1. Common Acquired Nevomelanocytic Nevus

• Description
  • Vary in gross appearance but lesions have a homogeneous surface and coloration pattern, round or oval shape, regular outlines and sharp borders 

• Clinical Manifestations
  • Appears after first 6-12 months of life
  • Enlarges with body growth and regresses later in life

• Treatment
  • No treatment needed for majority of nevi
  • Biopsy warranted for any atypical changes
  • Need for treatment is usually dictated by cosmetic concerns
  • Removal by surgical excision

2. Congenital Nevomelanocytic Nevus

• Description
  • Prevalence rate of 1-6% in neonates
  • Causal association between congenital nevi and melanoma exists; lifetime risk of melanoma in 4-10% of patients

• Clinical Manifestations
  • Present at birth and usually larger than acquired nevi; otherwise similar to acquired nevus
  • Round or oval, smooth and regular outlines and sharply demarcated
  • Frequently hirsute, usually medium to dark brown

• Treatment
  • Depends on cosmetic and functional considerations, and perceived risk of melanoma
  • Nevus should be documented at birth and followed for any atypical changes
  • Surgical excision with reconstruction is the standard of care
  • Requires lifelong follow-up

3. Blue nevus

• Description
  • Subtypes: Common blue revue, Cellular blue nevus, Combined blue nevus-nevomelanocytic nevus

• Clinical Manifestations
  • Usually a single, deep-blue macule or papule, 1-2 mm in diameter
  • Uncommon in darkly pigmented people

• Treatment
  • None needed when stable nevus

4. Spitz Nevus/ Spindle Cell Nevus (Benign Juvenile Melanoma)

• Description
  • A firm smooth-surfaced dome-shaped nodule with a distinctive pink or reddish-brown color
  • Usually ranges from 0.6-1cm in diameter

• Clinical Manifestations
  • Usually solitary, appears in children 3-13 years of age
  • Generally occurs on the face, usually the cheek
  • Behaves in a benign fashion but has histologic features resembling that of malignant melanoma

• Treatment
  • Conservative surgical excision after accurate diagnosis made

5. Halo Nevus

• Description
  • A centrally placed, usually pigmented skin tumor becomes surrounded by a 1-5mm halo of depigmentation

• Clinical Manifestations
  • Usually seen in ages 3-45, with late-adolescence as the average age of onset
  • Can appear on any cutaneous surface but most commonly the trunk
  • Spontaneous resolution- disappearance of the central lesions in ~50% of affected lesions

• Treatment
  • No treatment needed; observation until resolution 
  • A surgical excision is needed if the central pigmentation is suspicious-looking to rule out malignant melanoma

Resources:

1. Ho VCY. Benign Epithelial Tumors. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick’s Dermatology in General Medicine. 5th Ed. USA: The McGraw-Hill Companies, Inc. 1999. 873-889.
2. Rhodes AR. Benign Neoplasias and Hyperplasia of Melanotyes. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick’s Dermatology in General Medicine. 5th Ed. USA: The McGraw-Hill Companies, Inc. 1999. 1018-1059.
3. Sardana K, Chakravarty P, and Goel K. Optimal management of common acquired melanocytic nevi (moles): current perspectives.  Clin Cosmet Investig Dermatol. 2014; 7: 89–103.
4. Warner PM, Yakuboff KP, Kagan RJ, Boyce S, Warden GD.  An 18-year experience in the management of congenital nevomelanocytic nevi. Ann Plast Surg. 2008 Mar;60(3):283-7.
5. Rhodes AR. Congenital Nevomelanocytic Nevi: Histologic Patterns in the First Year of Life and Evolution During Childhood.  Arch Dermatol. 1986;122(11):1257-1262.
6. Price HN, Schaffer JV.  Congenital melanocytic nevi—when to worry and how to treat: Facts and controversies. Clinics in Dermatology. 2010 May-Jun; 28(3): 293-302.
7. Schwartz RA, Okulics JF, Joswiak S. Lentigo Treatment & Management. https://emedicine.medscape.com/article/1068503-treatment. Mar 13, 2018
8. Hurwitz S. Cutaneous Tumors in Childhood. In: Hurwitz S. Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. USA: WB Saunders Company. 1981. 159-189.

