Published online July 2, 2007
PEDIATRICS
Vol. 120
No. 1
July 2007, pp.
247-248
(doi:10.1542/peds.2007-0844)
Neonatal Blue-Light Phototherapy Could Increase the Risk of Dysplastic Nevus Development
Phyllis A. Dennery, MD
Scott Lorch, MD
Department of Pediatrics
University of Pennsylvania
School of Medicine
Children's Hospital of Philadelphia
Philadelphia, PA 19104
To the Editor.—
In their letter, Csoma et al1 described the possible concern that blue-light phototherapy would increase nevus development. They screened 747 school-aged children in their teens and reported that 44.6% of these children had received phototherapy. Although there were no differences in the prevalence of melanocytic nevi, the children exposed to blue-light phototherapy had higher numbers of moles and had a significantly higher prevalence of atypical nevi. Because atypical nevi are an important risk factor for the development of malignant melanoma, the authors raised the concern that phototherapy with blue lamps could have significant implications in the development of atypical nevi.
Although this was an interesting observation that disputes a previous report,2 the data are somewhat difficult to interpret, and the conclusions and statistical validity are not completely evident. We were not given sufficient information about patient demographics or how the data collection was undertaken. For a parent to remember whether their child was treated with blue-light phototherapy 14 to 18 years later would be very difficult. If information was based on old records, it is also not clear whether all charts specifically indicated whether a patient was under blue-light versus white-fluorescent-light therapy. Additional important confounders besides phototherapy, such as family history and sun exposure, were not discussed. In addition, 44.6% of the population received phototherapy. This is a very high number compared with what one would expect in a typical newborn population.3 Therefore, the question of which infants were included in the cohort becomes more important. It is also not clear how the reported odds ratios were derived. Was this a multivariate analysis, or were the odds ratios just obtained from a 2-by-2 table? The lack of information provided in this letter makes it difficult to raise concern about the risks of phototherapy in the pediatric community. Solid evidence with carefully conducted statistics and careful explanations about the cohort are needed. Phototherapy is an important tool in the management of neonatal jaundice.4,5 When severe, this condition may result in kernicterus. Although this event is rare in occurrence, it has devastating consequences that must not be forgotten.6,7 Phototherapy has been used since 1958. There should be large cohorts to assess whether the concerns for the development of atypical nevi are real or only applicable to the subset of children described in this letter.
We need to remember the devastating consequences of our reduced vigilance for hyperbilirubinemia in the late 1980s and early 1990s.7 We must seriously weigh the resurgence of kernicterus against the potential for moles and nevi until more strategies are available to prevent hyperbilirubinemia.
Rather than a letter, the investigators should have provided a full manuscript with sufficient information to address all of the concerns raised regarding the methodology, the cohort, and family history.
REFERENCES
- Csoma Z, Hencz P, Orvos H, et al. Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development.
Pediatrics. 2007;119
:1036
–1037[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
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- Seidman DS, Paz I, Armon Y, Ergaz Z, Stevenson DK, Gale R. Effect of publication of the "Practice Parameter for the Management of Hyperbilirubinemia" on treatment of neonatal jaundice.
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- Vreman HJ, Wong RJ, Stevenson DK. Phototherapy: current methods and future directions.
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- American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004;114:1138].
Pediatrics. 2004;114
:297
–316[Abstract/Free Full Text]
- Bhutani VK, Johnson L. Kernicterus in late preterm infants cared for as term healthy infants.
Semin Perinatol. 2006;30
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- Watchko JF. Vigintiphobia revisited.
Pediatrics. 2005;115
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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
