The increase in melanoma: are dietary furocoumarins responsible?

According to most cancer registries the incidence of cutaneous melanoma (CM) has been increasing for several decades. Unlike other skin cancers, CM does not clearly correlate with exposure to ultraviolet radiation. The strongest etiological evidence for CM in man is genetic predisposition, evidenced by very high risks in primary relatives of melanoma patients, and photochemotherapy with 8-methoxy psoralen in combination with ultraviolet-A radiation (PUVA) to treat psoriasis and vitiligo. Retrospective studies of PUVA patients show significantly increased incidence of CM. Psoralens, and other furocoumarins, are phototoxic and photocarcinogenic, intercalate DNA and photochemically induce mutations. Furocoumarins are botanical phytoalexins found to varying extents in a variety of vegetables and fruits, notably citrus fruits. The levels of furocoumarins present in our diets, while normally well below that causing evident acute phototoxicity, do cause pharmacologically relevant drug interactions. For the past approximately 50 years CM has increased at similar rates as the increased availability and consumption of citrus products. Recently in a large study of nurses, only orange juice drinking, indicative of dietary preference for citrus, was positively associated with significantly increased risk of developing CM. We hypothesize that the increases in cutaneous melanoma incidence may be in part related to concomitant increases in dietary photocarcinogenic furocoumarins.