Dermoscopic patterns of naevi in fifth grade children of the Framingham school system

Clinical and dermoscopic patterns of acquired melanocytic nevi in children and adolescents: a cross-sectional study from Turkey

BACKGROUND

Childhood and adolescence are the most active periods for nevi development, which provide insights into nevogenesis.

OBJECTIVES

To evaluate the clinical and dermoscopic characteristics of acquired melanocytic nevi in Turkish children (aged ≤ 10-years) and adolescents (aged > 10-years) regarding demographic, constitutional, and environmental factors.

METHODS

A cross-sectional study on participants aged < 18-years examined for acquired melanocytic nevi between January and June 2023.

RESULTS

One hundred participants (female: male ratio = 1:1; median age: 10) were assessed. The median nevi number was significantly higher in adolescents than in children (6 vs. 4; p < 0.05). The upper extremities (n = 68) and trunk (n = 67) were the most commonly involved anatomical regions. Females had a significantly higher nevi rate on the upper extremities than males (80% vs. 56%; p < 0.05). The trunk was involved slightly more frequently in males (76% vs. 58%; p = 0.06). The globular pattern rate was higher in children than in adolescents (70.6% vs. 42.9%; p < 0.05), whereas a striking increase was observed in the reticular pattern from childhood (2%) to adolescence (14.3%) (p < 0.05). The globular pattern was the major dermoscopic pattern in all anatomical locations except lower extremities where the homogeneous pattern prevailed. Sunscreen use had no impact on the nevi number or dermoscopic pattern.

STUDY LIMITATIONS

Limited number of participants.

CONCLUSIONS

The age and anatomical site were the most relevant factors influencing the number and dermoscopic patterns of nevi. The gender-related distribution pattern of nevi, without any effect of sunscreen use on either nevus count or dermoscopic pattern, suggests a genetic predisposition.

Clinical and Dermoscopic Insights Into Scalp Nevi in Chinese Children

BACKGROUND

The presence of scalp nevi in children frequently causes apprehension, leading physicians and parents to consider unnecessary biopsies or excisions of scalp nevi in children. There are limited data on the dermoscopic characteristics of scalp nevi in Chinese children.

OBJECTIVE

The aim of this study was to comprehensively analyze the clinical and dermoscopic features of scalp nevi in this specific population of Chinese pediatric patients, with a focus on a single pediatric dermatologic surgery practice.

METHODS

This retrospective cohort study investigated patients who underwent surgical excision of scalp nevi. All patients underwent dermoscopy with photographic documentation.

RESULTS

Seventy-two scalp nevi in 56 Chinese children were included. Notably, no melanoma cases were detected. The parietal region (35, 48.6%) was the most frequently affected anatomical site. Clinical asymmetry was more prevalent in nevi with a diameter exceeding 6 mm ( p < .05). The predominant dermoscopic pattern observed was the globular pattern (50, 69.4%) while an intriguing rarity of a reverse-eclipse pattern (1, 1.4%).

CONCLUSION

This study revealed that scalp nevi in Chinese children usually did not exhibit concerning behavior. Increasing awareness of the clinical characteristics, dermoscopic features, and the natural progression of scalp nevi in children can potentially help reduce unnecessary surgical interventions.

Dermoscopy aids in differentiating café-au-lait macules from congenital melanocytic nevi in patients with darker skin phototypes

Dermoscopy aids in the diagnosis and management of pigmented growths and disorders of pigmentation in children. However, there is limited literature on the dermoscopic appearance of café-au-lait macules (CALMs) and congenital melanocytic nevi in patients with dark skin. We report two cases of young children with dark skin and many hyperpigmented patches in whom dermoscopy was utilized to accurately diagnose CALMs and facilitate testing for neurofibromatosis.

Dermoscopic features of neoplasms in skin of color: A review

BACKGROUND

Dermoscopy is undoubtedly a useful tool to improve diagnostic accuracy and minimize the number of unnecessary biopsies. However, much of the literature on dermoscopy focuses on findings in lighter-skin phototypes, leaving potential gaps of knowledge regarding its use in skin of color (SoC). As the clinical applications of dermoscopy continue to increase, understanding dermoscopic patterns in SoC is imperative.

OBJECTIVE

This review discusses the literature on dermoscopic findings of neoplasms in SoC, highlighting unique and characteristic dermoscopic features.

METHODS

A literature review was performed using the PubMed database. Case reports, case series, case-control studies, and systematic reviews were included.

RESULTS

A total of 8326 studies were identified based on the selected search terms, and 41 were included in this review based on relevance.

