Nevi (moles) are important precursors and risk markers for melanoma. Current knowledge, derived largely from cross-sectional studies, indicates that adolescence is a critical period for the appearance and evolution f nevi. There is further compelling evidence that nevus phenotype is largely genetically determined with a significant modifying effect of sun exposure. The primary objective of this study is to evaluate specific genetic and environmental factors as risk factors for nevus development and growth in early adolescence. A secondary aim is to document the clinical and dermoscopic evolution of individual nevi in this age group. We will apply a combined cross-sectional and longitudinal study design to the cohort of all consenting 5th graders in the Framingham, Massachusetts school system (estimated n=735) to address three aims.
Aim #1 utilizes a cross-sectional study of the 5th grade students to test the hypothesis that germline melanocortin receptor (MC1 R) variants, intense childhood sun exposure, and lack of sun protection in childhood are associated with increased numbers of nevi and large nevi in early adolescence.
Aim #2 applies a longitudinal study design in the same student population followed through 8th grade to test the hypothesis that MC1R variants, ongoing intense sun exposure, and ongoing lack of sun protection are associated with increased numbers and increased size of nevi during adolescence.
Aim #3 utilizes digital photography and dermoscopy, a recently developed imaging technique, to document the clinical and subsurface appearance and evolution of common nevi in the cohort under study. We will use parent and child surveys conducted at baseline and repeated annually to ascertain sun sensitivity, childhood sun exposure and current sun exposure. We will conduct examinations of the skin of the back including high resolution overview photography and close up digital photography and digital dermoscopy of four index nevi at baseline (5th grade) and repeated in 8th grade to document pigmentary phenotype, the prevalence of nevi by size, the incidence of new and changed nevi, and the clinical and dermoscopic features of individual nevi. Mouthwash derived DNA collected at the baseline examination will be used for MC1R genotyping. The insights into nevus risk factors and evolution gleaned from this study will have significant implications for reduction of melanoma mortality through improved risk stratification and more informed prevention.
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