Melanoma arising in segmental nevus spilus: detection by sequential digital dermatoscopy.
BACKGROUND
Nevus spilus (NS) defines a café-au-lait macule with superimposed maculopapular speckles. Although the café-au-lait macule often presents at birth, the darker pigmented speckles increase in number and size during a period of several years. The need for close follow-up of patients with NS is underlined by reports of several cases of cutaneous melanoma developing within such lesions.


METHODS
We followed up 4 adult patients (3 male, one female; mean age 38 years) with unilateral segmental NS of the thoracic or abdominal region. The NS was present at birth in all 4 patients. Follow-up by sequential digital dermatoscopy and digital overview images was scheduled every 6 to 12 months.


RESULTS
During surveillance (mean follow-up time, 8.15 years), 3 melanocytic lesions were excised. In one patient focal enlargement prompted excision of two dysplastic compound nevi. In another patient new black dots and focal peripheral hyperpigmentation were detected by comparison with previous images. Histologic analysis confirmed the diagnosis of invasive melanoma (Breslow thickness, 0.6 mm).


CONCLUSIONS
This observational clinical study included a small number of patients. Sequential digital dermatoscopy of large NS in children may lead to unnecessary excisions because of physiologic changes.


CONCLUSIONS
We suggest close follow-up of patients with segmental NS whenever complete excision is not possible. In adults, follow-up by digital dermatoscopy and excision of lesions with dynamic changes may assist in the early detection of melanoma.
Haenssle
Holger A
HA
Department of Dermatology and Venerology, Georg-August-University, Von-Siebold-Str. 3, Göttingen D-37075, Germany. h.haenssle@med.uni-goettingen.de
Kaune
Kjell M
KM
Buhl
Timo
T
Thoms
Kai-Martin
KM
Padeken
Michael
M
Emmert
Steffen
S
Schön
Michael P
MP
D000328:Adult; D001707:Biopsy, Needle; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002675:Child, Preschool; D046169:Dermoscopy / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008991:Monitoring, Physiologic / Q000379:methods; D009367:Neoplasm Staging; D009508:Nevus, Pigmented / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome