Segregation and linkage analyses were undertaken in families with multiple cases of cutaneous malignant melanoma (CMM) and a recently-described melanoma precursor, the dysplastic nevus syndrome (DNS). Clinical and laboratory data, including 23 genetic markers, were collected on 401 members of 14 high-risk kindreds. Pedigree analysis was compatible with an autosomal dominant mode of inheritance for the familial CMM trait. Although a similar model probably applies to the DNS trait as well, segregation analysis could not confirm the presence of a major locus. However, linkage analysis suggested that an autosomal dominant model was appropriate for the DNS, and that a DNS/CMM susceptibility gene may be located on the short arm of chromosome 1, within 30 map units of the Rh locus [maximum logarithm of odds (lod) score = 2.00].Writing in 1820, Sir William Norris presented a vivid description of the familial variant of cutaneous malignant melanoma (CMM) (1). He concluded, "These facts . . . would incline me to believe that this disease is hereditary." Modem investigations of familial melanoma began with the seminal work of E. P. Cawley (2), and it is now clear that familial melanoma is not uncommon (3), but to date there have been no formal genetic studies of familial CMM. The recent identification of a unique precursor to CMM in high-risk family members (4-6) has provided new research opportunities. Designated the dysplastic nevus syndrome (DNS) (7), because cytologic atypia of melanocytes is its histologic hallmark, this disorder forms the substrate from which most cases of familial CMM arise (8-15). Here we present segregation and linkage analyses of a series of 14 melanoma-prone kindreds, which document that the distribution of CMM and DNS in families is consistent with an autosomal dominant mode of inheritance and suggest that the DNS/CMM susceptibility gene is linked to the Rh locus.
METHODSClinical Survey. The Cancer-Prone Family Registry, maintained by the Family Studies Section of the Environmental Epidemiology Branch, National Cancer Institute (16), is a nonpopulation-based series of malignancy-prone kindreds referred by physicians of the National Institutes of Health, community practitioners around the United States, and concerned family members. When this study began, there were approximately 1,000 families in the Registry, from which all kindreds with at least two living, pathologically confirmed cases of CMM were identified; the 25 kindreds found were listed in ascending numerical order by date of ascertainment. Families were contacted, seriatim, and offered an opportunity to participate in a combined clinical-laboratory evaluation of familial melanoma. Fourteen kindreds were studied; available data suggest that the remaining families are similar to those that were included. We examined, photographed, and obtained blood samples from all melanoma probands, from all additional living family members with melanoma, and from 97% of their first-degree relatives; in many cases, more distant relatives were...