Morphologic changes of a pigmented Spitz nevus assessed by dermoscopy

Pigmented Spitz nevus may simulate cutaneous melanoma clinically and histopathologically. In an effort to characterize Spitz nevi using dermoscopy, we documented the dermoscopic features of a single pigmented Spitz nevus over a 6-month period. A 3-year-old boy had a brownish black papule, 3 mm in diameter, on the dorsum of the first finger of his left hand, clinically diagnosed as a Reed nevus. Two follow-up examinations were performed after 3 and 6 months, when the lesion finally was excised for histopathologic examination. Dermoscopically, a globular pattern was recognized during the initial examination, whereas a starburst pattern was identified 3 months later. After 6 months, a variation of the starburst pattern was still detectable. Based on our observation, the globular and the starburst patterns might be considered different morphologic expressions corresponding to the evolutionary phases of pigmented Spitz nevi.     

Natural History of Atypical and Equivocal Melanocytic Lesions in Children: An Observational Study of 19 Cases

Digital dermoscopy follow‐up helps to identify patterns of change typical of common atypical nevi and early melanoma and improves the follow‐up of patients with atypical nevi. We report the morphologic changes observed over time in 19 atypical or equivocal acquired melanocytic nevi that underwent dermoscopic follow‐up. Two observers retrospectively examined digitalized dermoscopic images of 19 atypical melanocytic nevi from 15 children and young adults (median age 12 years, range 3–26 years). The images were assessed for global dermoscopic patterns at baseline and after a median 25‐month (range 6–138 mos) follow‐up. Ten (52.6%) nevi changed and nine (47.4%) retained a stable dermoscopic pattern. Of the 10 changing lesions, 2 of 4 homogeneous nevi evolved into a reticular pattern and 2 into a mixed pattern; 1 of 2 nevi with a mixed pattern evolved into a homogeneous nevus and 1 into a regressing nevus; 1 of 2 nevi with “other” patterns, such as negative pigment network and peppering throughout the lesion, evolved into a mixed nevus and 1 into a regressing nevus; 1 globular nevus evolved into a mixed pattern; and 1 starburst nevus evolved into a homogeneous nevus. The most striking results of our study were that atypical nevi can evolve into common nevi or they can regress, as documented by long‐term dermoscopic follow‐up. In children and young adults, dermoscopic follow‐up of atypical nevi might be a valid alternative to surgical excision and enables us to achieve new insights into the natural history of these nevi.     

Three years dermoscopic follow‐up of atypical nevi

Atypical nevi are dynamic lesions and may progressively transform into more or less atypical lesions. We aimed to investigate the dermoscopic features of atypical nevi and dynamic changes in these lesions over a period of 3‐years. Patients with 3‐year dermoscopic follow‐up records were enrolled in the study. We compared the dermatoscopic features of the nevus recorded in the first dermoscopic examination and at the end of the third year. Changes in size (mm), pattern, and color were investigated. The most common dermoscopic patterns were reticular (18 patients; 34%), reticular‐homogeneous (17 patients; 32.1%), and reticular‐globular (7 patients; 13.2%). The most common pigmentation patterns were central hyperpigmentation (28 patients; 52.8%), regular pigmentation (nine patients; 17.0%), and multifocal hypo/hyperpigmentation (eight patients; 15.1%). Twenty‐one (39.6%) patients showed changes in pattern. The transformation from reticular‐homogeneous pattern to the homogeneous pattern was the most frequent change in pattern (7 of 21 patients; 33.3%). The transformation from reticular pattern to reticular‐homogeneous pattern was the second most common change in pattern (5 of 21 patients; 23.8%). Fourteen (26.4%) patients experienced symmetrical enlargement. Symmetrical enlargement was statistically more frequent in patients who showed dermoscopic changes in pattern than in those who did not show any changes in the pattern (p: .038). In this study, we did not observe any new dermoscopic clues for the diagnosis of melanoma during the follow‐up. The nevi tended to turn into a homogeneous (structureless) pattern. We observed that the most common dermoscopic change in pattern was the transformation from reticular‐homogeneous pattern to homogeneous pattern, and the lesions had symmetrical enlargement during this transformation. In conclusion, despite the known association between atypical nevi and the risk of developing melanoma, most atypical nevi do not transform into melanoma. Therefore, our study suggests that the excision of atypical nevi is not necessary and dermatoscopic follow‐up can reduce the number of unnecessary excisions.     

Spitz nevus: follow-up study of 8 cases of childhood starburst type and proposal for management

Spitz nevus is an uncommon, benign melanocytic neoplasm that shares many clinical and histological features with melanoma. It presents clinical ambiguity that makes the diagnosis and management of the patient difficult. We present our experience in the management of Spitz nevus by rigorous dermoscopic long-term follow-up of 8 Spitz nevi in patients younger than 12 years. Dermoscopic images, acquired every 6 months, show evolution and modifications of these lesions. The aim of this paper is to better understand the long-term modifications of nevi with starburst pattern to avoid surgical excision of these lesions in the pediatric age group.     

Dermoscopic Evolution of Pediatric Nevi

BackgroundThe incidence of pediatric melanoma is very rare. Dermoscopic features help to distinguish pediatric melanoma and common nevi.ObjectiveTo study the evolution of dermoscopic findings in benign nevi in childhood through serial observation and photography.MethodsWe examined 504 melanocytic lesions in 100 patients. From each participant, dermoscopic images of the nevi from 4-year dermoscopic follow-up were obtained, including randomly selected nevi.ResultsThe most common dermoscopic patterns were homogeneous (193 nevi; 38.3%), globular (92 nevi; 18.3%), and reticular (86 nevi; 17.1%). Dermoscopic pattern changes were detected in 27% of patients aged 2~10 years and in 20% of patients aged 11~16 years. The main pattern changes consisted of the transition from homogeneous to globular-homogeneous (16%), from homogeneous to reticular-homogeneous (12%) and from globular to globular-homogeneous (10%). Although 257 of the 504 nevi (51.0%) have stable duration without size changes, 169 of the 504 nevi (33.5%) were enlarged, and 78 of the 504 nevi (15.5%) had become smaller.ConclusionThese results contrast with the prevailing view that dermoscopic patterns in pediatric nevi are usually characterized by globular patterns and that melanocytic nevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Fifty one percent of patients did not exhibit a size change. While 33% of patients had symmetrical enlargement, 15% of patients had involution. Therefore, enlargement is a common dermoscopic change in pediatric nevi, and is not a specific sign of pediatric melanoma.     

Differentiation of melanoma from benign mimics using the relative‐color method

Background: Previous studies have successfully classified 86% of malignant melanomas using a relative‐color segmentation method, by feature extraction from photographic images in the automatic identification of skin tumors. These studies were extended by applying the relative‐color method to dermoscopic images of melanoma grouped with melanoma in situ and clark nevus lesions in dermoscopic images allow more control over lighting variations, which contribute to lesion misclassification. Dermoscopic images then enable a more detailed examination of the structure of skin lesions, provide much more structural detail within lesions, and contain visual information that cannot be seen in photographic images. This present work extends the previous studies by applying relative‐color feature extraction to dermoscopic images to differentiate among melanoma, seborrheic keratoses and Reed/Spitz nevi. Objective: To develop a method for automatically differentiating among malignant melanoma, seborrheic keratoses and Reed/Spitz nevi, using digitized, color, dermoscopic images. Methods: Images underwent preprocessing, tumor segmentation, feature extraction and tumor classification. The relative‐color method was used in the segmentation stage. Classification was accomplished by taking the inner products of model tumor feature vectors with test‐image tumor vectors followed by the nearest‐neighbor classification method. Results: The classification rates of melanoma, seborrheic keratoses and Reed/Spitz nevi images mixed together, were 60%, 58.3% and 80%, respectively. Classification of melanoma and Reed/Spitz nevi mixed, were 70% and 90%, respectively. Classification rates were the best when melanoma was being differentiated from seborrheic keratoses. These rates were 100% and 88.9%, respectively. Conclusion: Dermoscopic rather than photographic images were preprocessed, using a hair‐removal technique. They were then converted to relative‐color images, which were segmented using the principal components transform and median split, followed by morphological filtering. After processing, the multi‐dimensional tumor feature space described herein was used to differentiate the tumors. The high success rates for differentiating seborrheic keratoses from melanoma show that the use of dermoscopic images has a strong promise in enabling prescreening, as well as automated assistance and significant improvement in tumor diagnosis in clinics.     