CONCLUSION

There are specific dermoscopic characteristics in SoC for benign nevi, acral lentiginous melanoma, ethnic melanonychia, and dermatofibroma; however, there is a lack of published data about specific features of cutaneous melanoma, subungual melanoma, pigmented basal cell carcinoma, and pigmented squamous cell carcinoma in SoC. Because pigmented basal cell carcinoma, pigmented squamous cell carcinoma, ethnic melanonychia, and acral lentiginous melanoma are diagnosed at later stages in this population, it is important to understand their dermoscopic features. Further descriptive studies are needed to better characterize unique dermoscopic features in neoplasms in SoC.

A practical review of dermoscopy for pediatric dermatology part I: Melanocytic growths

The value of dermoscopy in the detection of skin cancer is well established. Less is published on the utility of dermoscopy in the evaluation of pediatric skin disease. Our review (in two parts) aims to serve as an update on pediatric dermoscopy and to provide readers with a practical application for the use of dermoscopy in pediatric dermatology clinics. In part I, we propose a dermoscopy algorithm for pediatric skin disease and melanocytic growths, and in part II, we address vascular growths, common skin infections, and inflammatory conditions for which dermoscopy is valuable.

Dermoscopic and clinical predictors of reflectance confocal microscopy patterns of typical nevi on the back and legs: A cross-sectional study

BACKGROUND

Nevus phenotype is a marker of melanoma risk. In vivo prediction of microscopic pattern is needed to more precisely classify nevi.

OBJECTIVE

To identify dermoscopic and clinical predictors of microscopic patterns of typical nevi.

METHODS

We used reflectance confocal microscopy (RCM) to classify microscopic patterns of nevi. We prospectively accrued adults presenting for periodic skin screening and imaged, with dermoscopy and RCM, 3 randomly selected nevi from the upper and lower back and lower extremity. RCM patterns were classified into ring, clod, meshwork, and composite types. Logistic regression was used to identify best predictors of RCM pattern.

RESULTS

The study included 310 nevi from 112 participants (mean age 44 years; 51 women). Dermoscopic reticular pattern correlated most frequently (59.9%) with RCM ring pattern, dermoscopic globular with RCM composite (56.6%) and RCM clod (35.9%), dermoscopic complex with RCM composite (76.3%), and dermoscopic homogenous with RCM clod (50.8%). Integrating dermoscopic pattern with contour, diameter, color, and anatomic location of nevi improved prediction of microscopic patterns beyond dermoscopy alone. The dermoscopic clinical regression model correctly classified lesions to RCM ring versus RCM clod in 90% and to RCM ring versus RCM composite patterns in 81%.

LIMITATIONS

The study was restricted to adults, back and lower extremities, and typical nevi.

CONCLUSIONS

Integrating dermoscopic patterns with clinical attributes may improve prediction of microscopic patterns of nevi.

Dermoscopic Evolution of Pediatric Nevi

Background

The incidence of pediatric melanoma is very rare. Dermoscopic features help to distinguish pediatric melanoma and common nevi.

Objective

To study the evolution of dermoscopic findings in benign nevi in childhood through serial observation and photography.

Methods

We 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.

Results

The 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.

Conclusion

These 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.

Dermoscopic features of melanocytic skin lesions in Greek children and adolescents and their association with environmental factors and skin types

BACKGROUND

Acquired naevi often present in childhood and increase in number and size during early and middle life. As naevi represent potential mimickers of melanoma, the knowledge of their epidemiologic and morphologic characteristics is essential.

OBJECTIVE

In this study, we intend to determine the prevalence of dermoscopic patterns of naevi, as well their association with environmental and constitutional factors.

METHODS

Cross-sectional data derived from a population-based cohort of children and adolescents aged 6-18 years, from 12 different schools in Thessaloniki, Greece. For each participant, a consent form and a questionnaire were completed, which included data on age, sex, phototype, sun sensitivity, sun exposure, sunscreen use and previous sunburn history. All naevi, their body distribution, and their dermoscopic patterns were recorded.

RESULTS

Two thousand and five hundred and five (2505) subjects were enrolled into the study (47.8% males and 52.2% females). The mean number of MN counted in a single person was 29.11 (SD = ±23.863). TNC increased continuously with higher age. Males were found to have a significantly increased number on the trunk (11.7 ± 11.2 and 10.0 ± 8.7, respectively, P < 0.001) and face and neck (6.2 ± 5.3 and 5.1 ± 4.3, respectively, P < 0.001) while females on the upper (10.3 ± 10.1 and 9.3 ± 9.4, respectively, P = 0.008) and lower extremities (2.8 ± 3.4 and 2.5 ± 3.2, respectively, P = 0.008). Globular pattern was the most frequent dominant pattern in lower age groups, and its percentage fell as age increased. On the contrary, the reticular pattern was more often documented in individuals in adolescence.

