We read with interest article by Brewster entitled "Risk of skin
cancer after neonatal phototherapy: retrospective cohort study" published
online first on June 2010. The authors evaluated in a very large cohort
study the risk to develop skin cancers in young adults according to
exposure to blue-light neonatal phototherapy (NNPT).[1] As other cohorts
which evaluated the risk to develop melanocytic nevi - melanocytic nevi
are induced, in part, by sun exposure and are independent risk factors for
skin cancers - in youth,[2,3] theses results suggest that actually we have
no argument to consider NNPT as a risk factor for skin cancers. So, even
if NNPT plays a role in skin carcinogenesis, it is probably very low in
comparison to author risk factors such as fair phototype and sun exposure,
and it doesn't justify systematic skin follow-up in childhood. As previous
studies, there if a few limits in Brewster' study: no information of blue-
light irradiance, young population with low risk of skin cancer, NNPT 20-
year ago had probably a larger spectrum than blue-light, limited
statistical power, and absence of information about sun-exposure during
childhood.[1]
Yet, two populations which could have at higher risk of PTNN-induced skin
cancer, have not really been evaluated in this article and in previous
studies: 1) in a recent study, it has been suggested that a genetic
predisposition associated to PTNN could increase melanoma risk;[4] 2)
premature children could also have a higher risk of skin cancers induced
by NNPT. Stratum corneum is very thicker in premature children (less than
30-week gestational age), and effects of blue-light could be increased.[5]
Moreover, premature neonates have more frequently severe jaundice, so have
more frequently NNPT, and also "intensive" NNPT. In the study by
Matichard, intensive NNPT increased melanocytc nevus count in children.[6]
In the study by Brewster,[1] gestational age is lower in the group with
NNPT. It could be very interesting to have more information in premature
children notably those with gestational age less than 30 weeks.
References
1.Brewster DH, Tucker JS, Fleming M, et al. Risk of skin cancer after
neonatal phototherapy: retrospective cohort study. Arch Dis Child 2010 Jun
23. [Epub ahead of print]
2.Mahe E, Beauchet A, Aegerter P, et al. Neonatal blue-light phototherapy
does not increase nevus count in 9-year old children. Pediatrics
2009;123:e896-900.
3.Bauer J, Buttner P, Luther H, et al. Blue light phototherapy of neonatal
jaundice does not increase the risk for melanocytic nevus development.
Arch Dermatol 2004;140:493-494.
4.Di Lucca J, Guedj M, Descamps V, et al. Interactions between ultraviolet
light exposure and DNA repair gene polymorphisms may increase melanoma
risk. Br J Dermatol 2010;162:891-3.
5.Kalia YN, Nonato LB, Lund CH, et al. Development of skin barrier
function in premature infants. J Invest Dermatol 1998;111:320-6.
6.Matichard E, Le Henanff A, Sanders A, et al. Effect of neonatal
phototherapy on melanocytic nevus count in children. Arch Dermatol
2006;142:1599-604.
Conflict of Interest:
None declared
We read with interest article by Brewster entitled "Risk of skin cancer after neonatal phototherapy: retrospective cohort study" published online first on June 2010. The authors evaluated in a very large cohort study the risk to develop skin cancers in young adults according to exposure to blue-light neonatal phototherapy (NNPT).[1] As other cohorts which evaluated the risk to develop melanocytic nevi - melanocytic nevi are induced, in part, by sun exposure and are independent risk factors for skin cancers - in youth,[2,3] theses results suggest that actually we have no argument to consider NNPT as a risk factor for skin cancers. So, even if NNPT plays a role in skin carcinogenesis, it is probably very low in comparison to author risk factors such as fair phototype and sun exposure, and it doesn't justify systematic skin follow-up in childhood. As previous studies, there if a few limits in Brewster' study: no information of blue- light irradiance, young population with low risk of skin cancer, NNPT 20- year ago had probably a larger spectrum than blue-light, limited statistical power, and absence of information about sun-exposure during childhood.[1]
Yet, two populations which could have at higher risk of PTNN-induced skin cancer, have not really been evaluated in this article and in previous studies: 1) in a recent study, it has been suggested that a genetic predisposition associated to PTNN could increase melanoma risk;[4] 2) premature children could also have a higher risk of skin cancers induced by NNPT. Stratum corneum is very thicker in premature children (less than 30-week gestational age), and effects of blue-light could be increased.[5] Moreover, premature neonates have more frequently severe jaundice, so have more frequently NNPT, and also "intensive" NNPT. In the study by Matichard, intensive NNPT increased melanocytc nevus count in children.[6] In the study by Brewster,[1] gestational age is lower in the group with NNPT. It could be very interesting to have more information in premature children notably those with gestational age less than 30 weeks.
References
1.Brewster DH, Tucker JS, Fleming M, et al. Risk of skin cancer after neonatal phototherapy: retrospective cohort study. Arch Dis Child 2010 Jun 23. [Epub ahead of print]
2.Mahe E, Beauchet A, Aegerter P, et al. Neonatal blue-light phototherapy does not increase nevus count in 9-year old children. Pediatrics 2009;123:e896-900.
3.Bauer J, Buttner P, Luther H, et al. Blue light phototherapy of neonatal jaundice does not increase the risk for melanocytic nevus development. Arch Dermatol 2004;140:493-494.
4.Di Lucca J, Guedj M, Descamps V, et al. Interactions between ultraviolet light exposure and DNA repair gene polymorphisms may increase melanoma risk. Br J Dermatol 2010;162:891-3.
5.Kalia YN, Nonato LB, Lund CH, et al. Development of skin barrier function in premature infants. J Invest Dermatol 1998;111:320-6.
6.Matichard E, Le Henanff A, Sanders A, et al. Effect of neonatal phototherapy on melanocytic nevus count in children. Arch Dermatol 2006;142:1599-604.
Conflict of Interest:
None declared