Clinical and dermoscopic stability and volatility of melanocytic nevi in a population-based cohort of children in Framingham school system

Nevi are important risk markers of melanoma. The study aim was to describe changes in nevi of children using longitudinal data from a population-based cohort. Overview back photography and dermoscopic imaging of up to 4 index back nevi was performed at age 11 years (baseline) and repeated at age 14 years (follow-up). Of 443 children (39% females) imaged at baseline, 366 children (39% females) had repeated imaging 3 years later. At age 14, median back nevus counts increased by two; 75% of students (n=274) had at least one new back nevus and 28% (n=103) had at least one nevus that disappeared. Of 936 index nevi imaged dermoscopically at baseline and follow-up, 69% (645 nevi) had retained the same dermoscopic classification from baseline evaluation. Only 4% (n=13) of nevi assessed as globular at baseline were classified as reticular at follow-up, and just 3% (n=3) of baseline reticular nevi were classified as globular at follow-up. Of 9 (1%) index nevi that disappeared at follow-up, none showed halo or regression at baseline. In conclusion, the relative stability of dermoscopic pattern of individual nevi in the face of the overall volatility of nevi during adolescence suggests that specific dermoscopic patterns may represent distinct biological nevus subsets.     

Is rituximab therapy a risk factor for development of melanoma?

In the literature, there are reports about dermoscopic and size changes of nevi in patients undergoing biologic therapy and chemotherapeutics. There has not been any established data for melanoma and Rituximab therapy. Sixteen patients, with 94 nevi were included in this study. Dermoscopic images of follow‐up visits, which were performed at baseline, 3, 6, and 12 months after treatment, were evaluated. Suspicious lesions were excised. There was no increase in total nevus count. Although 61.7% of the 94 nevi have shown a stable duration without size changes, 26.5% had enlarged, and 11.7% had become smaller during our 1‐year experience of dermoscopic monitoring. There was not any pattern transformation. Atypical dots and clods appeared in 17% of nevi. All of the excised nevi were comparable with Clark nevi, there was no clue for melanoma development. According to our results, we found that Rituximab therapy influences nevus morphology, but there is no evidence that this was linked to melanoma development.     

Melanocytic nevi with special features: clinical‐dermoscopic and reflectance confocal microscopic‐findings

Histopathology is considered the ‘gold’ standard for the diagnosis and classification of melanocytic nevi, but the widespread use of in vivo diagnostic technologies such as dermoscopy and reflectance confocal microscopy (RCM), has enriched profoundly the knowledge regarding the morphological variability in nevi. This is because most morphological observations made via these in vivo tools are closely correlated with features seen in histopathology. Dermoscopy has allowed for a more detailed classification of nevi. As such, dermoscopy identifies four main morphologic groups (i.e. globular, reticular, starburst and structureless blue nevi), one group of nevi located at special body sites (i.e. face, acral, nail) and one group of nevi with special features. This latter category consists of nevi of the former categories, which are typified by peculiar clinical‐histopathological findings. They can be subdivided into ‘melanoma simulators’ including combined nevi, recurrent nevi and sclerosing nevus with pseudomelanomatous features, ‘targetoid’ nevi (i.e. halo, cockade, irritated targetoid haemosiderotic and eczematous nevus) and uncommon histopathological variants such as desmoplastic, white dysplastic or ballon cell nevus. While the dermoscopic and RCM patterns of the former categories have been studied in detail, little is currently known about the clinical morphology of the heterogeneous group of ‘special’ nevi. In this article, we describe the clinical, dermoscopic and RCM features of ‘special’ nevi and review the current literature on this group of melanocytic proliferations.     

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria

Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow‐up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.     

Dermoscopy for the Pediatric Dermatologist Part III: Dermoscopy of Melanocytic Lesions

Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision‐making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma‐specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma‐specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue‐white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma‐specific structure, the most common being atypical vascular structures and crystalline structures.     

