Number Of Naevi Research Articles

Common genetic variants associated with melanoma risk or naevus count in patients with wildtype MC1R melanoma.

Hypomorphic MC1R variants are the most prevalent genetic determinants of melanoma risk in the white population. However, the genetic background of patients with wildtype (WT) MC1R melanoma is poorly studied. To analyse the role of candidate common genetic variants on the melanoma risk and naevus count in Spanish patients with WT MC1R melanoma. We examined 753 individuals with WT MC1R from Spain (497 patients and 256 controls). We used OpenArray reverse-transcriptase polymerase chain reaction to genotype a panel of 221 common genetic variants involved in melanoma, naevogenesis, hormonal pathways and proinflammatory pathways. Genetic models were tested using multivariate logistic regression models. Nonparametric multifactor dimensionality reduction (MDR) was used to detect gene-gene interactions within each biological subgroup of variants. We found that variant rs12913832 in the HERC2 gene, which is associated with blue eye colour, increased melanoma risk in individuals with WT MC1R [odds ratio (OR) 1·97, 95% confidence interval (CI) 1·48-2·63; adjusted P < 0·001; corrected P < 0·001]. We also observed a trend between the rs3798577 variant in the oestrogen receptor alpha gene (ESR1) and a lower naevus count, which was restricted to female patients with WT MC1R (OR 0·51, 95% CI 0·33-0·79; adjusted P = 0·002; corrected P = 0·11). This sex-dependent association was statistically significant in a larger cohort of patients with melanoma regardless of their MC1R status (n = 1497; OR 0·71, 95% CI 0·57-0·88; adjusted P = 0·002), reinforcing the hypothesis of an association between hormonal pathways and susceptibility to melanocytic proliferation. Last, the MDR analysis revealed four genetic combinations associated with melanoma risk or naevus count in patients with WT MC1R. Our data suggest that epistatic interaction among common variants related to melanocyte biology or proinflammatory pathways might influence melanocytic proliferation in individuals with WT MC1R. What is already known about this topic? Genetic variants in the MC1R gene are the most prevalent melanoma genetic risk factor in the white population. Still, 20-40% of cases of melanoma occur in individuals with wildtype MC1R. Multiple genetic variants have a pleiotropic effect in melanoma and naevogenesis. Additional variants in unexplored pathways might also have a role in melanocytic proliferation in these patients. Epidemiological evidence suggests an association of melanocytic proliferation with hormonal pathways and proinflammatory pathways. What does this study add? Variant rs12913832 in the HERC2 gene, which is associated with blue eye colour, increases the melanoma risk in individuals with wildtype MC1R. Variant rs3798577 in the oestrogen receptor gene is associated with naevus count regardless of the MC1R status in female patients with melanoma. We report epistatic interactions among common genetic variants with a role in modulating the risk of melanoma or the number of naevi in individuals with wildtype MC1R. What is the translational message? We report a potential role of hormonal signalling pathways in melanocytic proliferation, providing a basis for better understanding of sex-based differences observed at the epidemiological level. We show that gene-gene interactions among common genetic variants might be responsible for an increased risk for melanoma development in individuals with a low-risk phenotype, such as darkly pigmented hair and skin.

Reproducible Naevus Counts Using 3D Total Body Photography and Convolutional Neural Networks

Background: The number of naevi on a person is the strongest risk factor for melanoma; however, naevus counting is highly variable due to lack of consistent methodology and lack of inter-rater agreement. Machine learning has been shown to be a valuable tool for image classification in dermatology. Objectives: To test whether automated, reproducible naevus counts are possible through the combination of convolutional neural networks (CNN) and three-dimensional (3D) total body imaging. Methods: Total body images from a study of naevi in the general population were used for the training (82 subjects, 57,742 lesions) and testing (10 subjects; 4,868 lesions) datasets for the development of a CNN. Lesions were labelled as naevi, or not (“non-naevi”), by a senior dermatologist as the gold standard. Performance of the CNN was assessed using sensitivity, specificity, and Cohen’s kappa, and evaluated at the lesion level and person level. Results: Lesion-level analysis comparing the automated counts to the gold standard showed a sensitivity and specificity of 79% (76–83%) and 91% (90–92%), respectively, for lesions ≥2 mm, and 84% (75–91%) and 91% (88–94%) for lesions ≥5 mm. Cohen’s kappa was 0.56 (0.53–0.59) indicating moderate agreement for naevi ≥2 mm, and substantial agreement (0.72, 0.63–0.80) for naevi ≥5 mm. For the 10 individuals in the test set, person-level agreement was assessed as categories with 70% agreement between the automated and gold standard counts. Agreement was lower in subjects with numerous seborrhoeic keratoses. Conclusion: Automated naevus counts with reasonable agreement to those of an expert clinician are possible through the combination of 3D total body photography and CNNs. Such an algorithm may provide a faster, reproducible method over the traditional in person total body naevus counts.

