title: Radiotherapy as a risk factor for malignant melanoma after childhood skin hemangioma.
abstract: The aim of this study was to determine therapy-related risk factors for the development of melanoma after hemangioma. A cohort study was conducted among 4620 patients treated before 16 years of age for skin hemangioma in France. A nested case-control study was also conducted on 13 patients who developed a melanoma (cases) matched with five controls in cohort according to sex, age at the hemangioma diagnostic, the calendar year of occurrence of the hemangioma, and follow-up. The radiation dose received at the site of the melanoma and at the same site in controls was estimated, and named 'local dose'. A total of 13 melanomas were registered during an average follow-up of overall 35 years, the risk of developing melanoma after a hemangioma treatment was 2.5-fold higher [95% confidence interval (CI): 1.4-4.1] compared with that of the general population, this ratio being only 0.8 (95% CI: 0.05-3.6) in 896 patients who did not receive radiotherapy, but 3.0 (95% CI: 1.6-5.1) after radiotherapy. When adjusting on sex, age, and year of the treatment and follow-up duration, melanoma risk was 11.9 (95% CI: 1.4-123) times higher in patients treated with ytrium 90 than in the ones who did not received radiotherapy. In the case-control study, the risk of melanoma was not linked to the local radiation dose. Indeed, the increase in melanoma risk was observed even for very low local doses. Compared with the corresponding skin areas in patients who did not receive radiotherapy, the ones having received less than 0.001 Gy had a melanoma risk of 3.9 (95% CI: 0.5-32) and those who received more than 0.01 Gy had a risk of 6.9 (0.5-99). This study suggests that radiation therapy of skin hemangioma increases the risk of further melanoma, but we were not able to evidence a relation with the local dose. Nevertheless, childhood treated for hemangioma should be considered at risk for developing melanoma and suspicious pigmented lesions should be carefully evaluated even far from treated areas.
authors.affiliation: Equipe n 3 : Epidémiologie des cancers : Radiocarcinogénèse et effets iatrogènes des traitements Centre de Recherche en Epidémiologie et Santé des Populations (CESP)-INSERM UMR 1018, France. nadia.haddy@igr.fr
authors.forename: Nadia
authors.initials: N
authors.lastname: Haddy
authors.forename: Abdeddahir
authors.initials: A
authors.lastname: Mousannif
authors.forename: Catherine
authors.initials: C
authors.lastname: Paoletti
authors.forename: Marie-Gabrielle
authors.initials: MG
authors.lastname: Dondon
authors.forename: Akhtar
authors.initials: A
authors.lastname: Shamsaldin
authors.forename: Françoise
authors.initials: F
authors.lastname: Doyon
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Avril
authors.forename: Philippe
authors.initials: P
authors.lastname: Fragu
authors.forename: Martine
authors.initials: M
authors.lastname: Labbé
authors.forename: Dimitry
authors.initials: D
authors.lastname: Lefkopoulos
authors.forename: Jean
authors.initials: J
authors.lastname: Chavaudra
authors.forename: Caroline
authors.initials: C
authors.lastname: Robert
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diallo
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006391:Hemangioma / Q000150:complications* / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications* / Q000209:etiology / Q000532:radiotherapy*