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May 2004

The Framingham School Nevus Study: A Pilot Study

Author Affiliations

From the Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (Drs Oliveria, Marghoob, Sachs, and Halpern and Mr Dusza); Department of Dermatology, Boston University, Boston, Mass (Mr Geller); Dermatoepidemiology Unit, Veterans Affairs Medical Center and Department of Dermatology, Rhode Island Hospital and Brown University, Providence (Dr Weinstock); and School Health Services, Framingham Public Schools, Framingham, Mass (Ms Buckminster). The authors have no relevant financial interest in this article.

Arch Dermatol. 2004;140(5):545-551. doi:10.1001/archderm.140.5.545

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 1 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.