A different finding on whether naevus numbers change during adulthood.

A different finding on whether naevus numbers change during adulthood.

Development and external validation study of a melanoma risk prediction model incorporating clinically assessed naevi and solar lentigines.

Melanoma risk prediction models could be useful for matching preventive interventions to patients' risk. To develop and validate a model for incident first-primary cutaneous melanoma using clinically assessed risk factors. We used unconditional logistic regression with backward selection from the Australian Melanoma Family Study (461 cases and 329 controls) in which age, sex and city of recruitment were kept in each step, and we externally validated it using the Leeds Melanoma Case-Control Study (960 cases and 513 controls). Candidate predictors included clinically assessed whole-body naevi and solar lentigines, and self-assessed pigmentation phenotype, sun exposure, family history and history of keratinocyte cancer. We evaluated the predictive strength and discrimination of the model risk factors using odds per age- and sex-adjusted SD (OPERA) and the area under curve (AUC), and calibration using the Hosmer-Lemeshow test. The final model included the number of naevi ≥2mm in diameter on the whole body, solar lentigines on the upper back (a six-level scale), hair colour at age 18 years and personal history of keratinocyte cancer. Naevi was the strongest risk factor; the OPERA was 3·51 [95% confidence interval (CI) 2·71-4·54] in the Australian study and 2·56 (95% CI 2·23-2·95) in the Leeds study. The AUC was 0·79 (95% CI 0·76-0·83) in the Australian study and 0·73 (95% CI 0·70-0·75) in the Leeds study. The Hosmer-Lemeshow test P-value was 0·30 in the Australian study and <0·001 in the Leeds study. This model had good discrimination and could be used by clinicians to stratify patients by melanoma risk for the targeting of preventive interventions. What's already known about this topic? Melanoma risk prediction models may be useful in prevention by tailoring interventions to personalized risk levels. For reasons of feasibility, time and cost many melanoma prediction models use self-assessed risk factors. However, individuals tend to underestimate their naevus numbers. What does this study add? We present a melanoma risk prediction model, which includes clinically-assessed whole-body naevi and solar lentigines, and self-assessed risk factors including pigmentation phenotype and history of keratinocyte cancer. This model performs well on discrimination, the model's ability to distinguish between individuals with and without melanoma, and may assist clinicians to stratify patients by melanoma risk for targeted preventive interventions.

Associations of pigmentary and naevus phenotype with melanoma risk in two populations with comparable ancestry but contrasting levels of ambient sun exposure.

BackgroundPeople at high risk of developing melanoma are usually identified by pigmentary and naevus phenotypes.ObjectiveWe examined whether associations of these phenotypes with melanoma risk differed by ambient sun exposure or participant characteristics in two population‐based, case–control studies with comparable ancestry but different ambient sun exposure.MethodsData were analysed from 616 cases and 496 controls from the Australian Melanoma Family Study and 2012 cases and 504 controls from the Leeds (UK) case–control study. Questionnaire, interview and dermatological skin examination data were collected using the same measurement protocols. Relative risks were estimated as odds ratios using unconditional logistic regression, adjusted for potential confounders.ResultsHair and skin colour were the strongest pigmentary phenotype risk factors. All associations of pigmentary phenotype with melanoma risk were similar across countries. The median number of clinically assessed naevi was approximately three times higher in Australia than Leeds, but the relative risks for melanoma associated with each additional common or dysplastic naevus were higher for Leeds than Australia, especially for naevi on the upper and lower limbs. Higher naevus counts on the head and neck were associated with a stronger relative risk for melanoma for women than men. The two countries had similar relative risks for melanoma based on self‐reported naevus density categories, but personal perceptions of naevus number differed by country. There was no consistent evidence of interactions between phenotypes on risk.ConclusionsClassifying people at high risk of melanoma based on their number of naevi should ideally take into account their country of residence, type of counts (clinical or self‐reported), body site on which the naevus counts are measured and sex. The presence of naevi may be a stronger indicator of a genetic predisposition in the UK than in Australia based on less opportunity for sun exposure to influence naevus development.

Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better?

Substantial public health efforts have been undertaken throughout the last 25years to increase awareness about skin cancer risks in the German population. An evaluation of long-term effects of these awareness campaigns and preventive activities on the population level and in specific subgroups is yet lacking. We address the temporal development of knowledge about skin cancer risk factors and agreement to the necessity of sun protection in different outdoor situations among parents of young children. We compiled data from four population-based surveys comprising data from 8184 parents of 3- to 6-year-old children in two regions of Germany performed over a nineteen-year period between 1993 and 2012. These individual cross-sectional studies used an identical methodology to recruit study subjects and to assess the principal outcome measures. Overall, parental knowledge about skin cancer risk factors and agreement to the necessity of sun protection improved significantly over the nineteen-year period. For instance, the recognition of fair skin/hair, sunburns during childhood and a high number of naevi, respectively, being risk factors for skin cancer increased by 20.0%, 19.9% and 19.2% from the first to the most recent survey. Two remaining knowledge gaps became evident: (i) the underrating of intermittent intensive sun exposure as a skin cancer risk factor and (ii) the erroneous belief that clouds provide sufficient sun protection at midday during summertime. The messages of future public health campaigns in Germany addressing skin cancer risks and informing about preventive measures for sun protection should thus be refined regarding these aspects.

Heritability of naevus patterns in an adult twin cohort from the Brisbane Twin Registry: a cross-sectional study.

Heritability of naevi counts is widely acknowledged as a potential surveillance parameter for prevention purposes. The contribution of heritability to the changes seen in naevus number and morphology over time and their corresponding dermoscopic characteristics is unknown, but is important to understand in order to account for adequate prevention measures. To identify naevus characteristics that are strongly influenced by heritability. This cross-sectional study included 220 individuals [76 monozygotic (MZ), 144 dizygotic (DZ)], recruited from the Brisbane Twin Naevus Study. Participants received full body imaging and dermoscopy of naevi ≥ 5 mm in diameter. Dermoscopic type, total naevus count (TNC), change in TNC with age, and naevus distribution, size, colour and profile were compared between MZ and DZ twins. Heritability of these traits was assessed via Falconer's estimate. Significant differences were found in comparing MZ and DZ twins for TNC, numbers of naevi 5·0-7·9 mm in diameter, counts of light-brown naevi, naevi on the back and sun-protected sites, and naevi with the 'nonspecific' dermoscopic pattern. This study strongly supports a heritable component to TNC, as well as changes in TNC, and the number of medium-sized naevi, light-brown naevi, specific sites and certain dermoscopic features in adults. These characteristics should be taken into account by naevus surveillance programmes and further studied to identify candidate gene associations for clinical and dermoscopic patterns in conjunction with melanoma risk stratification.

Melanoma: A new strategy to reduce morbidity and mortality.

Public awareness campaigns could address risk factors for melanoma to reinforce their sun protection message. The objective of this study is to prioritise risk factors associated with malignant melanoma (MM) to improve public awareness. A cross-sectional study with retrospective data analysis from 2004 to 2010. Western Australian Melanoma Advisory Service (WAMAS), a tertiary referral multidisciplinary organisation providing MM management advice. WAMAS data files were analysed with histologically confirmed cutaneous MM. Forty- seven patients had two or more melanomas, but the patient file was counted only once. Six MM data files with missing or incomplete information were excluded. The number of naevi, blood relatives with MM, and previous sunburns were the primary variables collected. The results showed that 70.9 per cent (268/378) had previous sunburn; 40.2 per cent (152/378) had multiple naevi; and 22.5 per cent (85/378) had a positive family history. In the 110 MM data files not associated with sunburn, multiple naevi and a positive family history represented 34.5 per cent (38/110) and 20.0 per cent (22/110), respectively. The results confirm the findings of previous studies that multiple naevi and a positive family history are important risk factors associated with MM. We suggest that MM can be detected earlier and its mortality decreased by focusing on these high-risk groups who are not targeted by current public awareness campaigns.

