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November 2007

Multiple Primary Melanomas in a CDKN2A Mutation Carrier Exposed to Ionizing Radiation

Author Affiliations

Author Affiliations: Department of Dermatology, Health Sciences Center (Drs Eliason, Hansen, Sturm, Bowen, Florell, Harris, Swinyer, and Leachman and Ms Porter-Gill), Huntsman Cancer Institute Melanoma Program (Drs Eliason, Hansen, Bowen, Florell, Harris, and Leachman and Mss Hart and Porter-Gill), and Department of Medical Informatics (Dr Cannon-Albright), University of Utah, Salt Lake City; and Melanogenix Group, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia (Drs Chen and Sturm).

Arch Dermatol. 2007;143(11):1409-1412. doi:10.1001/archderm.143.11.1409

Background  Recent research has shown a possible causal relationship between ionizing radiation exposure and melanoma. Individuals with mutations in CDKN2A (cyclin-dependent kinase inhibitor 2A), the major melanoma predisposition gene, have an increased susceptibility to melanoma-promoting exposures, such as UV light. We describe a patient from a familial melanoma pedigree with 7 primary melanomas on the right side of her body, the first occurring 5 years after exposure to atmospheric nuclear bomb testing in the 1950s.

Observations  Physical examination revealed phototype I skin, red hair, and 26 nevi (14 on the right and 12 on the left side of her body). One nevus was larger than 5 mm, and 2 were clinically atypical. Sequence analysis demonstrated a known deleterious mutation in CDKN2A (G−34T) and homozygosity for a red hair color variant in MC1R (melanocortin 1 receptor) (R151C). Fluorescence in situ hybridization analysis of blood, fibroblasts, and melanocytes from both upper extremities ruled out mosaicism.

Conclusions  Individuals such as this patient, who has CDKN2A and MC1R mutations, are likely to be more susceptible to environmental insults. A careful review of environmental exposures in these vulnerable cases may reveal cancer-promoting agents, such as ionizing radiation, that go unnoticed in less susceptible populations.