CONCLUSION

This first study of MN in our young population aims to be the basis of further investigation for the MM preventive policy of our state.

Dermoscopic patterns of melanocytic nevi in children and adolescents: a cross-sectional study

Background

Childhood is a dynamic period regarding nevogenesis. Dermoscopy is a noninvasive technique, recommended for the evaluation of pigmented cutaneous lesions.

Objectives

The purpose of this study was to describe the structures and dermoscopic patterns of melanocytic nevi observed in children and adolescents.

Methods

Dermoscopy with photographic documentation was used for nevi located on the face, trunk, and extremities of 38 patients aged from one to 16 years examined at the Pediatric Dermatology Outpatient Clinic of the Federal University of São Paulo.

Results

The study included 201 skin lesions that were diagnosed as nevi during clinic examination. Upon evaluation of the global dermoscopic pattern of the lesions, the most frequently observed nevi were reticular (39.0%), followed by homogeneous (23.9%) and globular nevi (16.4%). During evaluation of the dermoscopic structures, according to the body site, the pigment network was the most observed in the extremities.

Study limitations

A limitation to be considered is that the inclusion of small or new lesions may hinder the differentiation between dots and globules.

Conclusions

In our study, the most observed pattern was reticular. There was a difference in the predominance of structures dependent on the anatomical location.

Small Dysplastic Congenital Melanocytic Nevi in Childhood as Possible Melanoma Imitators

Small pigmented lesions in children can represent a significant diagnostic challenge. If the diagnostic features and therapeutic approach are relatively well established in large and giant nevi, there is still much controversy regarding small and intermediate-sized congenital pigmented lesions that can lead to significant diagnostic challenges, both clinically and dermoscopically, and consequently to difficulty in defining the optimal approach in such cases. Although dermoscopy can be useful in the diagnosis of pigmented lesions, the diversity of clinical and dermoscopic features of pigmented nevi in children usually hinder the differentiation between them and melanoma. Histological findings after resection often show surprising results that do not correspond either to the clinical nor the dermoscopic features. With the present case, we want to emphasise the variable natural behaviour of melanocytic lesions in children, which sometimes leads to unnecessary surgical excisions, which should be avoided in pediatric patients.

Factors in Early Adolescence Associated With a Mole-Prone Phenotype in Late Adolescence

Importance

Nevi are important phenotypic risk factors for melanoma in adults. Few studies have examined the constitutional and behavioral factors associated with a mole-prone phenotype in adolescents.

Objective

To identify host, behavioral, and dermoscopic factors in early adolescence (age, 14 years) that are associated with a mole-prone phenotype in late adolescence (age, 17 years).

Design, Setting, and Participants

A prospective observational cohort study from the Study of Nevi in Children was conducted from January 1, 2009, to December 31, 2014, with a 2- to 3-year follow-up. A total of 569 students from the school system in Framingham, Massachusetts, were enrolled in the 8th or 9th grade (baseline; mean [SD] age, 14.4 [0.7] years). The overall retention rate was 73.3%, and 417 students were reassessed in the 11th grade.

Main Outcome and Measures

Mole-prone phenotype in the 11th grade, defined as total nevus count of the back and 1 randomly selected leg in the top decile of the cohort or having any nevi greater than 5 mm in diameter.

Results

Of the 417 students assessed at follow-up in the 11th grade (166 females and 251 males; mean [SD] age, 17.0 [0.4] years), 111 participants (26.6%) demonstrated a mole-prone phenotype: 69 students (62.2%) with 1 nevus greater than 5 mm in diameter, 23 students (20.7%) with total nevus count in the top decile, and 19 students (17.1%) with both characteristics. On multivariate analysis, baseline total nevus count (adjusted odds ratio, 9.08; 95% CI, 4.0-23.7; P < .001) and increased variability of nevus dermoscopic pattern (adjusted odds ratio, 4.24; 95% CI, 1.36-13.25; P = .01) were associated with a mole-prone phenotype.

Conclusions and Relevance

This study found clinically recognizable factors associated with a mole-prone phenotype that may facilitate the identification of individuals at risk for melanoma. These findings could have implications for primary prevention strategies and help target at-risk adolescents for higher-intensity counseling about sun protection and skin self-examination.

The study of nevi in children: Principles learned and implications for melanoma diagnosis

Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.

