5 mei 2021: Bron: European Journal of Cancer Prevention: November 2017 - Volume 26 - Issue 6 - p 532-541
Huidkanker van het type melanoom, waarmee meer en meer mensen wereldwijd worden gediagnosteerd, is het resultaat van ingewikkelde interacties tussen individuele genetische factoren en omgevingsrisicofactoren waaronder vooral Ultraviolette straling - zonlicht. Ultraviolette straling vormt de belangrijkste omgevingsrisicofactor voor de ontwikkeling van huidkanker, waaronder dus het melanoom.
In onderstaande reviewstudie wordt aan de hand van de tot nu toe beschikbare literatuur een analyse gemaakt van met name de rol van de vitamine D-status in relatie tot een melanoom. Het is een puur wetenschappelijke analyse en niet echt voor leken, maar voor artsen en wetenschappers en ook voedingsdeskundigen is dit een hele interessante reviewstudie.
Blootstelling aan de zon en vroege zonnebrand tijdens de kindertijd zijn de belangrijkste oorzaken van het opkomen van huidmelanomen bij volwassenen, met een dubbel zo groot risico in vergelijking met een niet-blootgestelde populatie. Daarom wordt bescherming tegen ultraviolette straling al lang erkend als een belangrijke maatregel om een dergelijke vorm van kanker te voorkomen.
Fig. 2:
Vitamin-D-related compounds at skin level. UV, ultraviolet.
Biologische en epidemiologische gegevens suggereren dat de vitamine D-status het risico op kanker zou kunnen beïnvloeden en een rol zou kunnen spelen bij kankerpreventie door antiproliferatieve effecten uit te oefenen. Zonnestraling is cruciaal voor de synthese van vitamine D bij mensen; Ongecontroleerde en intensieve blootstelling aan de zon is echter gevaarlijk voor de gezondheid van de huid en kan bijdragen aan de ontwikkeling van kwaadaardig huidmelanoom. Een optimale balans tussen zonwering en blootstelling wordt dus bepleit.
Aanvullend onderzoek is nodig om de preventieve rol van vitamine D bij de incidentie van melanomen of een positieve invloed op de uitkomst van de patiënt te bevestigen.
Fig. 3:
Systemic production of vitamin D compounds and biological effects. 1,25(OH)2D3, 1,25-dihydroxycholecalciferol; 25(OH)D3, 25-hydroxycholecalciferol.
In deze reviewstudie wordt aan de hand van de tot nu toe beschikbare literatuur een analyse gemaakt van met name de rol van de vitamine D status in relatie tot een melanoom.
Het is een puur wetenschappelijke analyse en niet echt voor leken, maar voor artsen en wetenschappers en ook voedingsdeskundigen is dit een hele interessante reviewstudie. Klik op de titel voor het volledige studierapport:
Vitamin D status and risk for malignant cutaneous melanoma: recent advances
European Journal of Cancer Prevention: November 2017 - Volume 26 - Issue 6 - p 532-541
doi: 10.1097/CEJ.0000000000000334
Conclusion
In recent years, there has been growing interest in understanding the link between vitamin D status and melanoma as well as other cancers and chronic diseases. The relationship of serum levels and genetic factors of vitamin D with melanoma risk and melanoma mortality is actually not completely clear. There are few strong epidemiological studies to confirm the hypothesis that higher vitamin D levels might protect from melanoma, although a number of cohort studies have addressed a possible protective effect of vitamin D. In addition, there are insufficient indications to recommend vitamin D supplementation to decrease melanoma risk.
Certainly, vitamin D has clear antiproliferative activity on melanoma cell lines in vitro. There is evidence of reduced expression of the vitamin D receptor with progression from nevi through primary to metastatic melanoma. These observations suggest that if vitamin D is antiproliferative for melanoma cells in vivo, then those cells might be less likely to respond to the antiproliferative effects of vitamin D as progression occurs. Other results indicate that high levels of vitamin D are correlated with the development of less aggressive tumors. Some studies report that normal levels of vitamin D3 at the time of diagnosis are associated with a better prognosis in patients with melanoma. High circulating vitamin D concentration has been found to be associated with reduced melanoma progression and improved survival. Furthermore, reduced vitamin D serum levels have been reported in patients with stage IV melanoma compared with those with stage I.
An unresolved question remains as to which of the many described biological effects of vitamin D might have a protective effect for melanoma patients and what might be the optimal blood level to achieve those putative beneficial effects. The in-vitro antiproliferative effect of vitamin D added to melanoma cell cultures is convincing, and the Leeds Melanoma Cohort data suggest that primaries in individuals included in the study were thinner in patients with higher 25-hydroxyvitamin D2/D3 levels, which is consistent with an antiproliferative effect. Vitamin D, moreover, may exert pleomorphic effects including those on new blood vessel formation and immunity, and some of these effects might actually be deleterious for cancer patients. The reported effects of vitamin D on the immune system are extremely complex. If vitamin D supplementation suppresses adaptive immunity, then that would be a potentially harmful effect for melanoma patients. High doses of vitamin D should also be avoided. The evidence that vitamin D levels might influence melanoma risk remains uncertain; however, it should also be pointed out that studies of sufficient size to address this issue have not been carried out. In addition, there is evidence that patients with MM who strictly avoid sun exposure might benefit from 25-(OH)D supplements that are sufficient to maintain serum levels above 30 ng/ml. Given the interest in using vitamin D to reduce cancer risk, more research is warranted to establish its role in the control and progression of melanoma and whether vitamin D supplements can reduce risk and progression and improve outcomes.
Although the association between vitamin D and melanoma risk is still the object of considerable discussion, the potential effect of vitamin D on the risk of melanoma merits accurate consideration.
Acknowledgements
The authors are grateful to Maria Giglio and Francesco Rassu for their supporting assistance in this study.
Conflicts of interest
There are no conflicts of interest.
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Keywords:
calcitriol; cancer; melanoma; skin; sun exposure; vitamin D
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