"Sunburn" Freckles, Café-au-lait Macules, and Other Pigmented Lesions of Schoolchildren: the Vancouver Mole Study

Background: Relatively few studies have evaluated the prevalence of pigmented lesions in children.

Objective: We assessed the prevalence and constitutional correlates of "sunburn" freckles, café-au-lait macules, congenital nevi, and several other pigmented lesions.

Methods: Six specially trained nurses examined 1592 Vancouver schoolchildren, 6 to 18 years old, under uniform lighting conditions and counted all pigmented lesions except those on the genitals, buttocks, and breasts in girls.

Results: In the 1146 white children of European origin, 378 Asian children, and 68 Indo-Pakistani children, the prevalence of one or more café-au-lait macules was essentially equivalent (28%). The prevalence of Becker's nevus, nevus spilus, and congenital nevi were also similar among white and Asian children. White children of European origin had a higher prevalence of sunburn freckles than the other ethnic groups. The prevalence among children of European descent was higher in subjects with light skin color, a propensity to burn rather than tan in the sun, a history of severe or frequent sunburn, freckling, and a high count of acquired melanocytic nevi.

Conclusions: For most pigmented lesions prevalence rates were similar in the three ethnic groups examined. The results also suggest that the presence of large sunburn freckles in children of European descent correlates strongly with phenotypic risk factors that have been shown to be predictive of increased melanoma risk in adulthood. Parents should be counseled to take precautions with these children early in life in regard to overexposure to sunlight.