Dermoscopy of an acral congenital melanocytic nevus

Congenital melanocytic nevi carry a risk for malignant transformation into melanoma, therefore early detection of suspicious features is crucial to reduce mortality rates. Dermoscopy improves the early detection of melanoma while reducing the number of unnecessary excisions of benign pigmented skin lesions. Dermoscopically, congenital melanocytic nevi are often characterized by the presence of a cobblestone pattern, but to date, little is known about the dermoscopic features of acral congenital melanocytic nevi. We report an acral congenital melanocytic nevus typified by the presence of three different dermoscopic patterns that are commonly seen in acquired melanocytic nevi of palms and soles.     

The Framingham school nevus study: a pilot study

OBJECTIVES: To (1). describe nevus patterns using digital photography and dermoscopy; (2). evaluate the relationship between host and environmental factors and prevalence of nevi in schoolchildren; and (3). demonstrate the feasibility of conducting a longitudinal study. DESIGN: Cross-sectional survey and 1-year prospective follow-up study. PARTICIPANTS: Students from 2 classrooms, grades 6 and 7, in the Framingham, Mass, school system (N = 52). MAIN OUTCOME MEASURES: A survey was completed by students and 1 of their parents that included questions on demographic and phenotypic characteristics, family history of skin cancer, and sun exposure and protection practices. An examination of nevi on the back was performed that included digital photography and digital dermoscopy. Follow-up child and parent surveys and examinations were conducted at 1-year follow-up. RESULTS: At baseline, the median number of back nevi was 15 (mean [SD], 21.9 [15.3]). Older age, male sex, fair skin, belief that a tan is healthier, tendency to burn, and sporadic use of sunscreen were positively associated with mole count, although age was the only statistically significant factor. Predominant dermoscopic patterns for the index nevus were as follows: 38% globular, 14% reticulated, 38% structureless, and 10% combinations of the above patterns with no predominant characteristic. The overall participation rate from baseline to follow-up was 81% (42/52) for the skin examination process. At the 1-year follow-up examination, new nevi were identified in 36% of students (n = 15), while 9.6% of baseline index nevi had changes in the dermoscopic pattern. Dominant dermoscopic pattern was related to nevus size: smaller nevi tended to be structureless, while larger nevi were of mixed pattern. CONCLUSION: This study supports the feasibility and utility of digital photography and dermoscopy for the longitudinal study of nevus evolution in early adolescence.     

Dermoscopic classification of atypical melanocytic nevi (Clark nevi).

OBJECTIVES: To create a dermoscopic classification of atypical melanocytic nevi (Clark nevi) and to investigate whether individuals bear a predominant type. DESIGN: Digital dermoscopic images of Clark nevi were classified according to structural features, ie, reticular, globular, or homogeneous patterns or combinations of these types. The nevi were also characterized as central hypopigmented or hyperpigmented, eccentric peripheral hypopigmented or hyperpigmented, or multifocal hypopigmented or hyperpigmented. SETTING: Two pigmented skin lesion clinics. PATIENTS: We examined 829 Clark nevi on 23 individuals. MAIN OUTCOME MEASURE: A reliable dermoscopic classification of Clark nevi and frequency of different dermoscopic types. RESULTS: Using the dermoscopic classification, the 829 Clark nevi were classified as follows: 221 (26.7%) as reticular, 167 (20.1%) as reticular-homogeneous, 148 (17.9%) as globular-homogeneous, 112 (13.5%) as reticular-globular, 89 (10.7%) as homogeneous, 84 (10.1%) as globular, and 8 (1.0%) as unclassified. Most individuals were prone to a predominant type of Clark nevus. Seven individuals (30%) showed a single type of Clark nevus in more than 50% of their nevi and 5 (22%) in more than 40% of their nevi. CONCLUSIONS: The proposed dermoscopic classification of Clark nevi is easily applicable and allows a detailed characterization of the different dermoscopic types of Clark nevi. Knowledge of these dermoscopic types should reduce unnecessary surgery for benign melanocytic lesions. Exact classification of the different types of Clark nevi is a necessary prerequisite for further clinical, dermoscopic, and histopathologic studies, which will give new insights in the biology of acquired melanocytic nevi.     

