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Divergent cancer pathways for early-onset and late-onset cutaneous malignant melanoma
Cancer, 06/29/09

Anderson WF et al. - In a trial to discern the timing and/or age of exposure for cutaneous malignant melanomas (CMM), current results were consistent with a divergent and age-dependent solar hypothesis for CMM. Early-onset melanomas may represent gene-sun exposure interactions that occur early in life among susceptible individuals. Late-onset melanomas may reflect accumulated, lifelong sun exposure in comparatively less susceptible individuals.

• Effect of aging on CMM incidence were systematically examined in data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.
• Standard descriptive epidemiology was supplemented with mathematical models.
• Impact of advancing age on CMM incidence was assessed by sex, histopathologic classification (superficial spreading melanoma [SSM] or lentigo maligna melanoma [LMM]), and anatomic site (face, head, and neck [FHN] or lower extremity [LE]).

• Sex, histopathology, and anatomic site were age-specific effect modifiers for CMM that indicated divergent (bimodal) early-onset and late-onset cancer pathways.
• Early-onset melanomas were associated predominantly with women, SSM, and LE.
• Late-onset melanomas were correlated with men, LMM, and FHN.
• Early- and late-onset melanoma populations were confirmed with age-period-cohort models that were adjusted for period and cohort effects.
• 2-component mixture models also fit the data better than a single cancer population.

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