{
 "id": "109adb5e-240a-4a5a-9059-021828d9dd30",
 "disease": {
  "id": "H00038",
  "names": [
   "Melanoma"
  ],
  "dbLinks": {
   "icd10": [
    "C43"
   ],
   "mesh": [
    "D008545"
   ]
  },
  "category": "Cancer",
  "description": "Melanoma is a form of skin cancer that has a poor prognosis and which is on the rise in Western populations. Melanoma arises from the malignant transformation of pigment-producing cells, melanocytes. The only known environmental risk factor is exposure to ultraviolet (UV) light and in people with fair skin the risk is greatly increased. Melanoma pathogenesis is also driven by genetic factors. Oncogenic NRAS mutations activate both effector pathways Raf-MEK-ERK and PI3K-Akt. The Raf-MEK-ERK pathway may also be activated via mutations in the BRAF gene. The PI3K-Akt pathway may be activated through loss or mutation of the inhibitory tumor suppressor gene PTEN. These mutations arise early during melanoma pathogenesis and are preserved throughout tumor progression. Melanoma development has been shown to be strongly associated with inactivation of the p16INK4a/cyclin dependent kinases 4 and 6/retinoblastoma protein (p16INK4a/CDK4,6/pRb) and p14ARF/human double minute 2/p53 (p14ARF/HMD2/p53) tumor suppressor pathways. MITF and TP53 are implicated in further melanoma progression."
 },
 "article": {
  "id": "22833605",
  "text": "OBJECTIVE:\nTo estimate the burden of melanoma resulting from sunbed use in western Europe.\n\nDESIGN:\nSystematic review and meta-analysis.\n\nDATA SOURCES:\nPubMed, ISI Web of Science (Science Citation Index Expanded), Embase, Pascal, Cochrane Library, LILACS, and MedCarib, along with published surveys reporting prevalence of sunbed use at national level in Europe.\n\nSTUDY SELECTION:\nObservational studies reporting a measure of risk for skin cancer (cutaneous melanoma, squamous cell carcinoma, basal cell carcinoma) associated with ever use of sunbeds.\n\nRESULTS:\nBased on 27 studies ever use of sunbeds was associated with a summary relative risk of 1.20 (95% confidence interval 1.08 to 1.34). Publication bias was not evident. Restricting the analysis to cohorts and population based studies, the summary relative risk was 1.25 (1.09 to 1.43). Calculations for dose-response showed a 1.8% (95% confidence interval 0% to 3.8%) increase in risk of melanoma for each additional session of sunbed use per year. Based on 13 informative studies, first use of sunbeds before age 35 years was associated with a summary relative risk of 1.87 (1.41 to 2.48), with no indication of heterogeneity between studies. By using prevalence data from surveys and data from GLOBOCAN 2008, in 2008 in the 15 original member countries of the European Community plus three countries that were members of the European Free Trade Association, an estimated 3438 cases of melanoma could be attributable to sunbed use, most (n=2341) occurring among women.\n\nCONCLUSIONS:\nSunbed use is associated with a significant increase in risk of melanoma. This risk increases with number of sunbed sessions and with initial usage at a young age (\u003c35 years). The cancerous damage associated with sunbed use is substantial and could be avoided by strict regulations."
 },
 "questions": [
  {
   "id": "e2770142-ced4-48a0-911e-21322fd56261",
   "text": "What are the risk factors of Melanoma?",
   "answers": [
    {
     "answer_start": 1041,
     "text": "first use of sunbeds before age 35 years"
    },
    {
     "answer_start": 1543,
     "text": "Sunbed use"
    },
    {
     "answer_start": 1642,
     "text": "number of sunbed sessions and with initial usage at a young age (\u003c35 years)"
    }
   ]
  }
 ]
}