PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1037-1038 (doi:10.1542/peds.2007-0452)
LETTER TO THE EDITOR |
Neonatal Blue-Light Phototherapy Could Increase the Risk of Dysplastic Nevus Development: In Reply
M. Jeffrey Maisels, MB, BChDepartment of Pediatrics
William Beaumont Hospital
Royal Oak, MI 48073
Thomas B. Newman, MD, MPH
Departments of Epidemiology and Biostatistics and Pediatrics
University of California
San Francisco, CA 94143-0560
Csoma et al evaluated 747 teenagers and correlated their findings of dysplastic melanocytic nevi with a past history of "neonatal blue-light phototherapy." Because dysplastic nevi increase the risk for the development of malignant melanoma, these and other recent observations1 might be concerning. On the other hand, a large study found no relationship between exposure to phototherapy and the development of melanocytic nevi in children aged 2 to 7 years.2
It is difficult to tell how the study population was selected. Was this a random or convenience population of 747 schoolchildren, or were they being treated by a dermatologist because of the presence of atypical nevi? Obtaining an accurate history of phototherapy exposure from parents and, in particular, the type of phototherapy used when 14 to 18 years have elapsed is certainly difficult. Are the authors confident that the exposure was to blue light and not broad-spectrum or tungsten-halogen phototherapy? In the United States in the 1980s, the vast majority of infants who received phototherapy were exposed to daylight or cool white lights, not blue or special blue lights. Perhaps the situation was different in Hungary.
If this was an unselected group of schoolchildren, the fact that 44.6% were said to have received phototherapy is remarkable. In a similar population in the United States, exposure to phototherapy would be expected to be <5%.
Exposure to UV light is considered to be an important risk factor for the development of malignant melanoma. Fluorescent bulbs do emit some UV-A light (315–400 nm), but most of the higher-energy (shorter-wavelength) part of that is blocked by the phosphor and glass envelope. If properly used with a Plexiglas shield, all radiation below 
340 nm would be removed.
We agree that ongoing studies are necessary to identify any potential long-term effects of phototherapy, but it is premature to suggest that children with a history of neonatal phototherapy should undergo "dermatologic screening." A recommendation that calls for dermatologists worldwide to examine hundreds of thousands of children annually requires much stronger evidence.
ACKNOWLEDGMENTS
We thank Antony F. McDonagh, PhD, for his advice.
REFERENCES
- Matichard E, Le Henanff A, Sanders A, Leguyadec J, Crickx B, Descamps V. Effect of neonatal phototherapy on melanocytic nevus count in children.
Arch Dermatol. 2006;142
:1599
–1604
[Abstract/Free Full Text] - Bauer J, Buttner P, Luther H, Wiecker TS, Mohrle M, Garbe C. Blue light phototherapy of neonatal jaundice does not increase the risk for melanocytic nevus development. Arch Dermatol. 2004;140 :493 –494[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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  Z. Csoma, P. Hencz, H. Orvos, L. Kemeny, A. Dobozy, E. Dosa-Racz, Z. Erdei, D. Bartusek, and J. Olah Neonatal Blue-Light Phototherapy Could Increase the Risk of Dysplastic Nevus Development Pediatrics, June 1, 2007; 119(6): 1269 - 1269. [Full Text] [PDF]
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