Behavioral risk factors for melanoma in medical students
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Меланома кожи является достаточно агрессивной опухолью, на которую приходится до 80% случаев летальных исходов в онкодерматологии. Выделяют экзогенные и эндогенные факторы риска развития меланомы. Основным экзогенным фактором риска является воздействие как естественного, так и искусственного ультрафиолетового излучения. К наиболее важным эндогенным факторам риска относится фототип кожи, количество невусов более 50 и наличие атипичных, наследственные факторы (отягощенный семейный анамнез по меланоме).
Целью данного исследования было выделение основных поведенческих факторов риска развития меланомы кожи у студентов-медиков.
Под наблюдением находилось 60 человек (13 мужчин и 47 женщин). Возраст респондентов варьировал от 18 до 32 лет. Средний возраст исследуемых составил 22,75±3,5 лет. Основную группу наблюдения составили 42 студента медицинского факультета Санкт-Петербургского государственного университета. Группу сравнения – 18 врачей-дерматовенерологов (клинические ординаторы 1 и 2 года обучения).
Для каждого исследуемого была составлена анкета. Оценивали частоту отягощенного семейного и индивидуального анамнеза по меланоме кожи, изучали эндогенные факторы риска меланомы кожи – фототип кожи, множественные и атипичные невусы, а также наличие солнечного лентиго у студентов-медиков. Выделяли наиболее значимые поведенческие факторы риска меланомы кожи, проводили оценку знаний о защитных мерах при воздействии ультрафиолетового излучения и частоте их использования среди студентов-медиков. Достоверность результатов была проверена критерями Н-Крускалла-Уоллиса и Манна-Уитни с помощью программы Statistica версии 7.0 (Statsoft, Москва, Россия). Значимыми считались P-значения <0,05.
Полученные результаты позволили сформулировать следующие выводы:
Отягощенный семейный анамнез по меланоме кожи установлен у 16,7% студентов-медиков. Отягощенный индивидуальный анамнез по меланоме кожи не характерен ни для одного из них.
У подавляющего большинства студентов-медиков диагностируется II и III фототип кожи – (47,6% и 40,5%, соответственно), I фототип - у 9,5% человек. Студенты неправильно оценивают свой фототип кожи в пользу более устойчивого к повреждающему действию ультрафиолетового излучения (Р=0,0001) – 19,1% относят себя к IV фототипу. Множественных невусов (более 50) диагностируются у 46,7% студентов, достоверно чаще у лиц с отягощенным анамнезом по меланоме (Р=0,03). Атипичные невусы и солнечное лентиго характерны для 46,7% и 26,7% студентов, соответственно.
Регулярной инсоляции более чем 2 недели подвергаются до 80,9% студентов, 21,4% загорают в солярии, из них – 77,8% впервые посетили солярий до 18 лет, 61,9% студентов имели хотя бы один солнечный ожог до 18-летнего возраста, 40,5% – более 5 солнечных ожогов в течение жизни. Среди лиц с отягощенным анамнезом по меланоме 66,7% подвергаются регулярной инсоляции, 22,2% посещают солярий, из них все впервые посетили солярий до 18 лет, 66,7% имели хотя бы один ожог до 18 лет, 66,7% – более 5 солнечных ожогов в течение жизни.
Для защиты от воздействия солнечных лучей студенты-медики чаще используют солнцезащитные препараты (используют всегда 30,9% и почти всегда 33,3%), несколько реже – пребывание в тени (всегда 21,4% и почти всегда 35,7%) и существенно реже используют одежду, головные уборы, солнцезащитные очки. Лица с отягощенным семейным анамнезом по меланоме используют различные методы со сравнимой частотой, кроме пребывания в тени – этот метод защиты от воздействия солнечных лучей довольно распространён среди данной группы респондентов (всегда находятся в тени 11,1% и почти всегда – 66,7%). Во время посещения солярия 44,4% студентов-медиков используют солнцезащитные препараты, среди лиц с отягощенным семейным анамнезом – 50%. Студенты-медики показывают низкий уровень знаний относительно того, что использование солнцезащитных препаратов снижает риски развития меланомы и немеланомных опухолей кожи (57,1% и 52,4% студентов, соответственно, считают, что использование солнцезащитных препаратов снижает риски).
