Variation and Covariates of the Number of Benign Nevi in Adolescents

Coombs, Bernard D.; Sharples, Katrina; Cooke, K. R.; Skegg, D. C. G.; Elwood, J. Mark

doi:10.1093/oxfordjournals.aje.a116499

Cited by 52 publications

(33 citation statements)

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“…Sunburns were found to be associated significantly with the number of MN in children, 10,12,13,17,29,31,39,50 yet some studies could not demonstrate such an association. 19,28 In contrast to an earlier cross-sectional analysis, 19 the present longitudinal multivariate analysis identified history and the extent and severity of sunburns as significant risk factors for the development of new MN. This might be explained by better control of confounders, better awareness of parents concerning sunburn and sun exposure, and hence more reliable data.…”

Section: Table I -Basic Description Of 1232 German Children and Resucontrasting

confidence: 79%

Risk factors of incident melanocytic nevi: A longitudinal study in a cohort of 1,232 young German children

Bauer

Büttner

Wiecker

et al. 2005

Intl Journal of Cancer

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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 ...

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Section: Table I -Basic Description Of 1232 German Children and Resucontrasting

confidence: 79%

Risk factors of incident melanocytic nevi: A longitudinal study in a cohort of 1,232 young German children

Bauer

Büttner

Wiecker

et al. 2005

Intl Journal of Cancer

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“…The median count of melanocytic nevi Ն2 mm in diameter was 11 (25th-75th percentiles, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], and the corresponding median density was 7.1 (25th-75th percentiles, 3.2-14.3). The median nevus density was higher among boys than girls (7.72 vs. 6.77) with a relative geometric mean adjusted for phenotypic characteristics of 1.11 (95% CI 1.03-1.19).…”

Section: Resultsmentioning

confidence: 99%

“…11,12,14 Even if discrepant data exist, 10,13 these variations suggest a potential role for hormonal factors. In adults, nevus counts have been greater in women or equal between the sexes, 29 and in several countries, including Italy, melanoma incidence (but not mortality) is higher in women than in men.…”

Section: Resultsmentioning

confidence: 99%

The density of melanocytic nevi correlates with constitutional variables and history of sunburns: A prevalence study among Italian schoolchildren

Carli

Naldi

Lovati

et al. 2002

Intl Journal of Cancer

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In several studies from northern Europe, north America and Australia, melanocytic nevi are correlated with pigmentary traits and with intense sun exposure in a way similar to malignant melanoma. However, it is unclear if these data can be extrapolated to populations in other geographic locations and with different prevalent phenotypes. Our study was conducted among schoolchildren aged 13-14 years in 16 Italian cities. The parents of 3,127 children of a total of 3,160 (99%) consented to our study. A structured questionnaire was used to collect information about sun exposure and lifetime history of sunburns. Children were also examined by trained dermatologists to assess pigmentary traits and to make a count of melanocytic nevi. The median nevus density was higher among boys than girls. Areas that are usually chronically exposed to the sun exhibited a higher density of nevi compared to intermittently and rarely exposed areas. A higher density of nevi was found in children with lighter skin, blond hair and blue eyes. Red-haired children had a remarkably lower nevus density compared to the other color categories. The density of nevi increased with an increased number of reported episodes of sunburns. The results concerning nevi >6 mm in diameter paralleled those obtained for the total nevus density. However, at variance with total nevus density, a significant relation was also observed between larger nevi and freckling. Our study confirms that, in Italian schoolchildren, there is a relation between pigmentary traits, history of sunburns and the density of melanocytic nevi. Melanocytic nevi and malignant melanoma share a similar risk factor profile. © 2002 Wiley-Liss, Inc. Key words: melanocytic nevi; malignant melanoma; sunburns; pigmentary traits; epidemiology; South European populationA large number of common melanocytic nevi and the presence of large atypical nevi are strongly associated with cutaneous malignant melanoma. [1][2][3][4][5][6] The biologic correlates of such an association are still poorly understood, but it is plausible that factors that affect the density of melanocytic nevi may also influence the development of malignant melanoma later in life. Risk factors for malignant melanoma have been widely explored in epidemiologic studies and, besides the number of nevi, include pigmentary traits, e.g., light skin and hair color, propensity to sunburns and indicators of intense and intermittent exposure to solar ultraviolet (UV) radiation especially during early life. 7-8 A number of epidemiologic studies confirm that the number of acquired melanocytic nevi is correlated with pigmentary traits, similar to those associated with malignant melanoma, and with intense sun exposure and history of sunburns. 9 -19 Data concerning factors associated with melanocytic nevi have been mostly derived from populations in northern Europe, north America and Australia, and it is unclear if these data can be extrapolated to populations in other geographic locations and with different prevalent phenotypes. The aim of our s...

