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Pediatric Dermatology 2013We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November... (Review)
Review
We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November 2008 and January 2009 using the following key words on MEDLINE and EMBASE: child*, in combination with naevi, nevi, naevus, nevus and sunscreen, sun protection. We also used Medical Subject Headings [sunscreening agents], or [radiation protection] with [nevus, pigmented]. A first screening was done on title and abstract reading. Randomized trials and cohort and cross-sectional studies analyzing the relationship between the use of sunscreen and MN in children were selected. Three reviewers abstracted data from each article. The three sets of results were compared for concordance and rereviewed if necessary. Fifteen articles were included (20,743 children). The studies were not consistent in terms of the ages of the children, MN count methods, or sunscreen use assessment. Owing to this heterogeneity, we were unable to pool the studies and conduct a meta-analysis. Twelve studies did not report that the use of sunscreen had a protective effect against MN development. Three studies reported a lower MN count when sunscreen was applied. This systematic review underlines the methodologic differences between studies. Eight of 15 studies reported a positive association between sunscreen application and MN count. Differences in MN counts, overexposure to sun, and inadequate sunscreen application on fair-skinned children could explain the disparity in the results. There is still no evidence of a protective effect of sunscreen against MN development in children.
Topics: Age Distribution; Case-Control Studies; Child; Confidence Intervals; Dermoscopy; Female; Follow-Up Studies; Humans; Incidence; Logistic Models; Male; Nevus, Pigmented; Randomized Controlled Trials as Topic; Risk Assessment; Sex Distribution; Skin Neoplasms; Sunlight; Sunscreening Agents
PubMed: 22994908
DOI: 10.1111/j.1525-1470.2012.01847.x -
Cancer Prevention Research... Feb 2010Epidemiologic research has shown convincingly that certain phenotypic attributes are associated with increased relative risks of melanoma. Although such findings have... (Meta-Analysis)
Meta-Analysis
Epidemiologic research has shown convincingly that certain phenotypic attributes are associated with increased relative risks of melanoma. Although such findings have intrinsic utility, there have been few attempts to translate such knowledge into estimates of disease burden suitable for framing public health policy. We aimed to estimate the population attributable fraction (PAF) for melanoma associated with melanocytic nevi using relative risk estimates derived from a systematic review and meta-analysis. We identified eligible studies using citation databases, followed by manual review of retrieved references. Of 49 studies identified, 25 and 23, respectively, were included in meta-analyses of atypical and common nevi. For people with > or =1 atypical nevi, the summary relative risk was 3.63 (95% confidence interval, 2.85-4.62), with a PAF of 0.25. The relative risk increased by 1.017 (95% confidence interval, 1.014-1.020) for each common nevus; however, significant heterogeneity in risk estimates was observed. We estimated that 42% of melanomas were attributable to having > or =25 common nevi (PAF 25-49 nevi = 0.15; PAF > or =50 nevi = 0.27), whereas PAFs for low nevus counts were modest (PAF 0-10 nevi = 0.04; PAF 11-24 nevi = 0.07). We modeled PAF under scenarios of varying nevus prevalence; the highest melanoma burden was always among those with high nevus counts (PAF range of 0.31-0.62 for > or =25 common nevi). Patients with > or =25 common nevi and/or > or =1 atypical nevi are a high-risk group, which might be targeted for identification, screening, and education. This work is the necessary first step in designing targeted preventive strategies for melanoma, which must now be overlaid with information about cost and utility.
Topics: Humans; Melanoma; Nevus, Pigmented; Prevalence; Risk Factors; Skin Neoplasms
PubMed: 20086181
DOI: 10.1158/1940-6207.CAPR-09-0108 -
Actas Dermo-sifiliograficas Sep 2009Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of... (Review)
Review
Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of developing melanoma on giant congenital melanocytic nevi (GCMN) is lower than previously thought given that, in the most recent series of GCMN, only 2 % of patients developed melanoma and most did so before the age of 5 years. Therefore,prophylactic surgery should be considered on an individual basis according to the degree of clinical suspicion of melanoma and the esthetic and functional consequences.In extensive reviews of series of biopsies of melanoma, small congenital melanocytic nevi have been associated with 7 % to 8 % of cases. Many authors believe that these might represent a significant risk of malignant conversion from 10 years onwards and so recommend regular control visits during infancy and prophylactic exeresis in puberty.
