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Factors in Early Adolescence Associated With a Mole-Prone Phenotype in Late Adolescence

Educational Objective
To identify host, behavioral, and dermoscopic factors in early adolescence that are associated with a mole-prone phenotype in late adolescence.
1 Credit CME
Key Points

Question  Can factors associated with a mole-prone phenotype in late adolescence be identified in early adolescence?

Findings  In this cohort study, baseline total nevus count and variability in nevus dermoscopic pattern in early adolescence was significantly associated with a mole-prone phenotype in late adolescence.

Meaning  Clinically recognizable factors associated with a mole-prone phenotype may facilitate the identification of a population at risk for melanoma and have implications for primary prevention strategies and skin self-examination practices.


Importance  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.

Objective  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.

Main Outcome and Measures  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.

Results  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.

Conclusions and Relevance  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.

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Article Information

Corresponding Author: Allan C. Halpern, MD, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th St, New York, NY 10022 (halperna@mskcc.org).

Accepted for Publication: April 6, 2017.

Published Online: June 7, 2017. doi:10.1001/jamadermatol.2017.1547

Author Contributions: Mr Xu and Dr Dusza had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Xu, Marchetti, Dusza, Fonseca, Geller, Halpern.

Acquisition, analysis, or interpretation of data: Xu, Marchetti, Dusza, Chung, Fonseca, Scope, Bishop, Marghoob.

Drafting of the manuscript: Xu, Dusza.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Xu, Dusza.

Obtained funding: Geller, Halpern.

Administrative, technical, or material support: Marchetti, Chung, Fonseca, Scope.

Study supervision: Dusza, Fonseca, Halpern.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded in part through Cancer Center Support Grant P30-CA008748 from the National Institutes of Health (NIH)/National Cancer Institute and supported by award number R01-AR049342 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the NIH as well as grant P41-GM103545 from the National Institute of General Medical Sciences of the NIH.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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