The Effects of Sun Exposure and Pigmentation Phenotype on Prognosis in Metastatic Melanoma.
Level 3 - non-randomized controlled study
Retrospective cohort study evaluating prognostic factors for overall survival
PubMed 42124509 · doi:10.2340/actadv.v106.adv-2026-0388
What was done
A retrospective cohort study was conducted in 210 patients with stage IV melanoma. Patients completed a standardized questionnaire assessing melanoma risk factors, including self-assessed phenotypic traits and past sun exposure habits. Survival analyses were performed evaluating overall survival as the primary endpoint.
What was found
Patients reporting >5 severe sunburns during childhood had a significantly reduced risk of death compared with those reporting 0–1 sunburns (HR 0.46, CI 0.25–0.85, p=0.013). A fair or intermediate pigmentation phenotype was also associated with a decreased risk of death compared to a dark phenotype after adjustment for distant metastasis category (HR 0.57, CI 0.34–0.93, p=0.026).
Why it matters
While ultraviolet radiation and fair pigmentation increase the risk of primary melanoma, these findings suggest they may paradoxically associate with better overall survival in metastatic disease, potentially reflecting distinct biological subtypes or differential immunotherapy responsiveness.
Limits
The study is limited by its retrospective design and reliance on self-reported questionnaire data for childhood exposures, introducing recall bias. The sample size is modest (n=210), and details regarding specific immunotherapy regimens, tumor mutational burden, or detailed baseline clinical confounders were not reported in the abstract.
Cited by
- contradicts Sunburning increases the risk of melanoma mortality.