Topics: Algorithms; Humans; Nevus; Risk Factors; Skin Neoplasms
PubMed: 19715640
DOI: No ID Found -
Pediatric Neurology Dec 2008We report on a case of Cobb syndrome, a rare metameric disorder, characterized by a vascular abnormality of the spinal cord, with an associated vascular skin lesion of... (Review)
Review
We report on a case of Cobb syndrome, a rare metameric disorder, characterized by a vascular abnormality of the spinal cord, with an associated vascular skin lesion of the same metamere, in an 8-year-old girl presenting with leg weakness. Magnetic resonance imaging revealed a spinal arteriovenous malformation at the level of T(10)-L(5). This finding, together with a large, pigmented nevus at this level, is diagnostic for Cobb syndrome. A systematic review of the literature on Cobb syndrome, with a focus on treatment and outcomes, is presented. Current treatment options include combinations of embolization, neurosurgical intervention, corticosteroid therapy, and radiotherapy.
Topics: Central Nervous System Vascular Malformations; Child; Female; Humans; Magnetic Resonance Imaging; Skin Diseases; Spinal Diseases
PubMed: 19027589
DOI: 10.1016/j.pediatrneurol.2008.08.001 -
The British Journal of Dermatology Jul 2006The risk of malignant melanoma in congenital melanocytic naevi (CMN) is a matter of controversial and ongoing debate. (Review)
Review
BACKGROUND
The risk of malignant melanoma in congenital melanocytic naevi (CMN) is a matter of controversial and ongoing debate.
OBJECTIVES
The purpose of this systematic review is to provide a careful and detailed summary of the published data, including several recently published studies.
METHODS
Articles on CMN (n=1424) were retrieved from Medline, 1966-October 2005. Case reports and studies lacking relevant clinical information were excluded. Only systematic collections of cases were taken into consideration. Series with fewer than 20 patients or studies with a mean follow-up of <3 years were regarded as epidemiologically less significant.
RESULTS
Fourteen articles were finally chosen for further analysis. The studies varied significantly with respect to study design (source of cases; retrospective vs. prospective analysis), age of patients, follow-up time, and naevus characteristics. The frequency of melanomas ranged between 0.05% and 10.7% and was significantly higher in smaller studies (P<0.0001). In a total of 6571 patients with CMN who were followed for a mean of 3.4-23.7 years, 46 patients (0.7%) developed 49 melanomas. The mean age at diagnosis of melanoma was 15.5 years (median 7). By comparison with age-adjusted data from the Surveillance, Epidemiology and End Results database, we calculated that patients with CMN carry an approximately 465-fold increased relative risk of developing melanoma during childhood and adolescence. Primary melanomas arose inside the naevi in 33 of 49 cases (67%). In seven cases (14%), metastatic melanoma with unknown primary was encountered; in four cases (8%) the melanoma developed at an extracutaneous site. The risk of developing melanoma and the rate of fatal courses were by far highest in CMN>or=40 cm in diameter.
CONCLUSIONS
The overall risk of melanoma of 0.7% in all 14 studies was lower than expected. The higher incidence of melanomas in smaller studies indicates selection bias. The melanoma risk strongly depends on the size of CMN and is highest in those naevi traditionally designated as garment naevi. The median age of 7 years at diagnosis of melanoma points to a risk maximum in childhood and adolescence. Future studies on CMN should report: (i) diameter, percentage of body surface, and localization of the CMN; (ii) percentage of naevus area removed by excision or subject to dermabrasion or other superficial treatments; (iii) mean and median age at entry into the study; (iv) mean and median follow-up time; (v) details on each melanoma case; (vi) standardized morbidity ratio of melanoma; and (vii) percentage of neurocutaneous melanosis.
Topics: Adolescent; Child; Disease Progression; Humans; Melanoma; Nevus, Pigmented; Risk Assessment; Skin; Skin Neoplasms
PubMed: 16792745
DOI: 10.1111/j.1365-2133.2006.07218.x -
Ophthalmology Oct 2005To estimate the risk of malignant transformation of a choroidal nevus in the white population. (Review)
Review
PURPOSE
To estimate the risk of malignant transformation of a choroidal nevus in the white population.
