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Background: Patients with clinically diagnosed dysplastic nevi or a family history of melanoma with or without histologically diagnosed dysplastic nevi seem to be at higher risk for the development of multiple melanomas. Objective: Our purpose was to determine which factors increased the risk for the development of subsequent melanomas. Methods: This was a retrospective study in 56 patients with 157 melanomas. Results: Early age at onset (58.9%), clinically diagnosed dysplastic nevi (82.0%), a histologically diagnosed dysplastic nevus (64%), family history of clinically diagnosed dysplastic nevi (70.8%) or melanoma (64.7%) and a histologically diagnosed dysplastic nevus in combination with a family history of melanoma (48%) were found in a high percentage of patients. The mean age at diagnosis was 38.2 years. The mean interval between the first and second melanoma was 34.3 months. Of the second melanomas, 76.8% developed in a different anatomic region from the first melanomas. The mean tumor thickness (Breslow) decreased from 1.11 mm for the first melanomas to 0.90 mm for the second melanomas. Conclusion: The results suggest that genetic factors might be involved in a certain subset of patients in whom melanomas develop early and successively. (J Am Acad Dermatol 2001;44:22-7.)

To the Editor: African tickbite fever (ATBF), which is caused by Rickettsia africae, is well documented in travelers to southern Africa (1–3) and transmitted by ungulate ticks of the genus Amblyomma. Positive serologic results were reported in 9% of patients (1) and 11% of travelers (4) from southern Africa. We report an outbreak of ATBF with an attack rate of 100% among 12 Dutch travelers to Swaziland.

Five families with the dysplastic nevus syndrome, in each of which one member had ocular melanoma, are reported. These five families were examined within a 3-year period in one medical center. To date only five other families with such a combination have been reported. We suggest a causal relation between ocular melanoma and the familial dysplastic nevus syndrome.