Skip to main content

Role of BMI and hormone therapy in melanoma risk: a case–control study

Abstract

Background

Currently, the association between body mass index (BMI) and hormone therapies and Cutaneous Melanoma (CM) development is strongly debated. This study was carried out to assess the association between BMI, hormone therapies, and CM risk.

Methods

The present study is a hospital-based case–control study with 605 consecutive CM patients and 592 controls treated for non-neoplastic conditions at the Department of Dermatology in Florence. The associations of melanoma risk with BMI and hormone therapies were assessed performing unconditional logistic regression to estimate odds ratios (OR) and their 95% confidence intervals, adjusting for potential confounders.

Results

We found a significant interaction of BMI with age (P < 0.0001): being overweight significantly increased CM risk among individuals less than 50 years old (OR = 1.85 with 95% CI 1.14–2.94), whereas the association was not significant for individuals over 50 years old (OR = 1.15 with 95% CI 0.77–1.71). For oestrogen therapy, women taking oral contraceptives (OCs)/hormone replacement therapy (HRT) showed a lower CM risk than men (OR = 0.63, 95% CI 0.44–0.89), with risk estimates significantly lower (P < 0.0001) than in non OCs/HRT users, which had an increased risk compared to men (OR = 1.81, 95% CI 1.29–2.53).

Conclusions

Being overweight was significantly associated with CM risk, and this relationship was highly age-conditioned; the second finding was the protective effect of oestrogen therapies for women. Both findings may have a significant impact on melanoma prevention, as the prevalence of obesity and hormone therapy use is increasing worldwide.

This is a preview of subscription content, access via your institution.

Abbreviations

CM:

Cutaneous melanoma

NMSC:

Non-melanoma skin cancer

OCs:

Oral contraceptives

HRT:

Hormone replacement therapy

BMI:

Body mass index

OR:

Odds ratio

CI:

Confidence interval

ERs:

Oestrogen receptors

References

  • Amjadi F, Javanmard SH, Zarkesh-Esfahani H, Khazaei M, Narimani M (2011) Leptin promotes melanoma tumor growth in mice related to increasing circulating endothelial progenitor cells numbers and plasma NO production. J Exp Clin Cancer Res 30:21. doi:10.1186/1756-9966-30-21.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Antoniadis AG, Petridou ET, Antonopoulos CN, Dessypris N, Panagopoulou P, Chamberland JP, Adami HO, Gogas H, Mantzoros CS (2011) Insulin resistance in relation to melanoma risk. Melanoma Res 21(6):541–546

    CAS  Article  PubMed  Google Scholar 

  • Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS (2013) Epidemiology and prognosis of breast cancer in young women. J Thorac Dis 5(Suppl 1):S2–8. doi:10.3978/j.issn.2072-1439.2013.05.24.

    PubMed  PubMed Central  Google Scholar 

  • Brandon EL, Gu JW, Cantwell L, He Z, Wallace G, Hall JE (2009) Obesity promotes melanoma tumor growth: role of leptin. Cancer Biol Ther 8(19):1871

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • De Giorgi V, Gori A, Alfaioli B, Papi F, Grazzini M, Rossari S, Lotti T, Massi D (2011) Influence of sex hormones on melanoma. J Clin Oncol 29(4):e94–5. doi:10.1200/JCO.2010.33.1876.

    Article  PubMed  Google Scholar 

  • De Giorgi V, Gori A, Grazzini M, Rossari S, Longo AS, Oranges T, Savarese I (2012) Obesity and melanoma. Br J Dermatol 166(6):1357–8. doi:10.1111/j.1365-2133.2011.10752.x (author reply 1358–9)

    Article  Google Scholar 

  • Dennis LK, Lowe JB, Lynch CF, Alavanja MC (2008) Cutaneous melanoma and obesity in the agricultural health study. Ann Epidemiol 18(3):214–221