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“…However, CIA is currently unable to distinguish naevi and freckles, the two most common types of pigmented lesions among paleskinned adolescents (Coombs et al, 1992). Consequently, pigmented lesions countable by CIA included both naevi and freckles greater than 1.5 mm in diameter.…”

Section: Subjectsmentioning

confidence: 99%

Comparability of naevus counts between and within examiners, and comparison with computer image analysis

Aitken

Green²,

Eldridge³

et al. 1994

Br J Cancer

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SummaryIn the course of an investigation of melanocytic naevus development in Queensland, Australia, whole-body naevus counts of 66 adolescents were performed separately by two nurse examiners on two occasions on average 4 weeks apart. There was good agreement between the two examiners for counts of total naevi on the whole body (intra-class correlation coefficient = 0.96) and at selected subsites (face, neck, back, upper arms, lower arms). Agreement was lower when raised naevi only were counted (0.83). Intra-examiner repeatability was high for both nurses, particularly for the more experienced examiner (intra-class correlation coefficients = 0.98 and 0.91 for total naevi on the whole body), and was consistently better when all naevi were counted rather than naevi of a particular size. Independent counts of naevi on the back using a computer imaging technique were reproducible (intra-class correlation coefficient = 0.92), but showed only moderate agreement with counts by the nurse examiners. Overall, these results demonstrate high comparability of naevus counts between and within similarly trained examiners. They do not support the common practice in epidemiological studies of restricting counts to naevi larger than 2 mm, or of counting raised naevi only.Melanoma is an increasingly important public health problem in white-skinned populations throughout the world. In Australia, it is currently the second most common cause of cancer death, and its rapidly increasing incidence is expected to overtake that of all other cancers, with the exception of non-melanoma skin cancer, within the next decade (MacLennan et al., 1992). The number of naevi on the body is the strongest known predictor of melanoma risk and, as such, the reliable and accurate measurement of naevus numbers is important for ongoing individual risk assessment, in studies of naevus prevalence between and within populations over time and in aetiological investigations, in which the number of naevi is invariably a potential confounder of other melanoma risk factors (Green & Swerdlow, 1989).Counting naevi and consistently differentiating these from freckles and other pigmented lesions is one of the more difficult tasks in melanoma research (Green et al., 1991). Nevertheless, some limited data available indicate that reasonable agreement of naevus counts between and within examiners is possible. Roush et al. (1991) reported good agreement between examiners' counts of all naevi on the whole body (intra-class correlation coefficient = 0.92) and arm (0.88) of 153 melanoma patients at the Yale Melanoma Unit. Agreement for raised naevi on the arm was considerably lower (0.36) because of differences of opinion about what was considered palpable. In a small study in Canada (Walter et al., 1991), intra-examiner repeatability of naevus counts on the mid-left arm of eight volunteers, measured by the intra-class correlation coefficient, varied from 0.55 to 0.81 for the five examiners, and tended to be highest among those most experienced.Both of these studies were con...

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Variation and Covariates of the Number of Benign Nevi in Adolescents

Cited by 52 publications

References 0 publications

Risk factors of incident melanocytic nevi: A longitudinal study in a cohort of 1,232 young German children

Risk factors of incident melanocytic nevi: A longitudinal study in a cohort of 1,232 young German children

The density of melanocytic nevi correlates with constitutional variables and history of sunburns: A prevalence study among Italian schoolchildren

Comparability of naevus counts between and within examiners, and comparison with computer image analysis

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