Derm Dx: Hyperpigmented Macule on the Abdomen - Clinical Advisor

Derm Dx: Hyperpigmented Macule on the Abdomen

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An 11-year-old adolescent is brought to the office for treatment of low-grade acne that affects her face and back. Upon examination, a sizable hyperpigmented macule is identified on her abdomen that has been present for approximately 2 years. No other members of her family have similar lesions, and family history is negative for skin cancer (including melanoma). Can you diagnose this condition?

Nevus spilus, also known as speckled lentiginous nevus, is a benign, light brown, pigmented macule that contains multiple dark brown macules and occasionally papules scattered throughout the lesion.1 Nevus spilus may exceed 15 cm in diameter and may be so...

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Nevus spilus, also known as speckled lentiginous nevus, is a benign, light brown, pigmented macule that contains multiple dark brown macules and occasionally papules scattered throughout the lesion.1 Nevus spilus may exceed 15 cm in diameter and may be so faint that the pigment can only be recognized under a Wood lamp.1 These macules can be present at birth as hyperpigmented lesions and take years to develop into their recognizable spotted form.2 Occasionally, nevus spilus can be associated with complex birth defects such as phacomatosis pigmentokeratotica, phacomatosis pigmentovascularis, and speckled lentiginous nevus syndrome.3

It is important to identify and differentiate the 2 types of nevus spilus: macular and papular. Macular nevus spilus is a hallmark for a subtype of phacomatosis pigmentovascularis. Papular nevus spilus may be present in phacomatosis pigmentokeratotica and speckled lentiginous nevus syndrome.3

Histopathology is characterized by a “jentigo” pattern that indicates the darker speckles with increased melanocytes at the dermoepidermal junction. The background hyperpigmented macules show the microscopic features of a lentigo.3

Nevus spilus is best observed visually and with a dermatoscope.4 It is a benign lesion and association with melanoma is rare. Some patients request removal for cosmetic reasons; this is usually accomplished by excision or laser.

References

  1. Wolff K, Johnson RA, Saavedre AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw-Hill Companies, Inc; 2013.
  2. Schaffer JV, Orlow SJ, Lazova R, Bolognia JL. Speckled lentiginous nevus within the spectrum of congenital melanocytic nevi. Arch Dermatol. 2001;137(2):172-178.
  3. Vidaurri-de la Cruz H, Happle R. Two distinct types of speckled lentiginous nevi characterized by macular versus papular speckles. Dermatology. 2006;212(1):53-58.
  4. Kaminska-Winciorek G. Dermoscopy of nevus spilus. Dermatol Surg. 2013;39(10):1550-1554.
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