Skin melanoma is a fairly aggressive tumor, which accounts for up to 80% of cases of fatal outcomes in oncodermatology. Exogenous and endogenous risk factors for melanoma are distinguished. The main exogenous risk factor is exposure to both natural and artificial ultraviolet radiation. The most important endogenous risk factors include skin phototype, number of nevuses more than 50 and the presence of atypical, hereditary factors (burdened family history of melanoma). The purpose of this study was to highlight the main behavioral risk factors for developing skin melanoma in medical students. Under observation were 60 people (13 men and 47 women). The age of the respondents ranged from 18 to 32 years. The average age of the subjects was 22.75 ± 3.5 years. The main observation group consisted of 42 students of the medical faculty of St. Petersburg State University. Comparison group - 18 dermatovenerologists (clinical residents 1 and 2 years of study). A questionnaire was compiled for each subject. The incidence of family history and individual history of skin melanoma was assessed, endogenous risk factors for skin melanoma — skin phototype, multiple and atypical nevi, and the presence of solar lentigo in medical students were studied. The most significant behavioral risk factors for skin melanoma were identified, knowledge of protective measures when exposed to ultraviolet radiation and the frequency of their use were evaluated among medical students. The validity of the results was verified by the N-Kruskall-Wallis and Mann-Whitney criteria using the Statistica version 7.0 software (Statsoft, Moscow, Russia). Significant P-values <0.05 were considered. The results obtained allowed us to formulate the following conclusions: A burdened family history of skin melanoma was found in 16.7% of medical students. A burdened individual history of skin melanoma is not characteristic of any of them. The vast majority of medical students are diagnosed with a II and III phototype of the skin - (47.6% and 40.5%, respectively), I phototype - in 9.5% of people. Students incorrectly assess their skin phototype in favor of a more resistant to the damaging effect of ultraviolet radiation (P = 0.0001) - 19.1% attribute themselves to the IV phototype. Multiple nevi (more than 50) are diagnosed in 46.7% of students, significantly more often in individuals with a history of melanoma (P = 0.03). Atypical nevi and solar lentigo are characteristic for 46.7% and 26.7% of students, respectively. Up to 80.9% of students undergo regular insolation for more than 2 weeks, 21.4% are sunbathing in a tanning bed, of which 77.8% first visited a tanning bed before the age of 18, 61.9% of students had at least one sunburn before 18 summer age, 40.5% - more than 5 sunburns during life. Among people with a history of melanoma, 66.7% undergo regular insolation, 22.2% visit a tanning bed, all of them first visited a tanning bed before the age of 18, 66.7% had at least one burn before the age of 18, and 66.7% more than 5 sunburns in a lifetime. To protect against exposure to sunlight, medical students often use sunscreens (always use 30.9% and almost always 33.3%), somewhat less often - stay in the shade (always 21.4% and almost always 35.7%) and much less often use clothes, hats, sunglasses. Persons with a family history of melanoma use different methods with a comparable frequency, in addition to staying in the shade - this method of protection from exposure to sunlight is quite common among this group of respondents (always in the shade 11.1% and almost always 66.7%) . During a visit to the solarium, 44.4% of medical students use sunscreen, among people with a burdened family history - 50%. Medical students show a low level of knowledge that the use of sunscreens reduces the risks of developing melanoma and non-melanoma skin tumors (57.1% and 52.4% of students, respectively, believe that the use of sunscreens reduces the risks).
Skin melanoma is a fairly aggressive tumor, which accounts for up to 80% of cases of fatal outcomes in oncodermatology. Exogenous and endogenous risk factors for melanoma are distinguished. The main exogenous risk factor is exposure to both natural and artificial ultraviolet radiation. The most important endogenous risk factors include skin phototype, number of nevuses more than 50 and the presence of atypical, hereditary factors (burdened family history of melanoma). The purpose of this study was to highlight the main behavioral risk factors for developing skin melanoma in medical students. Under observation were 60 people (13 men and 47 women). The age of the respondents ranged from 18 to 32 years. The average age of the subjects was 22.75 ± 3.5 years. The main observation group consisted of 42 students of the medical faculty of St. Petersburg State University. Comparison group - 18 dermatovenerologists (clinical residents 1 and 2 years of study). A questionnaire was compiled for each subject. The incidence of family history and individual history of skin melanoma was assessed, endogenous risk factors for skin melanoma — skin phototype, multiple and atypical nevi, and the presence of solar lentigo in medical students were studied. The most significant behavioral risk factors for skin melanoma were identified, knowledge of protective measures when exposed to ultraviolet radiation and the frequency of their use were evaluated among medical students. The validity of the results was verified by the N-Kruskall-Wallis and Mann-Whitney criteria using the Statistica version 7.0 software (Statsoft, Moscow, Russia). Significant P-values <0.05 were considered. The results obtained allowed us to formulate the following conclusions: A burdened family history of skin melanoma was found in 16.7% of medical students. A burdened individual history of skin melanoma is not characteristic of any of them. The vast majority of medical students are diagnosed with a II and III phototype of the skin - (47.6% and 40.5%, respectively), I phototype - in 9.5% of people. Students incorrectly assess their skin phototype in favor of a more resistant to the damaging effect of ultraviolet radiation (P = 0.0001) - 19.1% attribute themselves to the IV phototype. Multiple nevi (more than 50) are diagnosed in 46.7% of students, significantly more often in individuals with a history of melanoma (P = 0.03). Atypical nevi and solar lentigo are characteristic for 46.7% and 26.7% of students, respectively. Up to 80.9% of students undergo regular insolation for more than 2 weeks, 21.4% are sunbathing in a tanning bed, of which 77.8% first visited a tanning bed before the age of 18, 61.9% of students had at least one sunburn before 18 summer age, 40.5% - more than 5 sunburns during life. Among people with a history of melanoma, 66.7% undergo regular insolation, 22.2% visit a tanning bed, all of them first visited a tanning bed before the age of 18, 66.7% had at least one burn before the age of 18, and 66.7% more than 5 sunburns in a lifetime. To protect against exposure to sunlight, medical students often use sunscreens (always use 30.9% and almost always 33.3%), somewhat less often - stay in the shade (always 21.4% and almost always 35.7%) and much less often use clothes, hats, sunglasses. Persons with a family history of melanoma use different methods with a comparable frequency, in addition to staying in the shade - this method of protection from exposure to sunlight is quite common among this group of respondents (always in the shade 11.1% and almost always 66.7%) . During a visit to the solarium, 44.4% of medical students use sunscreen, among people with a burdened family history - 50%. Medical students show a low level of knowledge that the use of sunscreens reduces the risks of developing melanoma and non-melanoma skin tumors (57.1% and 52.4% of students, respectively, believe that the use of sunscreens reduces the risks).