• A small brown spot or freckle; Lentigines (plural)
• Three common types: Lentigo Simplex, Nevus Spilus, Solar Lentigo

1. Lentigo Simplex/ Simple lentigo

• Description
  • Acquired or congenital brown macule
  • Most common form of lentigo
  • Isolated lesions on skin, nails, mucous membranes
  • Caused by intraepidermal melanocytic hyperplasia

• Clinical Manifestations
  • A small or large, sharply circumscribed, pigmented (light brown or dark brown macule)
  • No relationship to sun exposure
  • Peutz-Jeghers syndrome- autosomal dominant disorder with mucocutaneous pigmentation(oral mucosa always involved), intestinal polyposis, hamartomatous and malignant neoplasms in extra intestinal sites

• Treatment
  • No treatment needed unless lesion is irregular or darkly pigmented

2. Nevus Spilus

• Description
  • A simple lentigo with more dark pigmentation, raised or flat with speckled nevomelanocytic elements

• Clinical Manifestations
  • Lesion evident during late infancy or early childhood and new speckles appear over time

• Treatment
  • None is needed if small

3. Solar Lentigo

• Description
  • A circumscribed pigmented macule occurring alone or as multiple lesions
  • Mostly seen in older patients

• Clinical Manifestation
  • A circumscribed pigmented macule on skin exposed to UVR

• Treatment
  • Topical and energy-based treatment options exist
  • Topical treatments:
    • Cryotherapy
    • Tretinoin cream and hydroquinone cream can lighten lentigines over several months
    • Trichloroacetic acid (mild) or glycol acid peels
  • Energy-based treatments:
    • There are many lasers used with various success rates.  
    • Risk of postinflammatory hyperpigmentation exists in all modalities in darker skinned patients.

Resources:

1. Ho VCY. Benign Epithelial Tumors. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick’s Dermatology in General Medicine. 5th Ed. USA: The McGraw-Hill Companies, Inc. 1999. 873-889.
2. Rhodes AR. Benign Neoplasias and Hyperplasia of Melanotyes. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick’s Dermatology in General Medicine. 5th Ed. USA: The McGraw-Hill Companies, Inc. 1999. 1018-1059.
3. Sardana K, Chakravarty P, and Goel K. Optimal management of common acquired melanocytic nevi (moles): current perspectives.  Clin Cosmet Investig Dermatol. 2014; 7: 89–103.
4. Warner PM, Yakuboff KP, Kagan RJ, Boyce S, Warden GD.  An 18-year experience in the management of congenital nevomelanocytic nevi. Ann Plast Surg. 2008 Mar;60(3):283-7.
5. Rhodes AR. Congenital Nevomelanocytic Nevi: Histologic Patterns in the First Year of Life and Evolution During Childhood.  Arch Dermatol. 1986;122(11):1257-1262.
6. Price HN, Schaffer JV.  Congenital melanocytic nevi—when to worry and how to treat: Facts and controversies. Clinics in Dermatology. 2010 May-Jun; 28(3): 293-302.
7. Schwartz RA, Okulics JF, Joswiak S. Lentigo Treatment & Management. https://emedicine.medscape.com/article/1068503-treatment. Mar 13, 2018
8. Hurwitz S. Cutaneous Tumors in Childhood. In: Hurwitz S. Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. USA: WB Saunders Company. 1981. 159-189.

1. A 6 month old infant presents with a 3 cm dark pigmented lesion that was noted by the mother since birth.

• Patient/parent education is important as to this congenital nevus.
• A careful monitoring of this lesion will be crucial for growth and any atypical changes.
• A discussion for prophylactic excision should be carried out.
• Patient will need a lifelong follow up with a dermatologist.

2. A 71 year old male presents with a coarse, raised, pigmented 0.5 cm in diameter lesion with no changes in the last 10 years and is worried it may be skin cancer.

• This lesion is a seborrheic keratosis with a “stuck-on” appearance with no changes in size or atypical-appearance.
• Patient is reassured and is given a choice of doing nothing, cryotherapy, electrodissication or surgical excision.

3. A 13 year old female presents with small freckle-like brown spots on her lips.  She is accompanied by her mom who says she has always had them.  In passing, the patient also tells you that she has had intermittent abdominal pain and has noted blood in her stool recently.

• The lesions are tiny brown macules throughout the pink lip and the oral mucosa.
• These lesions suggest simple lentigines, which you explain don’t need any treatment.
• However, the GI symptoms in conjunction with the simple lentigines of the oral mucosa suggest possible Peutz-Jeghers syndrome.
• You recommend a GI consult for further evaluation.