Changing moles in teens

Total mole count by 13-14 years old may be the single best predictor of who, by 16-17 years old, will develop more moles and larger moles, according to a study in JAMA Dermatology.

“Before, we never quite had an exact handle on when you make most of your moles,” says co-author Allan Halpern, M.D., chief of dermatology at Memorial Sloan Kettering Cancer Center in New York. Mole count and the size of moles are risk factors for melanoma.

The study is culled from the NIH-funded Study of Nevi in Children, conducted from 2009 - 2014, whereby the development and evolution of moles were monitored in children as young as fifth grade and who were then followed until eleventh grade.

“The reason that this is important is twofold,” Dr. Halpern tells Dermatology Times. “One, it is during this period of life that we tend to develop our sun exposure habits. It is also the period in life where we tend to make most of our moles.”

Although melanoma in late adolescence is very rare, changing moles in this age group is exceedingly common. “In adults, we think of a changing mole as the most sensitive indicator to detect melanoma,” says Dr. Halpern. “But if you start applying that logic in adolescents and teens, you end up doing an enormous number of unnecessary biopsies.”

In fact, it is estimated that for every 500 to nearly 1,000 biopsies conducted in this younger age group, there is only 1 melanoma detected. The two major goals of the study:  (1) Determine who is most likely to develop the most moles (and therefore intervene at an even younger age in a more focused manner based on who needs sun protection) and (2) the elucidation of normal changes that occur in moles in this age group (therefore reducing the number of unnecessary biopsies).

The 417 students from the school system in Framingham, Mass., assessed at follow-up in the eleventh grade had a mean age of 17.0, of whom 26.6% had a mole-prone phenotype. Within that group, 62.2% had one nevus greater than 5 mm diameter, 20.7% had a total nevus count in the top decile and 17.1% shared both characteristics.

Dr. Halpern says that changes in sun behavior typically start around eighth grade, by which time some children and teenagers are intentionally tanning.

The study concluded that adolescents who received the most sunburns during the follow-up period correlated with those who ended up with the most moles. 

Framingham was chosen as the site to conduct the Study of Nevi in Children because the city is a reasonably representative group, at least at the beginning of the study. “We had children across the spectrum of skin color and skin type,” Dr. Halpern says. “White kids were much more likely to have more moles at the beginning and more moles at the end than the non-white children. Also, the more sun-sensitive a child, the more likely he was able to receive a burn and the more likely he would end up with more moles.”

Dermoscopic patterns 

One of the areas the current study focused on was dermoscopic features, for which there were four dermoscopic patterns. “It turns out that the more patterns present in one child in eighth grade, and the more complex any one pattern, the more likely that child would end up in the group with the most moles in eleventh grade,” Dr. Halpern says. “Dermoscopy helped beyond mole number.”

Dr. Halpern said the most of study results were not surprising. “It was more of a confirmation than a surprise,” he said. “However, we were surprised a bit that the story had largely played out by eighth grade as to being able to predict what was going to happen later on.”

If clinicians are going to single out a subset of children to be especially proactive in teaching them to be careful, “it should include the kids who have a lot of moles by the time they are in seventh or eighth grade,” Dr. Halpern says. 

As clinicians gain a clearer understanding of mole changes, particularly through photo documentation of very large number of moles, “we will be better equipped to apply modalities like computer vision to identify the true outliers,” Dr. Halpern says. “We will also have a much better handle on what normal change is and prevent most of these unnecessary biopsies. In other words, there is a lot of room for improvement.” 

References

Kyu Han Kim, MD, PhD, Tae Hyun Choi, MD, PhD; Yunhee Choi, PhD; et al. “Factors in Early Adolescence Associated with a Mole-Prone Phenotype in Late Adolescence,” JAMA Dermatology. June 7, 2017. DOI:10.1001/jamadermatol.2017.1547