August 1994

Risk Factors for Melanoma Incidence in Prospective Follow-upThe Importance of Atypical (Dysplastic) Nevi

Author Affiliations

From Kaiser Permanente, San Rafael, Calif (Dr Schneider); Biology and Biotechnology Research Program, Lawrence Livermore (Calif) National Laboratory (Dr Moore); and Departments of Pathology (Dr Sagebiel) and Dermatology (Dr Schneider), University of California—San Francisco.

Arch Dermatol. 1994;130(8):1002-1007. doi:10.1001/archderm.1994.01690080068009

Background and Design:  Assessment of melanoma risk factors can help identify individuals at greatest risk for melanoma. Previous studies were retrospective case-control or prospective without control groups. A prospective group of 3889 employees without previous melanoma or family history of multiple melanoma at the Lawrence Livermore (Calif) National Laboratory were examined as part of a melanoma screening program. Their subsequent incidence of melanoma in relationship to potential melanoma risk factors, which were recorded at the first examination, was determined.

Results:  Nine invasive melanomas developed after initial examination among the studied population over an 8-year period with an average follow-up of 5 years. The presence of an easily recognized pattern of definite clinically atypical (dysplastic) nevi was present in 7% of em- ployees and was associated with a cumulative melanoma risk of 1.9%. It was the strongest risk factor, with a relative risk of 47 compared with the 0.04% cumulative melanoma risk in the 64% of employees with no atypical (dysplastic) moles (χ2 for equal risk, P=7× 10-8). Significant, but less marked associations with melanoma risk were found for the total number of moles and for a history of many moles in other family members, with a maximal relative risk of 11.6 and 10.4, respectively.

Conclusion:  A small subgroup of the population with easily recognizable definite atypical (dysplastic) nevi have a marked increased risk of melanoma. Smaller significant melanoma risks were found for a total number of moles and a family history of many moles.(Arch Dermatol. 1994;130:1002-1007)