DESIGN
Systematic literature review.
METHODS
A literature review was performed to obtain data on the prevalence of choroidal nevi in the white population. Data from studies that used indirect ophthalmoscopy or otherwise corrected data to include the entire fundus were selected. Only studies reporting on the United States population were included. The number of affected individuals was estimated using 2000 U.S. census data. The estimate of annual incident choroidal melanoma cases in the corresponding age- and race-matched population was calculated using the Surveillance, Epidemiology, and End Result database (1973-2000). Average annual age-specific incidence rates for 1973 to 2000 for each of the 5-year age groups (adjusted for the U.S. 2000 population) were calculated and applied to the corresponding census data. The ratio of numbers of affected individuals with choroidal melanoma and choroidal nevi gave the annual rate of malignant transformation of a choroidal nevus.
MAIN OUTCOME MEASURES
Annual rate of malignant transformation of a choroidal nevus in the white population of the U.S.
RESULTS
The prevalence of choroidal nevus in the white U.S. population ranged from 4.6% to 7.9%. It was estimated that, on average, 8864625 individuals in the U.S. had a choroidal nevus. The number of individuals with choroidal melanoma in the corresponding age- and race-matched population ranged from 989 to 1008 (mean, 1002). The annual rate of malignant transformation of a choroidal nevus was estimated to be 1 in 8845.
CONCLUSIONS
If it is assumed that all choroidal melanomas arise from preexisting nevi, then the published data suggest a low rate (1/8845) of malignant transformation of a choroidal nevus in the U.S. white population.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Cell Transformation, Neoplastic; Choroid Neoplasms; Female; Humans; Incidence; Male; Melanoma; Middle Aged; Nevus, Pigmented; Prevalence; Risk Factors; Sex Distribution; United States; White People
PubMed: 16154197
DOI: 10.1016/j.ophtha.2005.06.011 -
Plastic and Reconstructive Surgery Jun 2004Large congenital melanocytic nevi are cutaneous lesions regarded by many as premalignant; estimates of malignancy incidence range from 0 to 42 percent. Given the often... (Review)
Review
Large congenital melanocytic nevi are cutaneous lesions regarded by many as premalignant; estimates of malignancy incidence range from 0 to 42 percent. Given the often complex and extensive nature of large congenital melanocytic nevi resection and reconstruction, the risk of malignant transformation is a crucial factor that surgeons and families must weigh when deciding whether or not to excise the lesion. The authors conducted a systematic analysis of data from the existing literature to critically evaluate the published studies and to establish a crude incidence rate for the risk of malignant melanoma transformation in large congenital melanocytic nevi. After a comprehensive literature search, they analyzed data from eight studies (containing a total of 432 large congenital melanocytic nevi patients) of sufficient scientific quality. Twelve patients (2.8 percent) in this sample developed cutaneous malignant melanoma during the reported follow-up periods. Using a subset of this data and comparing the incidence rates to those of the Surveillance, Epidemiology, and End Results population-based database using a standardized morbidity ratio, the authors found that the large congenital melanocytic nevi patients had an increased risk of melanoma (standardized morbidity ratio, 2599; 95 percent confidence interval, 844 to 6064) compared with the general population. Regarding treatment before developing melanoma in the 12 patients, 50 percent were observed before diagnosis, 17 percent had partial excision, 8.3 percent had dermabrasion, 8.3 percent had a chemical peel, and 17 percent did not have any treatment information. These combined data are clinically useful when consulting with the parents of children with large congenital melanocytic nevi and in the management of older patients with existing lesions. This study shows that there is a significantly increased risk of melanoma in large congenital melanocytic nevi patients. The data also reveal the need for a standardized definition of large congenital melanocytic nevi and a long-term, prospective outcomes study to determine the true lifetime risk of melanoma in patients with and without surgical excision.
Topics: Humans; Melanoma; Nevus, Pigmented; Risk Factors; Skin Neoplasms
PubMed: 15253185
DOI: 10.1097/01.prs.0000122209.10277.2a