Anthropometric features and cutaneous melanoma risk: A prospective cohort study in French women

BackgroundEpidemiological studies on anthropometric features and cutaneous melanoma risk in women yielded inconsistent results, with few analyses involving prospective cohort data. Our objective was to explore several anthropometric characteristics in relation to the risk of melanoma in women. MethodsWe prospectively analysed data from E3N, a French cohort involving 98,995 women born in 1925–1950. Participants completed self-administered questionnaires sent biennially over 1990–2008. Relative risks (RRs) and 95% confidence intervals (CIs) were computed using Cox proportional hazards regression models, adjusted for age, number of naevi, freckling, skin and hair colour, skin sensitivity to sun exposure, residential sun exposure, and physical activity. ResultsHeight was positively associated with melanoma in age-adjusted models only (RR=1.27, 95% CI=1.05–1.55 for ≥164cm vs. <160cm; P for trend=0.02). After full adjustment, there was a significantly positive relationship between sitting-to-standing height ratio and melanoma risk (RR=1.40, 95% CI=1.06–1.86 for ≥0.533 vs. <0.518; P for trend=0.02). A large body shape at menarche was inversely associated with the risk of melanoma (RR=0.78, 95% CI=0.62–0.98; compared with lean). However, weight, body mass index, body surface area, waist or hip circumference, sitting height or leg length were not significantly associated with risk. ConclusionThese results suggest that height, sitting-to-standing height ratio and body shape at menarche may be associated with melanoma risk. Further research is required to confirm these relationships and better understand the underlying mechanisms.

Personal melanoma risk awareness versus intrinsic risk.

9069 Background: Intrinsic risk factors for melanoma include personal and family history of the condition, a high number of naevi and a light skin phototype (I or II). The objective of this study was to evaluate the correlation between personal awareness of melanoma risk and objective risk factors and to analyze the elements associated with under-or over-evaluation of the actual risk. Methods: EDIFICE melanoma, a nationwide French observational survey, was conducted through phone interviews on a representative sample of 1502 subjects aged ≥ 18 using typical quotas. The survey took place from 28th Sept 2011 to 20th Oct 2011. Results: 393 subjects (26%) had at least one melanoma risk factor: personal: 1%; family history: 11%; high number of naevi: 8% and phototype I-II: 11%. 1109 (74%) had no risk factor. 1029 (73%) had a correct perception of their risk level, 135 (10%) overestimated their risk and 241 (17%) underestimated it. Compared to the control group (correct perception), the population overestimating the melanoma risk is characterised by a higher percentage of individuals living alone (32% vs. 24%, p&lt;0.05), socio-professional category + (38% vs. 28%, p&lt;0.01) and greater alcohol consumption (45% vs. 34%, p&lt;0.02). They are also more likely to expose themselves to the sun (89% vs. 78%, p&lt;0.004) and less likely to use sunscreen protection (58% vs. 44%, p&lt;0.003). A greater proportion of them participates in melanoma screening programmes (21% vs. 14%, p&lt;0.04). The population that underestimates the risk is characterised by lower educational attainment (11% vs. 7%, p&lt;0.05), greater use of high SPF sunscreen (41% vs. 29%, p&lt;0.0004) and a more frequent use of UV sunbeds (9% vs. 6%, p&lt;0.06). Conclusions: Overall, the French have a fair perception of their personal likelihood of developing melanoma. Interestingly, subjects overestimating their intrinsic risk do not behave appropriately with respect to sun protection measures (more sun exposure and less sunscreen protection). On the other hand, subjects underestimating their risk use UV sunbeds more extensively.

Risk factors for actinic keratosis in eight European centres: a case-control study