Cross-sectional analysis of the dermoscopic patterns and structures of melanocytic naevi on the back and legs of adolescents

BACKGROUND

Junctional (flat) naevi predominate on the extremities, whereas dermal (raised) naevi are found primarily on the head, neck and trunk. Few studies have investigated the anatomical site prevalence of melanocytic naevi categorized using dermoscopy.

OBJECTIVES

To identify the prevalence of dermoscopic patterns and structures of naevi from the back and legs of adolescents.

METHODS

Dermoscopic images of acquired melanocytic naevi were obtained from the back and legs of students from a population-based cohort in Framingham, Massachusetts. Naevi were classified into reticular, globular, homogeneous or complex dermoscopic patterns. Multinomial logistic regression modelling assessed the associations between dermoscopic pattern and anatomical location.

RESULTS

In total 509 participants (mean age 14 years) contributed 2320 back naevi and 637 leg naevi. Compared with homogeneous naevi, globular and complex naevi were more commonly observed on the back than the legs [odds ratio (OR) 29·39, 95% confidence interval (CI) 9·53-90·65, P < 0·001 and OR 6·8, 95% CI 2·7-17·14, P < 0·001, respectively], whereas reticular lesions were less likely to be observed on the back than on the legs (OR 0·67, 95% CI 0·54-0·84, P = 0·001). Naevi containing any globules were more prevalent on the back than on the legs (25% vs. 3·6%, P < 0·001). Naevi containing any network were more prevalent on the legs than on the back (56% vs. 40·6%, P < 0·001).

CONCLUSIONS

These findings add to a robust body of literature suggesting that dermoscopically defined globular and reticular naevi represent biologically distinct naevus subsets that differ in histopathological growth pattern, age- and anatomical-site-related prevalence, molecular phenotype and aetiological pathways.

Dermoscopy of black skin: A cross-sectional study of clinical and dermoscopic features of melanocytic lesions in individuals with type V/VI skin compared to those with type I/II skin

BACKGROUND

The identification of "normal" dermoscopic patterns of acquired melanocytic nevi provides better diagnostic accuracy for melanoma in people with black skin.

OBJECTIVE

We sought to describe melanocytic lesions (numbers and anatomic distributions) in skin types V and VI compared with skin types I and II, according to the Fitzpatrick classification. We sought to identify differences in dermoscopic findings in acquired melanocytic nevi (global pattern, pigment and color distribution) between the groups.

METHODS

We conducted cross-sectional, prospective, and consecutive data collection in 2 dermatologic outpatient clinics, between October 8, 2010, and March 20, 2013. From the 501 volunteers, 480 participants fulfilled the eligibility criteria. A total of 460 acquired melanocytic nevi were selected for dermoscopic analysis.

RESULTS

Individuals with skin type V/VI had fewer melanocytic lesions than those with skin type I/II (15.08 vs 7.90; P = .032), and the anatomic distribution in the first group was predominantly on the face and acral sites (P < .001). The acquired melanocytic nevi in the skin type V/VI group were associated with the reticular pattern (P < .0001), with a tendency toward central hyperpigmentation (P = .0025).

LIMITATIONS

The choice of a single representative nevus per patient is a limitation.

CONCLUSIONS

Acquired melanocytic nevi in individuals with skin type V/VI have a distinct dermoscopic pattern from those with skin type I/II.

Genetic factors associated with naevus count and dermoscopic patterns: preliminary results from the Study of Nevi in Children (SONIC)

BACKGROUND

Melanocytic naevi are an important risk factor for melanoma. Naevi with distinct dermoscopic patterns can differ in size, distribution and host pigmentation characteristics.

OBJECTIVES

We examined MC1R and 85 other candidate loci in a cohort of children to test the hypothesis that the development and dermoscopic type of naevi are modulated by genetic variants.

METHODS

Buccal DNAs were obtained from a cohort of 353 fifth graders (mean age 10·4 years). Polymorphisms were chosen based on a known or anticipated role in naevi and melanoma. Associations between single-nucleotide polymorphisms (SNPs) and baseline naevus count were determined by multivariate regression adjusting for sex, race/ethnicity and sun sensitivity. Dermoscopic images were available for 853 naevi from 290 children. Associations between SNPs and dermoscopic patterns were determined by polytomous regression.

RESULTS

Four SNPs were significantly associated with increasing (IRF4) or decreasing (PARP1, CDK6 and PLA2G6) naevus count in multivariate shrinkage analyses with all SNPs included in the model; IRF4 rs12203952 showed the strongest association with log naevus count (relative risk 1·56, P < 0·001). Using homogeneous naevi as the reference, IRF4 rs12203952 and four other SNPs in TERT, CDKN1B, MTAP and PARP1 were associated with either globular or reticular dermoscopic patterns (P < 0·05).

