Clinical and dermoscopic features of 88 scalp naevi in 39 children

Abstract

Summary Background Paediatric scalp nevi may represent a source of anxiety for practitioners and parents, as the clinical and dermoscopic features of typical nevi have yet to be defined. Prompted by concern about the large size, irregular borders, and colour variation of scalp nevi, clinicians and parents may request unnecessary excision of these nevi. Objective The purpose of this study is to establish the typical clinical and dermoscopic patterns of scalp nevi in children younger than 18 years old to help optimize clinical care and management. Methods Scalp nevi were imaged with a camera (Canon Rebel, XSi) and dermoscopic attachment (3Gen, Dermlite Foto, 30mm lens) to the camera. The clinical and dermoscopic images were reviewed and analyzed. Both acquired and congenital scalp nevi were included but were not further differentiated from each other. Results We obtained clinical and dermoscopic images of 88 scalp nevi in 39 Caucasian children. Two subjects had received chronic immunosuppressive medication. Nineteen children have had a family history of melanoma. Males (18/39 subjects, 46%) possessed 68% (60 nevi) of scalp nevi imaged. Younger (<10 years old) subjects (24/39 subjects, 62%) possessed 42% (37 nevi) of scalp nevi. The main clinical patterns included eclipse (n=18), cockade (n=3), solid brown (n=42), and solid pink (n=25) nevi. Solid-coloured nevi showed the following dermoscopic patterns: globular (57%), complex (reticular-globular) (27%), reticular (9%), homogenous (6%), and fibrillar (1%). The majority of nevi 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 nevi. Conclusions Older subjects and males tend to harbour a larger proportion of scalp nevi. The main clinical patterns include solid-coloured and eclipse nevi. The most common dermoscopic pattern of scalp nevi is the globular pattern. Perifollicular hypopigmentation is a hallmark feature of signature scalp nevi. Dermoscopy is a non-invasive tool in the evaluation of cutaneous melanocytic lesions in children and may decrease the number of unnecessary excisions.

Neoplastic skin lesions of the scalp in children: A retrospective study of 265 cases in Taiwan

“…Melanocytic nevi on the scalp frequently show site-specific atypia in both histopathology and clinical appearance, especially in children, but they are actually benign [9,10]. Perifollicular hypopigmentation is present in the majority of scalp nevi, contributing to the irregularity of borders and variation in pigmentation [11]. The atypical appearance is therefore the source of anxiety for parents and physicians, as scalp melanoma might have a poorer prognosis than melanoma elsewhere [12].…”

Histologic features of scalp melanocytic nevi

“…Scalp nevi in children usually evolve in a benign fashion not supportive of excisional biopsies. 23 A subset of patterned nevieeclipse and cockade nevi 24,25 erepresent around one fourth of childhood scalp nevi 26 and also do not warrant excision. 22 These findings, along with our current study, should help dermatologists and dermatopathologists identify morphologic features of scalp nevi in children.…”

Dermoscopy: distinguishing malignant tumors from benign

“…In the majority of scalp nevi a dotted vascular pattern can be detected. Other kinds of vessels may sometimes be observed such as hairpin, linear and looped vessels [97].…”

“…These patterns account for the clinical appearance of solid brown (globular) and solid pink nevi. Less frequently, a combination of the abovementioned patterns gives rise to clinical appearing eclipse (tan homogeneous center with a darker, reticulated peripheral ring) and cockade nevi (darker central globular pattern, more commonly reticular in adults compared with children, lighter homogeneous inner ring and a peripheral darker reticular ring) [96,97]. In addition, the majority of scalp nevi have a characteristic perifollicular hypopigmentation.…”