Dermoscopy of scalp tumours: a multi‐centre study conducted by the international dermoscopy society

Background Little is known about the dermoscopic features of scalp tumours. Objective To determine the dermoscopic features of scalp tumours. Methods Retrospective analysis of dermoscopic images of histopathologically diagnosed scalp tumours from International Dermoscopy Society members. Results A total of 323 tumours of the scalp from 315 patients (mean age: 52 years; range 3–88 years) were analysed. Scalp nevi were significantly associated with young age (<30 years) and exhibited a globular or network pattern with central or perifollicular hypopigmentation. Melanoma and non‐melanoma skin cancer were associated with male gender, androgenetic alopecia, age >65 years and sun damage. Atypical network and regression were predictive for thin (≤1 mm) melanomas, whereas advanced melanomas (tumour thickness > 1 mm) revealed blue white veil, unspecific patterns and irregular black blotches or dots. Conclusions The data collected provide a new knowledge regarding the clinical and dermoscopy features of pigmented scalp tumours.     

Dermoscopy patterns of halo nevi

BACKGROUND: Halo nevi (HN) are benign melanocytic nevi surrounded by a depigmented area (halo). This study aims to evaluate the dermoscopic features of HN and their changes during digital dermoscopic follow-up and to investigate the frequency of the halo phenomenon in a series of melanomas. OBSERVATIONS: In a retrospective study, digital dermoscopic images of HN from patients who attended the Pigmented Skin Lesions Clinic of the Department of Dermatology, Medical University of Graz, between October 1, 1997, and March 31, 2004, were reviewed and classified by dermoscopic morphologic criteria. For HN that were followed up with digital dermoscopy, the percentages of changes in the size of the nevus and halo components were calculated. In addition, digital dermoscopic images of histopathologically confirmed melanomas obtained from the same database were reviewed for the presence of an encircling halolike depigmentation. We classified 138 HN in 87 patients (mean age, 22.4 years). The most common dermoscopic structures were the globular and/or homogeneous patterns in more than 80% of HN. Follow-up of 33 HN revealed considerable size reduction of the nevus component, but this was not associated with significant structural changes. Of a total of 475 melanomas, only 2 revealed an encircling halo, but both displayed clear-cut melanoma-specific patterns according to dermoscopy. CONCLUSIONS: Halo nevi exhibit the characteristic dermoscopic features of benign melanocytic nevi, represented by globular and/or homogeneous patterns that are typically observed in children and young adults. Halo nevi reveal considerable changes of area over time during digital dermoscopic follow-up, albeit their structural patterns remain unchanged. For this reason and because melanoma with halolike depigmentation, despite being rare, additionally exhibits melanoma-specific dermoscopic criteria, the role of digital dermoscopic follow-up in the diagnosis of HN is insignificant.     

Dermoscopy

First, a brief introduction about types of dermoscope and an explanation on the theory of dermoscopy are provided. Second, some introduction on the difference of dermoscopic pictures between benign and malignant neoplasm is given. Basically, benign lesions tend to show symmetrical dermoscopic structures and colors, whereas malignant lesions have a tendency to present irregular and atypical dermoscopic structures. Third, the relationship between dermoscopic images and anatomical structures will be shown. Acral melanocytic lesions have site-specific dermoscopic patterns, namely parallel furrow pattern or parallel ridge pattern. These parallel patterns are due to different distribution of benign and malignant melanocytes. Benign melanocytes (nevus cells) are mainly found on the tips of crista profunda limitans and supply melanin granules to the furrows of stratum corneum, making a parallel furrow pattern. To the contrary, melanoma cells proliferate mainly on the tips of crista profunda intermedia or rather diffusely and randomly, and supply melanin granules irregularly and diffusely to the ridges of stratum corneum, having parallel ridge pattern. Fourth, the global features of dermoscopic findings are described respectively with definitions of the technical terms. To analyze dermoscopic structures, it is easier to look at global features first and local features next. Basic global features include reticular, globular, cobblestone, homogeneous, starburst and parallel patterns. If a given dermoscopy image has two patterns, the more prominent pattern might be chosen. If it has more than three dermoscopic patterns, then multi-component pattern is the reasonable selection. If there are no particular dermoscopic structures, then the unspecific pattern will be selected. Finally, some comments on the relationship between dermoscopy and dermatopathology are given briefly. It is always useful to imagine dermatopathological features when examining a dermoscopic image. There are considerable relations between dermoscopy and dermatopathology.     

