At the time of writing, I am on the family holiday to the South of France, hiding inside and trying valiantly to keep cool. We are battling 35 to 39 degrees Celsius and UV indices of up to 9 from mid-morning until the early evening hours and sticky nights.
As usual, I have brought a whole arsenal of suncreams, UPF clothing, wide-brimmed hats & shades for the whole family. But what was once an easy thing when the children were small is a whole different kettle of fish when said children are now mostly bigger than me and have a mind of their own.
It was therefore interesting to read in the June edition of the British Journal of Dermatology of a study which looked at the naevus (mole) counts in 12 year old children in Queensland, Australia between 1992 and 2016.
[Zhu G, Gordon S, Green AC et al. Halving of Australian children’s naevus counts 1992-2016 and change in sun behaviour. Br J Dermatol 2025 Jun:ljaf226. doi: 10.1093/bjd/ljaf226.]
This comes after listening to some very interesting talks at our British Association of Dermatologists annual meeting in July. One such talk was by the charity Skcin – The Karen Clifford Melanoma & Skin Cancer Charity where they talked about educating primary school children on sun awareness and sun avoidance. Another was by Professor Craig Sinclair, Head of Prevention at the Cancer Council Victoria, Australia on the total ban of sunbeds in Australia.
Both talks highlight that sun awareness education has to start early, be consistent and be combined with robust public health campaigning. One shocking statistic is that despite the skin cancer rates rising in the UK, 28% of UK adults are still using sunbeds and more people die of melanoma per year in the UK than in Australia.
[https://melanomafocus.org/about-us/may-is-melanoma-awareness-month/]
How has the mole count in Queensland children changed?
The most striking finding was an almost halving in the naevus (mole) counts over the 25 year period of study with the biggest drop being of 59% in one year. This affected large and small naevi equally.
Why did the mole count drop?
The authors postulate that it could be because the ethnicity of the study participants changed over time, which it did. 76% of the Australian population was Anglo-Celtic in 1986 compared to 66% in 2016. However, statistically, this change in ethnic mix had little effect on the decrease in naevus count over time.
Was it due to the sun awareness campaign in Australia at the time?
One would have thought so. However, the evidence in adolescents tells a different story.
The proportion of 12-13y olds in the study who reported a painful sunburn at least once in the last 6 months rose from 38% in 1992 to 44% in 2002. Those who wore a hat ‘frequently’ or ‘always’ fell from 18% in 1992 to 11% in 2002.
Previous studies in children aged 12-17y confirm this.
[Livington PM, White V, Hayman J et al. Sun exposure and sun protection behaviours among Australian adolescents: trends over time. Prev Med 2003:37:577-84.]
So what was responsible for the change then?
The authors postulate that it is sun exposure under the age of 3 years that is important with sun protective clothing and sunscreen in child care centres being key to reducing naevus counts. Other studies corroborate this.
[Harrison SL, Buettner PG, Nowak MJ. Sun-Protective clothing worn regularly during early childhood reduces the number of new melanocytic nevi: The North Queensland Sun-Safe Clothing Cluster Randomized Controlled Trial. Cancers 2023;15:1762.]
The authors estimate that a 12% reduction in the clear-sky annual UV dose can cause a 45% reduction in the average naevus count, ie that only small changes in sun exposure can cause a large change in total naevus count.
So does it matter how many moles children have then?
Absolutely. One of the greatest risk factors for melanoma is the number of acquired naevi (moles that develop from early childhood) present on the skin. Five or more large naevi increases the risk of melanoma four-fold. Childhood sun exposure is a strong determinant of naevus count and also then the subsequent risk of melanoma and non-melanoma skin cancers (basal cell carcinomas and squamous cell carcinomas) in later life.
So, basically, if we encourage sun safe practices in our very young, they will hopefully develop less moles and have less skin cancers in adult life. And if we keep our messaging consistent, hopefully, they will continue their sun safe practices into adolescence and beyond.
Kind regards,
Sandy
Dr Sandy Flann, Consultant Dermatologist.
