Elsevier

Survey of Ophthalmology

Volume 49, Issue 4, July–August 2004, Pages 419-428
Survey of Ophthalmology

Public health and the eye
Sunlight exposure and pathogenesis of uveal melanoma

https://doi.org/10.1016/j.survophthal.2004.04.009Get rights and content

Abstract

Uveal melanoma is the most frequent primary malignant intraocular tumor of adults. Among various non-modifiable risk factors, Caucasian race seems to be the most significant with light skin color, blond hair, and blue eyes being specific risk factors. The racial predisposition to uveal melanoma have been explained on the basis of susceptibility of Caucasian race to oncogenic effects of sunlight. Although there is ample evidence in support of this hypothesis in regard to skin melanoma, the evidence in regard to uveal melanoma is insufficient and contradictory. In the following review, we examine physiologic, epidemiological, and genetic data in order to determine the role of sunlight exposure in the pathogenesis of uveal melanoma.

Section snippets

Ultraviolet light

The sun is the major source of electromagnetic radiation reaching our atmosphere. The majority of solar electromagnetic radiation that passes through the earth's atmosphere falls in the visible spectrum (400–700 nm).43 Wavelengths of light smaller than the visible spectrum are termed ultraviolet light (UV) (Fig. 1). The UV light spectrum is divided into three groups: A, B, and C, from longer to smaller wavelength. The UV-A light (315–400 nm) is not absorbed by the ozone layer, whereas UV-B

Epidemiological studies

The relationship of sunlight and UV light exposure and occurrence of uveal melanoma has been evaluated in a few case-control studies (Table 1, Table 2). The case-control studies have inherent methodological limitations as such studies rely on questionnaires about lifestyle and exposures that occurred many years before the onset of disease (in this case uveal melanoma) and are subject to recall bias.71 Recall bias probably occurs because persons with a given disease are prone to think about and

Xeroderma pigmentosum

Xeroderma pigmentosum is an autosomal recessive, precancerous disorder due to defective nucleotide excision repair mechanism. The nucleotide excision repair mechanism specifically protects against mutations caused by environmental carcinogens such as UV light. Xeroderma pigmentosum serves as a model for ultraviolet light–induced carcinogenesis.16

In a review of published descriptions of 830 patients with xeroderma pigmentosum,41 45% of the patients had basal cell carcinoma or squamous cell

Oncogenicity of ultraviolet light

The incidence of cutaneous melanoma has increased about 15 times over the last 60 years.58There is strong epidemiological evidence that increase in the incidence of cutaneous melanoma is related to excessive intermittent exposure to the sunlight. A systematic review of published case-control studies revealed a significant positive association (OR = 1.71) for intermittent sun exposure but a weaker association for total sun exposure (OR = 1.18).14 Exposure to high levels of sunlight in childhood may

Conclusions

Following a critical review of the physiologic, epidemiological, and genetic data, it can be concluded that the current data are incomplete and conflicting, but rudimentary case-control study results suggest that a potential role of sunlight exposure in pathogenesis of uveal melanoma cannot be completely discounted and that further investigations are necessary.

Method of literature search

Medline-based literature search was performed with key words sunlight, ultraviolet light, and uveal melanoma for the years 1966–2002. Abstracts of the articles published in English language and English translation of the abstracts published in other languages were reviewed for relevance. Additional articles and books were consulted following review of relevant articles.

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