Systematic Review of Nevus Counting and Reporting Methodologies in Contemporary Studies of the General Population

Dilki Jayasinghe; Nathasha Naranpanawa; Daniel Paul Ashley; Åsa Ingvar; Brigid Betz-Stablein; H. Peter Soyer; Monika Janda

doi:10.5826/dpc.1404a223

Systematic Review of Nevus Counting and Reporting Methodologies in Contemporary Studies of the General Population

Authors

Dilki Jayasinghe Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
Nathasha Naranpanawa School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Queensland, Australia
Daniel Paul Ashley Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Ochsner Clinical School, Ochnser Health, New Orleans, Louisiana, United States of America
Åsa Ingvar Department of Dermatology, Skåne University Hospital, Lund University, Lund, Sweden; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Brigid Betz-Stablein Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
H. Peter Soyer TFrazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia; Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Monika Janda Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

Keywords:

melanoma risk, standardization, naevi, reliability, vailidity, inter- and intra-observer variation, naevus counts

Abstract

Introduction: Having many melanocytic nevi on the skin is a risk factor for melanoma. However, the reproducibility of nevus counts in previous studies is limited due to high inter- and intraobserver variation. Despite the introduction of a protocol for counting and reporting of nevi in 1990 by the International Agency for Research on Cancer (IARC), significant variations in nevus counting methods persist across studies.

Objectives: We sought to review the variations in nevus counting and reporting methods, adherence and deviations from the IARC protocol, and the reproducibility of nevus counting studies.

Methods: A systematic search of Embase, PubMed and Web of Science was conducted. The review was limited to nevus (>2 mm) counting studies of general population adults conducted between 2000 and 2022, and studies using skilled examiners.

Results: Out of the 8 studies which were eligible for inclusion, none followed the IARC protocol. Three studies used a predefined criterion to count nevi. Five studies provided training for their observers. Three studies assessed the inter- or intraobserver variation using the correlation coefficient (>0.75), and 3 studies attempted to verify the validity and the reproducibility of the counts. There was little to no agreement in nevus counting and reporting procedures in the reviewed studies, and most studies did not report their procedures adequately.

Conclusion: This review highlights the need for an easily accessible and feasible protocol for identification, counting and reporting of nevi, which also considers nevus counting from total-body imaging and automated nevus counts since these technologies are expected to become widely available for future studies.

References

Arnold M, Singh D, Laversanne M, et al. Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040. JAMA Dermatology. 2022;158(5):495-503. DOI: 10.1001/jamadermatol.2022.0160.

Jayasinghe D, Koh U, Plasmeijer EI, et al. The dynamic nature of naevi in adulthood: prospective population-based study using three-dimensional total-body photography. Br J Dermatol. 2023;188(3):437-9. DOI: 10.1093/bjd/ljac095.

English DR, Rivers J, Kelly JW, Armstrong BK. Epidemiological studies on melanocytic naevi: Protocol for identifying and recording naevi. Lyon France: International Agency for Research on Cancer; 1990. IARC Internal Report no.90/002 .

Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41(1):28-44. DOI: 10.1016/j.ejca.2004.10.015.

Jayasinghe D, Nufer KL, Betz-Stablein B, Soyer HP, Janda M. Body Site Distribution of Acquired Melanocytic Naevi and Associated Characteristics in the General Population of Caucasian Adults: A Scoping Review. Dermatology and Therapy. 2022. DOI: 10.1007/s13555-022-00806-x.

Walter SD, Marrett LD, Hertzman C. Reliability of interviewer and subject assessments of nevus counts in a study of melanoma. J Clin Epidemiol. 1991;44(7):633-40. DOI: 10.1016/0895-4356(91)90024-4.

English DR, Armstrong BK. Melanocytic Nevi in Children: II. Observer Variation in Counting Nevi. American Journal of Epidemiology. 1994;139(4):402-7. DOI: 10.1093/oxfordjournals.aje.a117012.

Green A, Swerdlow AJ. Epidemiology of melanocytic naevi. Epidemiol Rev. 1989;11(1):204-21. DOI: 10.1093/oxfordjournals.epirev.a036037.

Gallagher RP, McLean DI. The epidemiology of acquired melanocytic nevi. A brief review. Dermatol Clin. 1995;13(3):595-603. DOI: 10.1016/S0733-8635(18)30065-2.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, w64. DOI: 10.7326/0003-4819-151-4-200908180-00135.

Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. DOI: 10.1186/2046-4053-4-1.

Veritas Health Innovation M, Australia. Covidence systematic review software. 2021.

Joanna Briggs Institute. Checklist for Analytical Cross Sectional Studies. 2020. https://jbi.global/critical-appraisal-tools

Joanna Briggs Institute. Checklist for Case Control Studies. 2020. https://jbi.global/critical-appraisal-tools

Joanna Briggs Institute. Checklist for Cohort Studies. 2020. https://jbi.global/critical-appraisal-tools

Newton-Bishop JA, Chang YM, Iles MM, et al. Melanocytic nevi, nevus genes, and melanoma risk in a large case-control study in the United Kingdom. Cancer Epidemiol Biomarkers Prev. 2010;19(8):2043-54. DOI: 10.1158/1055-9965.EPI-10-0233.

