Using Dermoscopic Criteria and Patient-Related Factors for the Management of Pigmented Melanocytic Nevi

Abstract

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 4×4×6 “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.

Dermoskopide hasta yönetimi

“…Tipik olarak pubertede gelişmekte olan nevüslerde görülür. Digital dermoskopik izlemde simetrik genişleme, periferal globüllerin kaybolması ve nevüs çapında stabilleşme görülür 11 . Yetişkinde görüldüğünde ise o lezyon çok dikkatli izlenmelidir.…”

“…Ultraviyoleye maruziyet sonucunda renkte koyulaşma, çap artışı, pigment ağının kaybolması, eritem, irregüler nokta yapıları, globüller veya leke (blotche) oluşumu görülebilir 10,11 . UVB/PUVA fototerapi alan hastalarda nevüslerde çap artışı, pigmentasyonun koyulaşması, nokta ve globül yapılarında artış bildirilmiştir 12 .…”

“…Genellikle doğumdan 3-6 ay sonra geri döner. Gebelikte 3 ay aralıklı muayenede görülen herhangi bir değişiklik şüpheyle karşılanmalı ise de kısa süreli digital dermoskopik izlem sırasında fizyolojik değişiklikler de göz önünde bulundurulmalıdır 11 . Gebeliği sırasında veya hemen doğum sonrası melanom tanısı almış hastaların varlığı (Resim 7) göz önünde bulundurularak özellikle yüksek risk grubu hastaların gebelikleri boyunca ve doğum sonrası ayları da kapsayacak şekilde kontrol aralıklarının sıklaştırılması önerilebilir.…”

Dermoscopy of nevi and melanoma in childhood

“…Typical patterns observed in acquired nevi include: diffuse or patchy network; peripheral reticulation with central hypo-or hyper-pigmentation; homo geneous tan/pink/brown or blue pigmentation; peripheral network with central globules; peripheral globular or starburst; globular; twocomponent; and symmetric multicomponent [38,39]. In general, most individuals manifest a predominant nevus pattern, which is defined as the nevus pattern configuration in more than 30% of their nevi [40]. The prevalent nevus pattern depends to some degree on the age and skin type of the individual.…”

“…Children of less than 10 years of age classically have globular or homogeneous patterned nevi, whereas adults generally display reticulated nevi [41]. Individuals with Fitzpatrick skin type I (fair complexion) have a predominant nevus pattern typified by light brown coloration with central hypopigmentation (Figure 8), types II and III have light to dark brown nevi with multifocal pigmentation, and type IV individuals (dark complexion) classically have black or dark brown nevi with central hyperpigmentation (Figure 9) [40]. Visualization of a predominant nevus pattern can help identify Brooks, Scope, Braun & Marghoob those individuals who are at an increased risk for developing melanoma, and aid in the detection of 'ugly duckling' outlier lesions that may represent malignancy [42,43].…”