CONCLUSIONS

Our results provide evidence that subsets of naevi defined by dermoscopic patterns differ in their associations with germline genotypes and support the hypothesis that dermoscopically defined subsets of naevi are biologically distinct. These results require confirmation in larger cohorts. If confirmed, these findings will improve the current knowledge of naevogenesis and assist in the identification of individuals with high-risk phenotypes.

Dermatoscopic imaging of skin lesions by high school students: a cross-sectional pilot study

BACKGROUND

The ability of novices to perform imaging of skin lesions is not well studied.

OBJECTIVES

To determine the ability of 12th grade high school students without formal training to take clinical and dermatoscopic images of skin lesions on patient-actors.

PATIENTS/METHODS

Nineteen participants were divided into 11 gender-specific groups of 1-2 students. Groups were provided written instructions and assessed in their ability to (a) identify 8 pre-specified skin lesions, (b) take overview clinical images, and (c) take contact, polarized dermatoscopic images. Groups captured the same images twice using two different cameras [Nikon TM 1 J1 / VEOS HD1 and a VEOS DS3 (Canfield Scientific, Inc.)]. The sequence of camera use was determined using block randomization. If students made visibly poor skin contact during dermatoscopic imaging using their first camera, study investigators provided verbal instructions to place the second camera directly onto the skin. Students completed anonymous surveys before and after the imaging activity.

RESULTS

Students were proficient at identifying the correct pre-specified skin lesions (86/88, 98%), capturing sufficient quality overview clinical images of the back and legs (41/42, 98%), and taking dermatoscopic images of the entire skin lesion (174/176, 99%). Regarding dermatoscopic image quality, 116 of 175 (66%) images were in focus. Out of focus images were attributed to poor skin contact. Groups that received feedback (n=4) were able to obtain a significantly higher proportion of in focus dermatoscopic images using their second camera compared to their first camera (16% to 72%, P<0.001).

CONCLUSIONS

We identified several barriers that exist for participant-acquired dermatoscopic imaging. Instructions emphasizing the importance of skin contact are useful. Our results may help guide future patient-acquired teledermatoscopy efforts.

Update on melanocytic nevi in children

A new or changing melanocytic nevus in a child or adolescent often leads to concern in parents and physicians. To avoid undue alarm and unnecessary procedures, dermatologists should be aware of the natural history and clinical spectrum of nevi in pediatric patients, as well as findings that are potentially worrisome in this age group. This review provides an update on melanocytic nevi in children, focusing on their dynamic evolution over time, molecular insights into nevogenesis, and phenotypic markers for increased risk of melanoma in adolescence and adulthood. Special considerations for Spitz nevi and nevi located in particular sites (eg, scalp, acral, genital) are highlighted. Current understanding of the risks associated with congenital melanocytic nevi of different sizes and strategies for the management of children with numerous acquired nevi, Spitz nevi, and congenital nevi are also discussed.

Melanocytic naevi with globular and reticular dermoscopic patterns display distinct BRAF V600E expression profiles and histopathological patterns

BACKGROUND

BRAF (v-raf murine sarcoma viral oncogene homologue B) V600E mutations have been detected with high frequency in melanocytic naevi. Few studies have stratified analyses by naevus dermoscopic pattern.

OBJECTIVES

To determine the frequency of BRAF V600E expression and histopathological pattern in acquired melanocytic naevi distinguished by a globular vs. reticular dermoscopic pattern.

METHODS

We retrospectively identified histologically proven melanocytic naevi with banal reticular or globular dermoscopic patterns and evaluated BRAF V600E expression using immunohistochemistry.

RESULTS

BRAF V600E expression was detected in 11 of 12 globular naevi vs. four of 13 reticular naevi (91·7% vs. 30·1%, P = 0·004). A predominantly dermal growth pattern (P < 0·001) and the presence of large junctional nests (P = 0·017) were each associated with a globular dermoscopic pattern. The presence of either a predominantly dermal growth pattern or large junctional nests was found in 13 of 15 naevi positive for BRAF V600E and in two of 10 naevi negative for BRAF V600E (86·7% vs. 20%, P = 0·002).

CONCLUSIONS

The frequency of BRAF V600E mutations differs in naevi distinguished by unique dermoscopic structures and microanatomical growth patterns. Globular naevi, which most often histologically correspond to a predominantly dermal growth pattern and/or the presence of large junctional nests, are significantly more likely to express BRAF V600E than reticular naevi. These preliminary results require validation, but may directly inform future studies of naevogenesis and melanoma genesis.