There are limited data regarding the association of actinic keratosis (AK) and other types of nonmelanoma skin cancer (NMSC); studies investigating possible correlation of AK with melanocytic naevi are even scarcer. To our knowledge, there are no data examining the risk of AK in people using specific medications. To investigate constitutional and exposure risk factors leading to AK and the coexistence of AK with NMSC and melanoma. A multicentre hospital-based case-control study was performed in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain, including 343 patients with actinic keratosis (AK), 409 with squamous cell carcinoma (SCC), 602 with basal cell carcinoma (BCC), 360 with invasive melanoma and 119 with in situ melanoma, and 686 control subjects. Exposures were assessed by questionnaires that were partly self-administered and partly filled out by dermatologists. Unconditional logistic regression modelling was used to assess associations including the influence of phenotypic characteristics, presence of naevi, sun-exposure habits and certain drugs on AK risk. Differences in hair and eye coloration variably influenced the risk for AK, with red hair signifying a seven times higher risk [odds ratio (OR) 6·9, 95% confidence interval (CI) 4·34-11·00), and brown - compared with blue - eyes, about a 40% reduced risk (OR 0·61, 95% CI 0·13-0·92). The darker the skin phototype, the lower the risk for AK, with phototype IV exhibiting nine times less risk of developing AK. Some and many freckles on the arms were associated with an OR of 1·8 (95% CI 1·08-2·81) and 3·0 (95% CI 1·10-3·54), respectively, while overall number of naevi and high educational level were inversely associated with AK. Sun exposure, thiazide diuretics and cardiac drugs had a higher risk for AK. SCC was the most frequent (58%) skin neoplasm coexisting with AKs, followed by BCC (30%), melanoma in situ (12%) and invasive melanoma (6%). In this large case-control study from across Europe the expected associations were confirmed for known risk factors. Some possible new risk factors, including cardiac and diuretic drugs, were identified, creating a new field for further investigation in future studies.

Nævus éruptifs sous octréotide

Octreotide is a synthetic octapeptide having properties related to those of natural somatostatin, a hypothalamic hormone. We report a case of eruptive naevus in patients treated with octreotide. A 52-year-old man consulted for multiple achromic naevi of recent onset. He was undergoing treatment with octreotide 30 mg per month for hepatic metastases in a setting of operated colonic carcinoid tumor. Since the start of this treatment, he had presented an efflorescence of diffuse naevus comprising over 200 lesions, certain of which were highly atypical. Annual follow-up was carried out. Ten years later, the patient was still alive and undergoing octreotide therapy at the same dose. The number of naevi had stabilized and there was no evidence of melanoma. Eruptions of naevi are rare; they may occur at the sites of lesions in bullous diseases or during immunodepression (malignant or drug induced, HIV infection). There are questions concerning possible stimulation of naevus cells and the risk of onset of melanoma. Routine monitoring of pigmented lesions is thus necessary in patients treated with octreotide.

Familial and sporadic melanoma: different clinical and histopathological features in the Italian population – a multicentre epidemiological study – by GIPMe (Italian Multidisciplinary Group on Melanoma)

Having a familial member affected by cutaneous melanoma is a risk factor for this neoplasm. Only a few epidemiological case-control studies have been carried out to investigate whether familial and sporadic melanomas show different clinical and histopathological features. The aim of this study was to evaluate eventual different features and risk factors in subjects affected by familial and sporadic cutaneous melanoma. A case-control multicentre study interesting 1407 familial (n = 92) and sporadic (n = 1315) melanomas in the Italian population. The analysis was made using t-test for continuous variables and chi-squared test for categorized ones. The variables which have shown statistically significant differences in the two groups in the univariate analysis were included in a multivariate model. The results showed some main significantly clinical differences between the two groups investigated: earlier age at diagnosis, a greater proportion of sunburns and a higher number of naevi were observed for the familial cases compared with sporadic ones. Nevertheless, we did not find a diagnostic anticipation in familial melanomas, in fact the invasion level and the thickness of melanomas was similar in the two groups. Some relevant clinical differences are observed between the two groups examined. The familial melanoma members, although carriers of constitutional risk factors, are not careful enough to primary and secondary prevention.

Current patterns of the sun protection measures adopted by nurses and the risk factors influencing their compliance

The incidence of skin cancer is increasing worldwide. Included in high risk group are people who have light common phenotypic factors (hair, skin, eyes), have high number of naevi, report previous sunburns and have a family history of skin cancer. Protecting the skin from the sun by wearing protective clothing, using sunscreen and avoiding sun exposure are recommended among primary preventive activities. The purpose of this study was to describe the current patterns of sun protection measures adopted by nurses and to examine the association between compliance with sun protection measures and the main risk factors of melanoma. This cross sectional study was conducted in 2007 during the Annual Greek National Conference of Nursing. Nurses most commonly chose to use sunscreen, to wear glasses, to use an umbrella or to seek for shade in order to protect themselves against sun exposure. Finally, phenotypic factors, previous sunburns and common naevi presence were found to affect nurses’ attitude towards protective measures. This study poses the necessity of targeting high risk groups for melanoma through campaigns aiming to foster sun protection behaviours.

