The Framingham school Nevus study - A pilot study

Objectives: To (1) describe nevus patterns using digital photography and dermoscopy; (2) evaluate the relationship between host and environmental factors and prevalence of nevi in schoolchildren; and (3) demonstrate the feasibility of conducting a longitudinal study. Design: Cross-sectional survey and 1-year prospective follow-up study. Participants: Students from 2 classrooms, grades 6 and 7, in the Framingham, Mass, school system (N=52). Main Outcome Measures: A survey was completed by students and I of their parents that included questions on demographic and phenotypic characteristics, family history of skin cancer, and sun exposure and protection practices. An examination of nevi on the back was performed that included digital photography and digital dermoscopy. Follow-up child and parent surveys and examinations were conducted at 1-year follow-up. Results: At baseline, the median number of back nevi was 15 (mean [SD], 21.9 [15.3]). Older age, male sex, fair skin, belief that a tan is healthier, tendency to burn, and sporadic use of sunscreen were positively associated with mole count, although age was the only statistically significant factor. Predominant dermoscopic patterns for the index nevus were as follows: 38% globular, 14% reticulated, 38% structureless, and 10% combinations of the above patterns with no predominant characteristic. The overall participation rate from baseline to follow-up was 81% (42/ 52) for the skin examination process. At the 1-year follow-up examination, new nevi were identified in 36% of students (n=15), while 9.6% of baseline index nevi had changes in the dermoscopic pattern. Dominant dermoscopic pattern was related to nevus size: smaller nevi tended to be structureless, while larger nevi were of mixed pattern. Conclusion: This study supports the feasibility and utility of digital photography and dermoscopy for the longitudinal study of nevus evolution in early adolescence.