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To the Editor: Dr Gallagher and colleagues¹ found that broad-spectrum sunscreen attenuated the development of nevi in children. However, their analysis may significantly underestimate the benefits of broad-spectrum sunscreen because only an intent-to-treat analysis was performed in this randomized trial. Table 3 of their article illustrates that the median reported protected episodes (with sunscreen) in the control group were almost 90% of those reported in the intervention group. Gallagher et al essentially report the relative effectiveness of consistent broad-spectrum sunscreen use compared with a control group derived from a community with an already high prevalence of sunscreen use. However, it would be of more interest to estimate the efficacy of sunscreen use as a protective factor relative to no sunscreen use.

Figure 3 of the article also depicts a modest dose-response effect with decreasing number of new nevi developing with increasing amounts of sunscreen use, although, as the authors . . . [Full Text of this Article]

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Broad-Spectrum Sunscreen Use and the Development of New Nevi in White Children: A Randomized Controlled Trial
Richard P. Gallagher, Jason K. Rivers, Tim K. Lee, Chris D. Bajdik, David I. McLean, and Andrew J. Coldman
JAMA. 2000;283(22):2955-2960.
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