Re: High nevus counts confer a favorable prognosis in melanoma patients by S ribero and co-workers, published in the International Journal of Cancer, 2015 (online 21 march 2015)

Dear Sir, The study by S Ribero and co-workers is welcome because only few studies have examined the outcome of cutaneous melanoma patients according to host characteristics associated with greater risk to be diagnosed with this cancer.1 Number and size of nevi is the strongest risk factor for melanoma occurrence, and despite a lack of evidence, it is generally assumed that higher risk of melanoma occurrence would also mean a higher risk of melanoma death. Because of this assumption, subjects with high nevus count are recommended to have regular skin examinations so that detection of melanoma at an early stage may prevent the occurrence of late stage, potentially lethal melanoma. However, contrary to assumptions, the study of Ribero et al. rather suggests that a high nevus count could be associated with a lower risk to die from melanoma, and this lower risk was in a multivariate analysis independent of age, sex, anatomic location, tumour phenotype, and sentinel lymph node status. Ribero et al. concluded that in patients with an excessive number of nevi, melanoma would have a less aggressive biological behavior.