Reed痣26例临床病理特征分析

【摘要】 目的 分析总结Reed痣的临床病理特点。方法 分析2015年1月至2019年6月于第四军医大学西京皮肤医院确诊的26例Reed痣患者的临床病理特征。结果 男15例,女11例,平均发病年龄17.35岁,中位发病年龄13.85岁。发病部位：下肢12例,面部6例,上肢5例,躯干3例。皮疹颜色均呈黑色,7例为斑疹,19例为扁平丘疹,22例皮疹形态类圆形,4例皮疹形态不规则。皮疹直径2 ~ 10 mm,23例直径 ≤ 5 mm。组织病理：15例为交界痣,11例为混合痣,26例黑素细胞形态均呈梭形,细胞色素明显,4例痣细胞巢与周围表皮融合,22例与周围表皮形成明显的裂隙,均未见明显细胞异型性及有丝分裂象,6例可见Kamino小体。皮损均予手术切除,随访1 ~ 5年无复发。结论 Reed痣皮疹形态可不规则,组织病理可出现呈Paget样分布的大小不一梭形细胞,需与黑素瘤鉴别。     

Ex vivo dermoscopy of cutaneous biopsies for melanocytic neoplasms: a retrospective review of 517 cases with histopathologic correlation

ABSTRACT:: Clinical dermoscopy has provided new insights into the diagnosis and classification of melanocytic neoplasms. There are only limited data on its applications in dermatopathology. In our laboratory, we routinely photograph all skin biopsies with ex vivo dermoscopy (EVD). We retrospectively reviewed 517 cutaneous biopsies with corresponding EVD images to determine whether EVD provides useful ancillary information in the histopathologic diagnosis of melanocytic neoplasms. Four hundred eighty-three cases (93.4%) yielded usable images. The lesions could be categorized according to a published dermoscopic classification system of melanocytic proliferations. Reticular pigmentation correlated with dysplastic nevi, globular pigmentation with congenital nevi, homogenous blue pigmentation with blue nevi, starburst peripheral globular pigmentation with Spitz nevi, and atypical pigment patterns with melanoma. Eighteen of 25 cases (72%) with ambiguous histopathology were assigned a more definite diagnosis when reviewed contemporaneously with EVD images. The surgical margins in 40 cases (7.7%) were reclassified when EVD images were included in the review. We found EVD to be a useful technique and advocate its use for diagnosis and clinical-pathologic correlation.     

Epidermolysis bullosa nevus: an exception to the clinical and dermoscopic criteria for melanoma

BACKGROUND: Large acquired melanocytic nevi that occur in patients with epidermolysis bullosa (EB), referred to as EB nevi, may pose a diagnostic challenge because of their clinical and dermoscopic resemblance to melanoma. These unconventional melanocytic nevi have been encountered in all categories of hereditary EB, most of them in childhood. Although some of the reported cases have an alarming clinical appearance that is indistinguishable from melanoma, long-term follow-up has confirmed the benign nature of these rarely encountered melanocytic lesions. The histopathologic patterns of these nevi range from a banal congenital pattern to the problematic persistent pseudomelanoma pattern. OBSERVATION: We describe the clinical, dermoscopic, and histopathologic features of a large EB nevus in a toddler. Clinically, the lesion was markedly asymmetrical and irregularly pigmented with foci of stippled pigmentation and scarring, which easily fulfilled the ABCD criteria for melanoma. Accordingly, a false-positive score resulted when dermoscopy was performed. Histopathologically, a pattern of persistent melanocytic neoplasm was observed. In the following 18 months, dynamic changes of the lesion included near-complete disappearance of the pigment, which was replaced by scar, milia, and areas of healing ulcers. CONCLUSION: Epidermolysis bullosa nevi are dynamic melanocytic lesions that may simulate melanoma.