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Review
. 2016 Oct;75(4):813-823.
doi: 10.1016/j.jaad.2016.03.027. Epub 2016 Jun 17.

The study of nevi in children: Principles learned and implications for melanoma diagnosis

Alon Scope  1 , Michael A Marchetti  2 , Ashfaq A Marghoob  2 , Stephen W Dusza  2 , Alan C Geller  3 , Jaya M Satagopan  4 , Martin A Weinstock  5 , Marianne Berwick  6 , Allan C Halpern  7
Affiliations
Review

The study of nevi in children: Principles learned and implications for melanoma diagnosis

Alon Scope et al. J Am Acad Dermatol. 2016 Oct.

Abstract

Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.

Keywords: adolescence; childhood; dermoscopy; detection; melanoma; nevi; nevogenesis.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1. Melanoma and Nevus
Age-dependent evaluation of globular lesions. (A) An 84-year-old female patient with history of 3 prior melanomas presented with a 6 mm light brown flat papule adjacent to a previous melanoma scar on the leg. (B) On dermoscopy, the lesion presented a diffuse globular pattern. While banal-appearing, a new globular-patterned nevus in an older individual is unlikely. The lesion was excised and diagnosed as melanoma 0.8mm in thickness. (C) Clinical image of a nevus presenting as 4 mm macule on the upper back of a 14 year-old child. (D) On dermoscopy, this nevus shows a globular pattern. Despite the morphologic resemblance of the nevus to the melanoma shown in (B), the young age and anatomic location are typical for a globular nevus.
Figure 2
Figure 2. Nevus and Melanoma
Age-dependent evaluation of lesions with peripheral globules. (A) A growing nevus on the back of a 17-year-old female patient with family history of melanoma. The dermoscopic pattern, showing symmetric rim of peripheral globules, is commonly encountered in growing nevi in young patients. (B) A 5 mm brown macule on the right upper abdomen of a 60-year-old male patient without personal or family history of melanoma. Dermoscopy shows a reticular pattern with peripheral globules and streaks, and although these are distributed around the entire perimeter, the pattern indicates a growing melanocytic neoplasm in an individual >50 years. The lesion was excised and proved melanoma 0.5mm in thickness.
Figure 3
Figure 3. Melanoma
Anatomic site-dependent evaluation of a globular lesion. (A) A 77-year-old male patient with 2 prior melanomas, was found to have a 5 mm brown macule on the leg. (B) Dermoscopy reveals a globular pattern with globules non-uniform in shape and spacing. A globular patterned lesion on the leg of an older individual, without history of long-standing stability is highly suspicious; indeed, the lesion proved melanoma 0.1mm in thickness.
Figure 4
Figure 4. Melanoma
A solitary lesion “breaking” the cephalad-caudal distribution gradient of nevi. (A) A 74-year-old male patient without personal or family history of melanoma, was found to have a >20mm brown patch on the chest. The patient denied having this lesion from childhood and noticed this growing lesion on his chest for many years. (B) Dermoscopy revealed a seemingly uniform reticular pattern, but without criteria for the diagnosis of solar lentigo. A solitary, large, acquired reticular-patterned melanocytic neoplasm on the torso of an adult is suspicious for melanoma, and indeed, the lesion proved to be melanoma 0.15mm in maximal thickness.
Figure 5
Figure 5. Melanoma
Lesions “too dark” for the patient’s pigmentary phenotype. (A) An 80-year-old male patient presented with multiple nevi, blue eyes and skin phototype II, and reported blonde hair in his youth. A 5-mm papule (arrow) stands out as an ugly duckling based on its dark brown color. (B) Dermoscopy reveals a central homogenous peripheral reticular pattern with focal thickened network. This was a melanoma 0.45mm in thickness. (C) A 43-year-old male patient, with multiple atypical nevi and without previous history of melanoma, presented for routine examination. A 9-mm macule (arrow) stands out as an ugly duckling based on its dark brown color. (D) Dermoscopy shows a homogenous reticular pattern with variegate colors. This was a melanoma 0.95mm in thickness.
Figure 6
Figure 6. Nevi
Patterns of nevus disappearance in childhood. Among SONIC participants we observed 2 patterns of disappearance of nevi. The overwhelming majority of disappearing nevi showed only gradual fading of pigmentation pattern (A, upper panel), in contrast to the halo-nevus phenomenon with blue-grey granularity (B, Lower panel), which was infrequently observed.
Figure 7
Figure 7. Nevi
Nevus volatility in childhood. Overview images of the back at age 11 (A) and 17 (B) showing multiple new (blue circles), disappearing / fading (red circles) and stable nevi (green circles).
See this image and copyright information in PMC

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