The number of melanocytic nevi is the most important independent risk factor for cutaneous melanoma. Aim of our study was to add information to the controversial discussion on the role of chronic-moderate and intermittent-high sun exposure and sunburns for the development of melanocytic nevi by the use of a large longitudinal study. A longitudinal study with a 3-year follow-up was conducted in 1,232 young children 2-7 years of age attending 78 public nursery schools in Bochum and Stuttgart, Germany. Total body nevus counts, assessment of pigmentary features and nevus counts on arms of parents were carried out. Parents underwent a standardized interview concerning sun exposure, sunburns and sun-protective behavior. Applying multiple linear regression analysis higher numbers of incident nevi were associated with host factors like light skin complexion (skin Type II vs. IV, p ؍ 0.022) and freckling of the face (p < 0.001), with parental factors like nevus counts on mothers' (p < 0.001) and fathers' (p ؍ 0.004) arms and at least one parent being of German descent (p ؍ 0.006), and with environmental factors like intermittent-high sun exposure during holidays (p < 0.001) and chronic-moderate ultraviolet radiation at home (p ؍ 0.007). Sunburns were a significant risk factor for nevus development (p ؍ 0.005). Total cumulative sun exposure seems to be the crucial environmental risk factor for the development of nevi, whether the child is exposed to chronicmoderate or intermittent-high ultraviolet light doses. Public health education should focus primarily on avoiding sun exposure especially in children with fair skin and parents with high nevus counts. The total number of melanocytic nevi (MN) on the body is known to be the strongest intrinsic risk factor for the development of cutaneous melanoma (CM). 1-5 Moreover, MN were considered to be precursor lesions of a substantial proportion of CM. 6,7 Case control studies on risk factors for CM in adults are influenced by recall bias. 8 Childhood is a period of particular susceptibility to the carcinogenic effects of solar radiation. 9 Thus, studies on MN in children might give new insights into the pathogenesis of CM.To date, numerous cross-sectional studies have been published identifying risk factors for MN development in children. 10 -19 Studies yielded partly contradicting results to important points like the amount and intensity of sun exposure needed for MN development and the role of sunburns. Few longitudinal studies exist that investigated risk factors for incident MN. 20 -24 Such studies might give a better control of the influence of environmental factors and confounders. Our present study longitudinally investigated risk factors for the development of MN in a cohort of 1,232 German kindergarten children, 2-7 years of age, followed-up over a 3-year period.
Material and methods
ParticipantsOur analysis utilized data of children who participated in a randomized controlled trial set up to investigate whether educational intervention and the provision of ...