Melanocytic nevi in children of southern Italy: dermoscopic, constitutional, and environmental factors

The objective was to estimate the prevalence of melanocytic nevi (MN) in children and to determine their dermoscopic characteristics and relationship with anatomic location and environmental and constitutional factors. The population was a randomly selected sample of 144 children who attended primary schools in Naples, Italy. Before physical examination of the children, standardized interviews were conducted with their parents. Follow-up interviews of both the children and parents were conducted 1 year later. Photographic and dermoscopic images were obtained. Boys had more MN than girls; 465 MN (55.6%) were observed in boys and 371 (44.4%) in girls (p < 0.05). The trunk and neck were the most common locations of MN (p < 0.001). The main dermoscopic feature of all MN observed was a globular pattern (p < 0.001). A significant correlation between duration of sunbathing and MN counts was revealed (p < 0.05). At 1-year follow-up, 118 new MN were identified in 66 children. The trunk and neck areas were the most common regions involved in the appearance of new MN (n = 68, 57.6% of all new MN, p < 0.001). The new MN count was significantly higher in children who reported more sunbathing (p < 0.001). Changes in the dermoscopic pattern were observed in 45 persistent MN, demonstrating more MN with a reticular-globular pattern, especially on the trunk, neck, and upper extremities (p < 0.001). MN development in early life is the result of complicated relationships between nevus evolution, anatomic location, and environmental and constitutional factors.

Clinical and dermoscopic patterns of melanocytic nevi in Hispanic adolescents: a descriptive study

BACKGROUND

Melanocytic nevi are well-known, important precursors of melanoma among children and adults. The adolescence period is an important period for nevi formation and evolution. This study provides data of a longitudinal study of nevi in a Hispanic adolescent population.

MATERIALS AND METHODS

A cross-sectional survey and 1-year prospective follow-up study was performed on Hispanic students from grades 6 and 7 at a school in Caguas, Puerto Rico (n = 90). The survey was completed by the students and one of their parents. The backs of the children were clinically examined for melanocytic nevi using digital photography and dermoscopy. Follow-up was conducted one year later.

RESULTS

The study cohort consisted of 53 (59%) boys and 37 (41%) girls, with an average age of 11.9 years (range 11-13 years). At the beginning of the study, 85% (n = 71/90) of the students presented with melanocytic nevi on their backs. After one year, new nevi were identified in 62% (n = 44/71), and there was a mean increase in nevus count of 1.8 (P < 0.001). A trend toward increased nevus count in lighter skin types was observed (P < 0.001). The predominant dermoscopic pattern was reticular (44%). The globular pattern was found most commonly in children with skin-type II (100%), while the reticular pattern was the most common among skin-types III (32%), IV (56%), and V (45%).

CONCLUSIONS

This study supports the utility of digital photography and dermoscopy for the evaluation of melanocytic nevi, providing evidence of the interrelationship between nevus count, dermoscopic pattern, and skin phenotype.

Problematic lesions in the elderly

As the population continues to age, clinicians and dermatologists are increasingly faced with geriatric patients presenting with a range of dermatologic manifestations, including benign and malignant skin tumors. Knowledge of epidemiologic and morphologic features, including dermoscopy of common and benign melanocytic and nonmelanocytic skin tumors, provides the basis for a better understanding and management of problematic skin tumors in this age group. This article provides an overview of common and problematic skin lesions in elderly patients and addresses epidemiologic, clinical, and dermoscopic clues that aid the differential diagnosis and management of challenging skin lesions.

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.

Dermoscopic features of melanocytic nevi in seven different anatomical locations in patients with atypical nevi syndrome

BACKGROUND

Dermoscopic screening facilitates early detection of melanoma and is recommended in patients with multiple or atypical nevi.

OBJECTIVES

To investigate whether dermoscopic features of acquired melanocytic nevi differ between six body sites (neck, axilla, pectoral area, shoulders, buttocks, legs) and the trunk.

METHODS AND MATERIALS

One hundred six patients with atypical nevi syndrome from a Digital Dermoscopy Unit were evaluated for the presence of nevi in each of seven body sites, and nevi representative of each region were selected as the predominant nevi. Dermoscopic features of 684 melanocytic nevi located in seven different body sites were analyzed.

RESULTS

Globular and globular-homogeneous pattern nevi showed a cephalad distribution. Nevi at the neck, axilla, shoulders, and pectoral area showed a higher proportion of globular and globular-homogeneous patterns than other locations (p < .001). Comma vessels were also more frequent on the neck, axillary area, and shoulders (p < .001). A reticular pattern was more frequent on caudal areas (legs, buttocks and lower back, and abdomen; p < .001).