    Article  PubMed  PubMed Central  Google Scholar 

  • Gallus S, Naldi L, Martin L, Martinelli M, La Vecchia C, Oncology Study Group of the Italian group for Epidemiologic Research in Dermatology (GISED) (2006) Anthropometric measures and risk of cutaneous malignant melanoma: a case-control study from Italy. Melanoma Res 16(1):83–87

    Article  PubMed  Google Scholar 

  • Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF (2005) Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 41(1):45–60

    Article  PubMed  Google Scholar 

  • Gandini S, Iodice S, Koomen E, Di Pietro A, Sera F, Caini S (2011) Hormonal and reproductive factors in relation to melanoma in women: current review and meta-analysis. Eur J Cancer 47(17):2607–2617. doi:10.1016/j.ejca.2011.04.023

    CAS  Article  PubMed  Google Scholar 

  • Karagas MR, Stukel TA, Dykes J, Miglionico J, Greene MA, Carey M, Armstrong B, Elwood JM, Gallagher RP, Green A, Holly EA, Kirkpatrick CS et al. (2002) A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use. Br J Cancer 86(7):1085–1092.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Karimi K, Lindgren TH, Koch CA, Brodell RT (2016) Obesity as a risk factor for malignant melanoma and non-melanoma skin cancer. Rev Endocr Metab Disord 17(3):389–403

    CAS  Article  PubMed  Google Scholar 

  • Key TJ, Spencer EA, Reeves GK (2010) Symposium 1: overnutrition: consequences and solutions. obesity and cancer risk. Proc Nutr Soc 69(1):86–90

    Article  PubMed  Google Scholar 

  • Kirkpatrick CS, White E, Lee JA (1994) Case-control study of malignant melanoma in Washington state. II. Diet, alcohol, and obesity. Am J Epidemiol 139(9):869–880.

    CAS  Article  PubMed  Google Scholar 

  • Koomen ER, Joosse A, Herings RM, Casparie MK, Guchelaar HJ, Nijsten T (2009) Estrogens, oral contraceptives and hormonal replacement therapy increase the incidence of cutaneous melanoma: a population-based case-control study. Ann Oncol 20(2):358–364

    CAS  Article  PubMed  Google Scholar 

  • Kushiro K, Núñez NP (2011) Ob/ob serum promotes a mesenchymal cell phenotype in B16BL6 melanoma cells. Clin Exp Metastasis 28(8):877–886. doi:10.1007/s10585-011-9418-4

    CAS  Article  PubMed  Google Scholar 

  • Kushiro K, Chu RA, Verma A, Núñez NP (2012) Adipocytes promote B16BL6 melanoma cell invasion and the epithelial-to-mesenchymal transition. Cancer Microenviron 5(1):73–82. doi:10.1007/s12307-011-0087-2

    CAS  Article  PubMed  Google Scholar 

  • Odenbro A, Gillgren P, Bellocco R, Boffetta P, Håkansson N, Adami J (2007) The risk for cutaneous malignant melanoma, melanoma in situ and intraocular malignant melanoma in relation to tobacco use and body mass index. Br J Dermatol 156:99–105

    CAS  Article  PubMed  Google Scholar 

  • Olsen CM, Green AC, Zens MS, Stukel TA, Bataille V, Berwick M, Elwood JM, Gallagher R, Holly EA, Kirkpatrick C, Mack T, Østerlind A et al. (2008) Anthropometric factors and risk of melanoma in women: a pooled analysis. Int J Cancer 122(5):1100–8.

    CAS  Article  PubMed  Google Scholar 

  • Olsen CM, Zens MS, Green AC, Stukel TA, Holman CD, Mack T, Elwood JM, Holly EA, Sacerdote C, Gallagher R, Swerdlow AJ, Armstrong BK et al. (2011) Biologic markers of sun exposure and melanoma risk in women: pooled case-control analysis. Int J Cancer 129(3):713–723. doi:10.1002/ijc.25691.

