomiphene citrate) in a cohort of 3,837 women evaluated at infertility clinics in Seattle, WA, between 1974 and 198 5, Computer linkage with a population-based tumour registry was used t o identify women diagnosed with melanoma before 1992, Data regarding i nfertility testing and treatment were abstracted from the infertility clinic medical records for women who developed cancer and a randomly s elected subcohort. Twelve women in the cohort developed cutaneous mali gnant melanoma, in comparison with an expected number of 6.8 cases (st andardized incidence ratio = 1.8; 95% confidence interval (CI) 0.9-3.1 ). Within the cohort, risk was increased among women who had used clom iphene during 12 or more menstrual cycles (relative risk = 2.2; 95% CI 0.5-10.2), All four of the women with this duration of clomiphene use who developed melanoma had ovulatory abnormalities, and three had als o used human chorionic gonadotropin (HCG). No elevation in risk associ ated with the presence of ovulatory abnormalities was observed in the absence of at least 12 cycles of clomiphene exposure; also, there was no increased risk associated with long-term use of clomiphene among wo men without ovulatory abnormalities, but the number of such women was very small, Thus, it is not certain to what extent the observed increa sed risk of melanoma in this cohort (if not due to chance) may be attr ibutable to the use of clomiphene or HCG, or is a reflection of some u nderlying hormonal abnormality for which the drug was administered.