Xu Haoming, Marchetti Michael A, Dusza Stephen W, Chung Esther, Fonseca Maira, Scope Alon, Geller Alan C, Bishop Marilyn, Marghoob Ashfaq A, Halpern Allan C
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
JAMA Dermatol. 2017 Oct 1;153(10):990-998. doi: 10.1001/jamadermatol.2017.1547.
Nevi are important phenotypic risk factors for melanoma in adults. Few studies have examined the constitutional and behavioral factors associated with a mole-prone phenotype in adolescents.
To identify host, behavioral, and dermoscopic factors in early adolescence (age, 14 years) that are associated with a mole-prone phenotype in late adolescence (age, 17 years).
DESIGN, SETTING, AND PARTICIPANTS: A prospective observational cohort study from the Study of Nevi in Children was conducted from January 1, 2009, to December 31, 2014, with a 2- to 3-year follow-up. A total of 569 students from the school system in Framingham, Massachusetts, were enrolled in the 8th or 9th grade (baseline; mean [SD] age, 14.4 [0.7] years). The overall retention rate was 73.3%, and 417 students were reassessed in the 11th grade.
Mole-prone phenotype in the 11th grade, defined as total nevus count of the back and 1 randomly selected leg in the top decile of the cohort or having any nevi greater than 5 mm in diameter.
Of the 417 students assessed at follow-up in the 11th grade (166 females and 251 males; mean [SD] age, 17.0 [0.4] years), 111 participants (26.6%) demonstrated a mole-prone phenotype: 69 students (62.2%) with 1 nevus greater than 5 mm in diameter, 23 students (20.7%) with total nevus count in the top decile, and 19 students (17.1%) with both characteristics. On multivariate analysis, baseline total nevus count (adjusted odds ratio, 9.08; 95% CI, 4.0-23.7; P < .001) and increased variability of nevus dermoscopic pattern (adjusted odds ratio, 4.24; 95% CI, 1.36-13.25; P = .01) were associated with a mole-prone phenotype.
This study found clinically recognizable factors associated with a mole-prone phenotype that may facilitate the identification of individuals at risk for melanoma. These findings could have implications for primary prevention strategies and help target at-risk adolescents for higher-intensity counseling about sun protection and skin self-examination.
痣是成人黑色素瘤重要的表型风险因素。很少有研究探讨与青少年易长痣表型相关的体质和行为因素。
确定青春期早期（14岁）的宿主、行为和皮肤镜检查因素，这些因素与青春期晚期（17岁）的易长痣表型相关。
设计、地点和参与者：一项来自儿童痣研究的前瞻性观察队列研究于2009年1月1日至2014年12月31日进行，随访2至3年。马萨诸塞州弗雷明汉姆学校系统的569名学生在八年级或九年级（基线；平均[标准差]年龄，14.4[0.7]岁）入学。总体保留率为73.3%，417名学生在十一年级重新接受评估。
十一年级的易长痣表型，定义为背部痣总数和随机选择的一条腿上的痣总数在队列前十分位，或有任何直径大于5mm的痣。
在十一年级随访评估的417名学生（166名女性和251名男性；平均[标准差]年龄，17.0[0.4]岁）中，111名参与者（26.6%）表现出易长痣表型：69名学生（62.2%）有1颗直径大于5mm的痣，23名学生（20.7%）痣总数在前十分位，19名学生（17.1%）具有这两种特征。多变量分析显示，基线痣总数（调整后的优势比，9.08；95%置信区间，4.0 - 23.7；P < .001）和痣皮肤镜模式变异性增加（调整后的优势比，4.24；95%置信区间，1.36 - 13.25；P = .01）与易长痣表型相关。
本研究发现了与易长痣表型相关的临床可识别因素，这可能有助于识别黑色素瘤风险个体。这些发现可能对一级预防策略有影响，并有助于针对有风险的青少年进行更高强度的防晒和皮肤自我检查咨询。