    CAS  Article  PubMed  Google Scholar 

  • Pandey V, Vijayakumar MV, Ajay AK, Malvi P, Bhat MK (2012) Diet-induced obesity increases melanoma progression: involvement of Cav-1 and FASN. Int J Cancer 130(3):497–508. doi:10.1002/ijc.26048.

    CAS  Article  PubMed  Google Scholar 

  • Pothiawala S, Qureshi AA, Li Y, Han J (2012) Obesity and the incidence of skin cancer in US Caucasians. Cancer Causes Control 23(5):717–726. doi:10.1007/s10552-012-9941-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Randerson-Moor JA, Taylor JC, Elliott F, Chang YM, Beswick S, Kukalizch K, Affleck P, Leake S, Haynes S, Karpavicius B, Marsden J, Gerry E et al (2009) Vitamin D receptor gene polymorphisms, serum 25-hydroxyvitamin D levels, and melanoma: UK case-control comparisons and a meta-analysis of published VDR data. Eur J Cancer 45(18):3271–3281

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D, Million Women Study Collaboration (2007) Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 335(7630):1134.

    Article  PubMed  PubMed Central  Google Scholar 

  • Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371:569–578

    Article  PubMed  Google Scholar 

  • Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JF Jr (2006) Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes Control 17:901–909

    Article  PubMed  Google Scholar 

  • Sergentanis TN, Antoniadis AG, Gogas HJ, Antonopoulos CN, Adami HO, Ekbom A, Petridou ET (2013) Obesity and risk of malignant melanoma: A meta-analysis of cohort and case–control studies. Eur J Cancer 49(3):642–657. doi:10.1016/j.ejca.2012.08.028

    Article  PubMed  Google Scholar 

  • Shors AR, Solomon C, McTiernan A, White E (2001) Melanoma risk in relation to height, weight, and exercise (United States). Cancer Causes Control 12(7):599–606

    CAS  Article  PubMed  Google Scholar 

  • Tang JY, Henderson MT, Hernandez-Boussard T, Kubo J, Desai M, Sims ST, Aroda V, Thomas F, McTiernan A, Stefanick ML (2013) Lower skin cancer risk in women with higher body mass index: the women’s health initiative observational study. Cancer Epidemiol Biomark Prev 22(12):2482–2485

    Article  Google Scholar 

  • Taylor AW, Dal Grande E, Gill TK, Chittleborough CR, Wilson DH, Adams RJ, Grant JF, Phillips P, Appleton S, Ruffin RE (2006) How valid are self-reported height and weight? A comparison between CATI self-report and clinic measurements using a large cohort study. Aust N Z J Public Health 30(3):238–246

    Article  PubMed  Google Scholar 

  • Thune I, Olsen A, Albrektsen G, Tretli S (1993) Cutaneous malignant melanoma: association with height, weight and body-surface area. A prospective study in Norway. Int J Cancer 55(4):555–561.

    CAS  Article  PubMed  Google Scholar 

  • Wolin KY, Carson K, Colditz GA (2010) Obesity and cancer. Oncologist 15(6):556–565

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vincenzo De Giorgi.

Ethics declarations

Conflict of interest

Vincenzo De Giorgi declares that he has no conflict of interest. Alessia Gori declares that she has no conflict of interest. Imma Savarese declares that she has no conflict of interest. Antonietta D’Errico declares that she has no conflict of interest. Federica Scarfi declares that she has no conflict of interest. Federica Papi declares that she has no conflict of interest. Vincenza Maio declares that she has no conflict of interest. Piero Covarelli declares that he has no conflict of interest. Daniela Massi declares that she has no conflict of interest. Sara Gandini declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

De Giorgi, V., Gori, A., Savarese, I. et al. Role of BMI and hormone therapy in melanoma risk: a case–control study. J Cancer Res Clin Oncol 143, 1191–1197 (2017). https://doi.org/10.1007/s00432-017-2387-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-017-2387-5

Keywords

  • Cutaneous melanoma
  • Body mass index
  • Overweight status
  • Hormone therapies
  • Age