Solar keratoses: a risk factor for melanoma but negative association with melanocytic naevi

Solar keratoses have been associated with increased risk of squamous-cell and basal-cell carcinomas, but their association with melanoma is less clear. This study investigated solar keratoses as a risk factor for cutaneous melanoma in Australia, also associations between solar keratoses and other host factors associated with melanoma. A total-body naevus count was made of 258 melanoma cases and 281 controls recruited from New South Wales, Australia, and solar keratoses were counted on the left forearm. Solar elastosis was also assessed by clinical examination on the face and the side of the neck. Solar keratoses were a significant risk factor for melanoma in Australia. The presence of 10 or more solar keratoses on the left forearm (compared with none) was associated with an odds ratio of 4.7 (95% CI, 2.0-10.9). A highly significant association was found between number of solar keratoses and a past history of multiple basal-cell carcinomas in cases and controls respectively. Numbers of common and atypical naevi decreased significantly with age, while solar keratoses were more common in older individuals. Solar keratoses were found more commonly in men than women in cases and in controls (p < 0.0001). A negative association was found between numbers of common naevi and numbers of solar keratoses in cases and controls, and this remained significant after stratifying for age, gender and hair colour (p < 0.0001 and p < 0.0016 respectively). Solar keratoses were more common in males with melanoma on the head and neck as compared with melanoma on any other site. Solar keratoses and naevi were independently predictive of increased melanoma risk. The fact that these 2 phenotypes were found to be negatively associated suggests that susceptibility to melanoma may be expressed via 2 distinct cutaneous phenotypes which may be genetically determined.