CONCLUSIONS

Dermoscopic differences were found in different body areas. This information should be considered in the evaluation of lesions in patients with atypical nevus syndrome.

Advances in dermoscopy for detecting melanocytic lesions

Over the last 30 years dermatological approaches to diagnosis and management of melanocytic lesions have been revolutionized by the introduction of dermoscopy. Continuous improvements are being made in applying the technique, mostly in melanoma diagnosis, follow-up of melanocytic lesions and nevogenesis. Identification of new dermoscopic criteria, such as the dermoscopic island and the blue-black color for thin and nodular melanoma, respectively, further add two new weapons in the dermoscopical armamentarium for diagnosis of otherwise featureless melanoma. Recent advances show that short-term, 3-month, follow-up is the optimum time interval to identify minimal changes in initially featureless melanomas. Nevertheless, long-term follow-up is still useful for the recognition of changes in melanomas with a very low-rate of growth. Dermoscopy greatly improves diagnosis and early excision of melanomas and reduces the number of unnecessary excisions.

Clinical and dermoscopic features of 88 scalp naevi in 39 children

BACKGROUND

Paediatric scalp naevi may represent a source of anxiety for practitioners and parents, as the clinical and dermoscopic features of typical naevi have yet to be defined. Prompted by concern about the large size, irregular borders and colour variation of scalp naevi, clinicians and parents may request unnecessary excision of these naevi.

OBJECTIVES

To establish the typical clinical and dermoscopic patterns of scalp naevi in children younger than 18 years old to help optimize clinical care and management.

METHODS

Scalp naevi were imaged with a camera (Canon Rebel, XSi; Canon, Tokyo, Japan) and dermoscopic attachment (Dermlite Foto, 30 mm lens; 3Gen, San Juan Capistrano, CA, U.S.A.) to the camera. The clinical and dermoscopic images were reviewed and analysed. Both acquired and congenital scalp naevi were included but were not further differentiated from each other.

RESULTS

We obtained clinical and dermoscopic images of 88 scalp naevi in 39 white children. Two subjects had received chronic immunosuppressive medication. Nineteen children had a family history of melanoma. Boys (18/39 subjects, 46%) possessed 68% (60 naevi) of scalp naevi imaged. Younger (< 10 years old) subjects (24/39 subjects, 62%) possessed 42% (37 naevi) of scalp naevi. The main clinical patterns included eclipse (n=18), cockade (n = 3), solid brown (n=42) and solid pink (n=25) naevi. Solid-coloured naevi showed the following dermoscopic patterns: globular (57%), complex (reticular-globular) (27%), reticular (9%), homogeneous (6%) and fibrillar (1%). The majority of naevi had a unifying feature - perifollicular hypopigmentation, which caused the appearance of scalloped, irregular borders if occurring on the periphery, or variegation in pigmentation, if occurring within the naevi.

CONCLUSIONS

Older subjects and boys tend to harbour a larger proportion of scalp naevi. The main clinical patterns include solid-coloured and eclipse naevi. The most common dermoscopic pattern of scalp naevi is the globular pattern. Perifollicular hypopigmentation is a hallmark feature of signature scalp naevi. Dermoscopy is a noninvasive tool in the evaluation of cutaneous melanocytic lesions in children and may decrease the number of unnecessary excisions.

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 (baseline) and repeated at age 14 (follow-up). Of 443 children (39% females) imaged at baseline, 366 children (39% females) had repeated imaging three year later. At age 14, median back nevus counts increased by 2; 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 biologic nevus subsets.

Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies

Congenital melanocytic nevi (CMN) are evident in 1% to 6% of neonates. In some studies, nevi with clinical, dermatoscopic, and histologic features identical to CMN have had a prevalence of more than 15% in older children and adults, possibly reflecting the "tardive" appearance of nevi programmed from birth. There is ongoing debate about the magnitude of the risk of melanoma and other complications associated with CMN of various sizes and the best approach to management of these lesions. We review the natural history of CMN, including proliferative nodules and erosions during infancy, neurotization, and spontaneous regression, and features of variants such as speckled lentiginous and congenital blue nevi. The risk of melanoma arising within small-sized (<1.5 cm) and medium-sized CMN is low (likely <1% over a lifetime) and virtually nonexistent before puberty. Recent data suggest that melanoma (cutaneous or extracutaneous) develops in approximately 5% of patients with a large (>20 cm) CMN, with about half of this risk in the first few years of life. Melanoma and neurocutaneous melanocytosis (NCM) are most likely in patients with CMN that have a final size of >40 cm in diameter, numerous satellite nevi, and a truncal location. One-third of individuals with NCM have multiple medium-sized (but no large) CMN. In patients at risk for NCM, a screening gadolinium-enhanced magnetic resonance imaging, preferably before age 6 months, and longitudinal neurologic assessment are recommended. Management of CMN depends on such factors as the ease of monitoring (more difficult for large, dark, thick nevi) and cosmetic and psychologic benefits of excision or other procedures. CMN require lifelong follow-up. Periodic total body skin examinations are necessary for all patients with large CMN, even when complete resection (often impossible) has been attempted.

Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi

OBJECTIVE

To review recent dermoscopy studies that provide new insights into the evolution of nevi and their patterns of pigmentation as they contribute to the diagnosis of nevi and the management of pigmented melanocytic nevi.

DATA SOURCES

Data for this article were identified by searching the English and German literature by Medline and Journals@Ovid search for the period 1950 to January 2009.

STUDY SELECTION

The following relevant terms were used: dermoscopy, dermatoscopy, epiluminescence microscopy (ELM), surface microscopy, digital dermoscopy, digital dermatoscopy, digital epiluminescence microscopy, digital surface microscopy, melanocytic skin lesion, nevi, and pigmented skin lesions. There were no exclusion criteria.

DATA SYNTHESIS

The dermoscopic diagnosis of nevi relies on the following 4 criteria (each of which is characterized by 4 variables): (1) color (black, brown, gray, and blue); (2) pattern (globular, reticular, starburst, and homogeneous blue pattern); (3) pigment distribution (multifocal, central, eccentric, and uniform); and (4) special sites (face, acral areas, nail, and mucosa). In addition, the following 6 factors related to the patient might influence the pattern of pigmentation of the individual nevi: age, skin type, history of melanoma, UV exposure, pregnancy, and growth dynamics.

CONCLUSIONS

The 4 x 4 x 6 "rule" may help clinicians remember the basic dermoscopic criteria of nevi and the patient-related factors influencing their patterns. Dermoscopy is a useful technique for diagnosing melanocytic nevi, but the clinician should take additional factors into consideration to optimize the management of cases of pigmented lesions.

Dermoscopic patterns and subclinical melanocytic nests in normal-appearing skin

BACKGROUND

Dermoscopic patterns of normal-appearing skin have received little scrutiny. We have recently completed an analysis of dermoscopic patterns of naevi in children.

OBJECTIVES

To describe dermoscopic patterns in the normal-appearing skin surrounding naevi and to explore histological features of patterned background skin.

METHODS

Dermoscopic images of back naevi were obtained from a population-based sample of fifth grade students. The dermoscopic pattern of the background skin around the naevi was analysed. We examined histopathological features of background skin patterns in a convenience sample of seven specimens from six adult patients.

RESULTS

We observed a dermoscopic pattern in the background of normal-appearing skin in 41% of 1192 dermoscopic images from the backs of the 443 children. The background skin pattern was less frequent in individuals with a fair skin (P < 0.001). A globular pattern was observed in 201 images (17%) and a reticular pattern was seen in 287 images (24%), of which 112 images also showed globules. Inter-rater reliability between the two observers for a random sample of 100 images was excellent (kappa = 0.77). In four specimens with a globular background pattern, microscopic melanocytic nests were observed in the normal-appearing skin. No subclinical naevus nests were observed in three reticular pattern specimens.

CONCLUSIONS

Dermoscopically recognized patterns are commonly present in clinically normal skin of children. Microscopic melanocytic nests may be observed in normal-appearing skin with a globular skin pattern.

[What's new in pediatric dermatology?]

The main selected articles in pediatric dermatology covered the following topics: development and maturation of the epidermal barrier in the neonate, iatrogenic events in the neonatal ICU, diagnostic value of minor birthmarks, complications, risk factors and treatment of hemangiomas, coagulopathy in venous malformations, epidemiology and dermoscopy of congenital and acquired melanocytic nevi in childhood, growth of the body surface area, new pathogenic concepts and treatment in atopic dermatitis, the impact of filaggrin deficiency, hereditary factors in Kawasaki disease, severe and drug resistant cases, management of juvenile dermatomyositis, treatment of childhood psoriasis with biologics, the new classification of epidermolysis bullosa and therapeutic approach with cell therapy, neurological impairment in xeroderma pigmentosum, behavioural anomalies in X-linked ichthyosis, guidelines for neurofibromatosis type I, the genetics of an hereditary hypotrichosis, infantile acne, rosacea in childhood, mast cell disease management and, last but not least, treatment of hair lice with silicone.