Public health and the eyeSunlight exposure and 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.
References (96)
- et al.
Epidemiologic aspects of uveal melanoma
Surv Ophthalmol
(1988) - et al.
Benign nevi and malignant melanomas of the choroid
Am J Ophthalmol
(1973) - et al.
Ocular spectral characteristics as related to hazards from lasers and other light sources
Am J Ophthalmol
(1968) - et al.
Amelanotic metastatic melanoma in a patient with oculocutaneous albinism
J Am Acad Dermatol
(1993) - et al.
The color of the human eye: a review of morphologic correlates and of some conditions that affect iridial pigmentation
Surv Ophthalmol
(1997) - et al.
N-ras mutations are common in melanomas from sun-exposed skin of humans but rare in mucosal membranes or unexposed skin
J Invest Dermatol
(1998) - et al.
Choroidal melanoma in an African-American albino
Am J Ophthalmol
(1996) - et al.
Association between iris color and iris melanocytic lesions
Am J Ophthalmol
(1985) - et al.
Supranuclear melanin caps reduce ultraviolet induced DNA photoproducts in human epidermis
J Invest Dermatol
(1998) - et al.
Malignant melanoma in xeroderma pigmentosum patients: report of five cases
Eur J Surg Oncol
(1997)
Incidence of surgically treated uveal melanoma by race and ethnicity
Ophthalmology
Retinal pigment epithelial cell count, distribution, and correlations in normal human eyes
Am J Ophthalmol
Ocular effects of various laser wavelengths
Surv Ophthalmol
Melanin
Int J Biochem Cell Biol
Color as a risk factor in iris melanoma
Am J Ophthalmol
Incidence of uveal melanoma in the United States: 1973–1997
Ophthalmology
Ultraviolet A and melanoma: a review
J Am Acad Dermatol
Malignant melanoma of the choroid and the ciliary body 1956–1975 in Halland and Gothenburg. Incidence, histopathology and prognosis
Acta Ophthalmol (Copenh)
Occupation and risk of uveal melanoma. An exploratory study
Cancer
Conjunctival malignant melanoma with xeroderma pigmentosum
Ophthalmologica
Incidence of uveal melanoma in Sweden from 1960 to 1998
Invest Ophthalmol Vis Sci
Ocular melanoma: a population-based study
Can J Ophthalmol
Uveal melanoma in Asian Indians: a clinicopathological study
Arch Ophthalmol
Transmission of ocular media
Invest Ophthalmol
Comparison of the site distribution of melanoma in New Zealand and Canada
Int J Cancer
Choroidal malignant melanoma in an albino
Br J Ophthalmol
Epidemiology of ocular melanoma. Incidence and geographic relationship in Ohio (1967–1977)
Ohio State Med J
Analysis of n- and k-ras mutations in the distinctive tumor progression phases of melanoma
J Invest Dermatol
Uveal melanoma: is solar ultraviolet radiation a risk factor?
Ophthalmic Epidemiol
Melanoma and sun exposure: an overview of published studies
Int J Cancer
Wavelength dependence of pyrimidine dimer formation in DNA of human skin irradiated in situ with ultraviolet light
Proc Natl Acad Sci USA
How nucleotide excision repair protects against cancer
Nat Rev Cancer
Risk factors for ocular melanoma: Western Canada Melanoma Study
J Natl Cancer Inst
The pathogenesis of melanoma induced by ultraviolet radiation
N Engl J Med
Malignant melanoma of the uvea in Iceland 1955–1979
Acta Ophthalmol (Copenh)
Occupational risk factors, ultraviolet radiation, and ocular melanoma: a case-control study in France
Cancer Causes Control
Cancer of the eye, a review of trends and differentials
World Health Stat Q
Activated ras. Yet another player in melanoma?
Am J Pathol
Intraocular melanoma linked to occupations and chemical exposures
Epidemiology
Uveal melanoma in relation to ultraviolet light exposure and host factors
Cancer Res
Melanocytes and iris color. Electron microscopic findings
Arch Ophthalmol
Posterior uveal malignant melanoma: temporal stability and ethnic variation in rates in Israel
Anticancer Res
An epidemiological study of posterior uveal melanoma in Israel, 1961–1989
Int J Cancer
Malignant melanomas of the uvea in Denmark 1943–1952
Acta Ophthalmol
Malignant melanoma of the iris. A 25-year analysis of Danish cases
Eur J Ophthalmol
Malignant melanoma of the iris in xeroderma pigmentosum
Arch Ophthalmol
[Malignant ophthalmic tumors]
Nippon Rinsho
Xeroderma pigmentosum. Cutaneous, ocular, and neurologic abnormalities in 830 published cases
Arch Dermatol
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2018, Human Pathology: Case ReportsErratum: The genetic basis of uveal melanoma (Journal Francais d'Ophtalmologie (2015) 38:6 (516-21))
2015, Journal Francais d'OphtalmologieCitation Excerpt :The clinical phenotype of the BAP1-hereditary cancer predisposition syndrome (MIM 614327) includes UM, CM, renal cell carcinoma (RCC), mesothelioma and melanocytic atypical intradermal tumors (MBAITs). Other tumors reported in BAP1 families include lung adenocarcinoma, basal cell carcinoma, ovarian, pancreas and breast cancer [25,27,28,30–34]. Patients presenting with metastatic disease have a higher frequency of germline BAP1 mutations, suggesting that UM is more aggressive in these patients [32].
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The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article