FC1 Cutaneous melanoma and endogenous hormonal factors: a large French prospective cohort study

Introduction Several observations have led to the hypothesis of a hormonal dependence of cutaneous melanoma. However, previous research yielded conflicting results as to the influence of reproductive and hormonal factors on melanoma risk, and most findings relied on case-control designs. Methods To assess the role of these factors on the risk of melanoma, we conducted a prospective analysis of 91,972 French women from the National Education System, aged 40–65 years at inclusion into the E3N cohort study. Data on reproductive and hormonal factors were collected at baseline and were updated every two/three years. Between 1990 and 2005, 460 incident first primary melanoma cases were reported and confirmed through pathology reports. Relative risks (RR) were computed using Cox proportional hazards regression models, adjusted for host factors (number of naevi, freckling, skin colour, hair colour, skin sensitivity to sun exposure), mean daily ultraviolet radiation dose in regions of birth and inclusion, history of endometriosis, history of uterine fibroma, age at menarche, menstrual cycle length, parity, age at menopause, and educational level. Results We observed significantly inverse relationships between melanoma risk and late age at menarche (RR=0.68, 95% confidence interval (CI)=0.47–0.99; for menarche ≥15 years compared to 13–15 years), and irregularity of menstrual cycles (RR=0.54, 95% CI=0.31–0.91; compared to regular cycles of 25–31 days periodicity). Early age at natural menopause was marginally significantly associated with risk (RR=0.72, 95% CI=0.51–1.02, for menopause <48 years compared to 48–52 years). Other reproductive and hormonal factors (parity, number of pregnancies, age at first live birth or pregnancy, or history of miscarriages) were not significantly associated with melanoma risk. Conclusion Our findings suggest an inverse association between melanoma and some menstrual factors in women. These results from a large prospective cohort provide some evidence for a hormonal-dependent etiological component of this cancer. Biological mechanisms that could explain these associations remain unclear and should be further explored in experimental and epidemiological studies.

Malignant transformation in Pre-existing Naevi. A review of two cases

Pigmented naevi (melanocytic naevi) are common and are widely distributed all over the body. The average number of naevi seen in a Caucasian is between twenty and thirty. They are either congenital or acquired benign neoplasm of melanocytes. They may occur as giant lesions at birth, and are more prone to malignant transformation. However, the risk of malignant transformation associated with naevi irrespective of size is well established and a variety of malignancies have been reported to arise from a naevus. The incidence of malignant transformation in naevi is 4% to 9%. We present two cases of malignant tumours arising from pre-existing naevus. The first was a 60-year old woman with a malignant melanoma arising in a vulva intradermal naevus. The second was a 51-year old woman with a basal cell carcinoma arising in a facial naevus.

Creation and test of a questionnaire for self-assessment of melanoma risk factors

The objective of this study was to create a self-administrated questionnaire for people to enable them to assess their own melanoma risk factors. To test the validity of this questionnaire in a large prospective study, the answers given by the patient were systematically checked by his or her general practitioner. In this prospective study, the choice of questions was based on a review of the literature. The validity of the questionnaire was assessed by testing 1500 consecutive patients attending a consultation with their general practitioner. Considerable variations concerning the prevalence of different melanoma risk factors were noticed in the population: 44.1% had a phototype I or II, 41% had severe sunburn during infancy, 29.9% had freckling tendency, 22% had more than 50 naevi and 1.4% a personal history of melanoma. In total, 45% had more than one melanoma risk factor. The accuracy of the answers given by the patients was assured by the correction given by their general practitioners. The percentage of correct answers given by the patients was 79.9% for the phototype, 90.6% for freckling tendency, 86.6% for the number of naevi, 96.5% for severe sunburn during infancy and 98.1 and 95.8% for personal and familial history of melanoma. This study confirms that individuals with multiple risk factors for melanoma are common among patients consulting their general practitioners. Furthermore, self-screening with the self-assessment questionnaire is easily feasible and is accurate for identifying high-risk individuals. This tool might be useful for carrying out melanoma-targeted screening.

