Two Distinct Types of Speckled Lentiginous Nevi Characterized by Macular versus Papular Speckles

Abstract

Background: Speckled lentiginous nevus (SLN; synonym: nevus spilus) is a darkly spotted light-brown macule that mostly occurs as an isolated lesion of rather limited dimensions but sometimes may involve large areas of the body. So far, this skin disorder has been considered to represent one clinical entity. Objective: Because SLN is occasionally associated with complex birth defects such as phacomatosis pigmentovascularis, phacomatosis pigmentokeratotica, or SLN syndrome, we tested our idea that two different types of SLN may exist, each one associated with a particular syndrome. Methods: A review of case reports on SLN published during the years 1970–2004 was performed. Results: This evaluation of cases provided evidence that two different types of SLN exist, in the form of macular versus papular SLN, each one being related to a specific syndrome. Macular SLN is characterized by a tannish-brown background with darker flat speckles. The distribution of speckles is rather even and resembles a polka-dot pattern. Histopathologically, this type of SLN is characterized by what has been called a ‘jentigo’ pattern in the darker speckles and by some nests of melanocytes at the dermoepidermal junction at the tips of the papillae, whereas the background pigmentation shows the microscopical features of a lentigo. Papular SLN is characterized by a light-brown macule superimposed by multiple melanocytic nevi in the form of papules or nodules that show a more uneven distribution reminiscent of a star map. Small dark macules may likewise be present. Histopathologically, the papular component consists of dermal or compound melanocytic nevi. A separation of the two types of SLN is important because our analysis showed that macular SLN is a hallmark of a particular type of phacomatosis pigmentovascularis, whereas papular SLN is typically present in phacomatosis pigmentokeratotica as well as in SLN syndrome. Conclusions: Macular SLN and papular SLN appear to be two distinct cutaneous entities. This dichotomy may turn out to be important when such nevi will be analyzed at the molecular level.

Dermoscopy of nevi and melanoma in childhood

“…However, the network is not contiguous and is interrupted by the presence of homogeneous structureless areas. This pattern can be seen in congenital nevi, especially those located on the lower extremity, and in acquired nevi Review an increased probability of developing SN, which must be distinguished from melanoma [29]. Interestingly, the risk of developing cutaneous melanoma within a SPLN appears to be greater for those exhibiting the macular subtype (25 vs 10%) [29].…”

“…This pattern can be seen in congenital nevi, especially those located on the lower extremity, and in acquired nevi Review an increased probability of developing SN, which must be distinguished from melanoma [29]. Interestingly, the risk of developing cutaneous melanoma within a SPLN appears to be greater for those exhibiting the macular subtype (25 vs 10%) [29]. Nevus spilus has been likened to a 'melanocytic garden' in which BN, SN, junctional nevi, compound nevi, intradermal nevi and melanoma can arise [27,31].…”

“…Monitoring of SPLN in a clinical and dermoscopic manner provides information about any variations in morphology that would be indicative of melanoma. Two subtypes of nevus spilus have been reported in the literature and include the macular variant, nevus spilus maculosus, and the papular variant, nevus spilus papulosus [29,30]. The macular type is characterized by evenly distributed, flat, dark speckles within a large, well-circumscribed, light brown patch.…”

Giant Maculo-Papular Speckled Lentiginous Nevus Associated with Isolated and Centrofacial Located Lentiginosus

“…Macular form is characterized by flat and dark brown spots on a light-brown background, while papular form is characterized by dark brown papules or nodules on a light-brown background, although small dark spots may also be present [1]. On the other hand, the term "speckled lentiginous nevus (SLN)" was first introduced to literature by Stewart el al.in 1978 [2,3]. Today, the terms NS and SLN are used interchangeably, although first one is usually used to describe smaller lesions while second is usually preferred to describe extensive lesions [3].…”

Papular Speckled Lentiginous Nevus: Case Report

“…Papüler BLN'de ise benekler papül veya nodül tarz nda ve düzensiz da lm lard r. Papüler BLN'nin maküler BLN'den en önemli fark (25/64 olguda) progresif seyir gös-termesi ve daha az (6/64) oranda melanom geli me riskidir (3). Histopatolojide papüllerin dermal veya compound melanosit yuvalanmalar ndan olu tu u görülür (3).…”