It’s Not All Sunshine: Non-sun-related Melanoma Risk-factors
Preview of fully accepted paper, still not published in any volume
There is increasing evidence that the behaviour of naevi and melanoma is under significant genetic and/or epigenetic control. Melanoma tumours behaves similarly all over the world. Many genes have now been implicated in melanoma risk and naevi number. Embryogenesis has also been important in the discovery of links between several neurological diseases and melanoma susceptibility. Telomere biology, which regulates cell senescence, is increasingly relevant in melanoma. Melanoma is often found in the context of family cancer syndromes and the identification of these families is important as screening for cancer will save lives. Melanoma is also one of the most immunogenic cancer as the behaviour of naevi and melanoma differ in patients with vitiligo or eczema. The search for non-sun related melanoma risk factors should continue as it is likely to lead to important discoveries which will, in turn, have an impact on therapeutic targets for this tumour.
Many risk factors for melanoma are non-UV related and progress in the last 20 years have been instrumental in discovering melanoma genes which are involved in telomere biology, naevi number, pigmentation, body composition, energy expenditure, neural and melanocyte differentiation. Melanoma behaves in a very similar way all over the world in all Caucasian populations and many host factors are under tight genetic control. Research in these areas is important as it sheds new light on genetic and epigenetic factors which are often set early on in life and less likely to be influenced by sun exposure in adulthood. It is also unravelling pathways which could be exploited for future therapies as public health campaigns have, so far, not been very effective. Perhaps, the role of sun exposure in melanoma has been over-estimated in the past as, like all cancers, melanoma is a very complex tumour so addressing environmental exposure cannot be the only focus of our efforts.