Agminated acquired melanocytic naevus modified by vitiligo vulgaris arising in the elderly

Conflict of interest: none declared. A healthy 74‐year‐old Japanese woman, who had a history of vitiligo vulgaris on her neck for several years, visited our dermatology clinic with a 6‐month history of slowly growing pigmented macules on her right breast (Fig. 1a). On physical examination, she had a cluster of approximately 15 melanocytic macules, 15 × 10 mm in size. The cluster was surrounded by vitiligo (Fig. 1b). The vitiligo patch on her right breast had not been seen before the appearance of pigmented macules, which suggested that the vitiligo and pigmented macules had appeared simultaneously. Dermatoscopic analysis revealed patchy reticular networks for all macules within the cluster, some of which had irregular pigment networks. Bluish‐white veils were also seen in the centre of the cluster (Fig. 1c). The number of naevi over the entire body was > 10. Because malignant melanoma (MM) was suspected on clinical observation, the lesion was excised.

Endometriosis risk in relation to naevi, freckles and skin sensitivity to sun exposure: the French E3N cohort

Endometriosis is an important women's health issue, however its aetiology remains unknown. An association between endometriosis and cutaneous melanoma was described, possibly explained through common genetic features. To further investigate this association, we assessed the link between phenotypic traits predisposing to melanoma and the risk of endometriosis. Using a case-control design, we analysed data from 97,215 women of the Etude Epidémiologique auprès de femmes de l'Education Nationale study, a cohort of 98,995 French women insured by a national health scheme mostly covering teachers, and aged 40-65 years at inclusion in 1990. Risk estimates were computed using unconditional logistic regression models. After adjustment for potential confounding factors, there was a positive dose-effect relationship between risk of endometriosis (reported as surgically ascertained, n = 4241) and skin sensitivity to sun exposure [moderate: odds ratio (OR) 1.09, 95% confidence interval (CI) 0.99-1.19; high: OR 1.22; 95% CI 1.10-1.36; compared with none; Ptrend < 0.0001], number of naevi (few: OR 1.19, 95% CI 1.05-1.35; many: OR 1.37, 95% CI 1.21-1.55; very many: OR 1.59, 95% CI 1.37-1.83; compared with none; Ptrend < 0.0001) and number of freckles (few: OR 1.08, 95% CI 1.00-1.17; very many/many: OR 1.11, 95% CI 1.03-1.20; compared with none; Ptrend = 0.005). This study is, to our knowledge, the first to report a positive dose-effect relationship between the risk of endometriosis and skin sensitivity to sun exposure, and number of naevi and freckles. These data suggest that endometriosis and melanoma may share some genetic features.

Sensitivity to ultraviolet B is a risk factor for cutaneous melanoma in a Mediterranean population: results from an Italian case-control study

Sun sensitivity is one of the predictors of melanoma risk, together with other individual characteristics such as skin and eye colour and number of naevi. However, it is unclear how best to measure sun sensitivity in order to quantify the individual risk of melanoma. In this case-control study, the relationship between minimal erythema dose (MED) and skin colour (both instrumentally assessed) was investigated, and their possible role as independent risk factors for melanoma in a Mediterranean population evaluated. In total, 143 patients with cutaneous melanoma and 102 controls were enrolled in the study. Skin colour was assessed using a Minolta CR-200 chromameter. For MED calculation, a fluorescent lamp (Philips TL 4W/12) was used as a source of ultraviolet B light. MED was defined as the lowest dose that produced an increase of 2.5 in the redness value, expressed by the parameter a* of the Commission Internationale d'Eclairage (CIE) L*a*b* colour space (Deltaa* = 2.5). A significant excess of risk was associated with increasing L* values of skin colour (P < 0.05; OR = 1.12; 95% CI 1.01-1.24) for each unit of change. Low MED values were also associated with an increasing risk of melanoma, with an excess of risk of 18% (OR = 1.18, 95% CI 1.04-1.35) for every 10 mJ/cm(2) of MED reduction. Compared with the highest MED values (> 97.7 mJ/cm(2)), subjects with MED values <or= 50 euro mJ/cm(2) or lower had a > 2-fold increased risk of melanoma (OR = 2.37, 95% CI 1.05-5.38). The effect of decreasing MED value as a melanoma risk factor persisted after adjustment for skin colour and atypical naevi in a multivariate model. In conclusion, both instrumentally assessed skin colour and MED are significant risk factors for malignant melanoma in a Mediterranean population. MED seems be an independent variable in establishing the subject's risk profile.