Landi MT, Baccarelli A, Calista D, et al. Combined risk factors for melanoma in a Mediterranean population. British Journal of Cancer. 2001;85(9):1304-10. DOI: 10.1054/bjoc.2001.2029.

Nagore E, Hueso L, Botella-Estrada R, et al. Smoking, sun exposure, number of nevi and previous neoplasias are risk factors for melanoma in older patients (60 years and over). Journal of the European Academy of Dermatology and Venereology. 2010;24(1):50-7. DOI: 10.1111/j.1468-3083.2009.03353.x.

Naldi L, Imberti GL, Parazzini F, et al. Pigmentary traits, modalities of sun reaction, history of sunburns, and melanocytic nevi as risk factors for cutaneous malignant melanoma in the Italian population - Results of a collaborative case-control study. Cancer. 2000;88(12):2703-10. DOI: 10.1002/1097-0142(20000615)88:12<2703::aid-cncr8>3.0.co;2-q.

Karlsson P, Stenberg B, Rosdahl I. Prevalence of pigmented naevi in a Swedish population living close to the arctic circle. Acta Dermato-Venereologica. 2000;80(5):335-9. DOI: 10.1080/000155500459259.

Silva ID, Higgins CD, Abramsky T, et al. Overseas Sun Exposure, Nevus Counts, and Premature Skin Aging in Young English Women: A Population-Based Survey. J Invest Dermatol. 2009;129(1):50-9. DOI: 10.1038/jid.2008.190.

Bataille V, Snieder H, MacGregor AJ, Sasieni P, Spector TD. Genetics of risk factors for melanoma: an adult twin study of nevi and freckles. J Natl Cancer Inst. 2000;92(6):457-63. DOI: 10.1093/jnci/92.6.457.

Breitbart EW, Waldmann A, Nolte S, et al. Systematic skin cancer screening in Northern Germany. J Am Acad Dermatol. 2012;66(2):201-11. DOI: 10.1016/j.jaad.2010.11.016.

Grulich AE, Bataille V, Swerdlow AJ, et al. Naevi and pigmentary characteristics as risk factors for melanoma in a high-risk population: A case-control study in New South Wales, Australia. Int J Cancer. 1996;67(4):485-91. DOI: 10.1002/(SICI)1097-0215(19960807)67:4<485::AID-IJC4>3.0.CO;2-O.

Bataille V, Bishop JA, Sasieni P, et al. Risk of cutaneous melanoma in relation to the numbers, types and sites of naevi: a case-control study. Br J Cancer. 1996;73(12):1605-11. DOI: 10.1038/bjc.1996.302.

Lund C. The estimation of areas of burns. Surgery Gynecology and Obstetrics. 1944;79:352-8.

Augustsson A, Stierner U, Suurkula M, Rosdahl I. Prevalence of common and dysplastic naevi in a Swedish population. Br J Dermatol. 1991;124(2):152-6. DOI: 10.1111/j.1365-2133.1991.tb00424.x.

Seidenari S, Benati E, Ponti G, et al. Italian Euromelanoma Day Screening Campaign (2005-2007) and the planning of melanoma screening strategies. Eur J Cancer Prev. 2012;21(1):89-95. DOI: 10.1097/CEJ.0b013e3283498e14.

Schmitt J, Seidler A, Heinisch G, Sebastian G. Effectiveness of skin cancer screening for individuals age 14 to 34 years. JDDG - Journal of the German Society of Dermatology. 2011;9(8):608-16. DOI: 10.1111/j.1610-0387.2011.07655.x.

Suppa M, Gandini S, Njimi H, et al. Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign. Journal of the European Academy of Dermatology and Venereology. 2019;33:76-88. DOI: 10.1111/jdv.15307.

Green A, Siskind V, Hansen ME, Hanson L, Leech P. Melanocytic nevi in schoolchildren in Queensland. J Am Acad Dermatol. 1989;20(6):1054-60. DOI: 10.1016/s0190-9622(89)70131-6.

Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: Measures of agreement. Perspectives in clinical research. 2017;8(4):187-91. DOI: 10.4103/2229-3485.342656.

Randi G, Naldi L, Gallus S, Di Landro A, La Vecchia C. Number of nevi at a specific anatomical site and its relation to cutaneous malignant melanoma. J Invest Dermatol. 2006;126(9):2106-10. DOI: 10.1038/sj.jid.5700334.

Betz-Stablein B, D’Alessandro B, Koh U, et al. Reproducible Naevus Counts Using 3D Total Body Photography and Convolutional Neural Networks. Dermatology. 2021. DOI: 10.1159/000517218.