Tuesday, February 23, 2016

A Thing of Beauty

The patient is a 7 year-old boy with a lesion present since infancy.  He was adpopted at age 11 months and prior history is unknown.  The lesion has changed only minimumly over the past few years.

O/E:  7 mm lesion with macular dots and two darker pigmented papules on the left abdomen. He has a small area of segmental vitiligo on the left neck.

Ckinical and Dermatoscopic Images:
Workup:  None at this time

Diagnosis:  Nevus spilus, Speckled Lentiginous Nevus
Note:  An association of segmental vitiligo with SLN has not been reported.


Speckled lentiginous naevus: which of the two disorders do you mean?
Happle R1.  Clin Exp Dermatol. 2009 Mar;34(2):133-5
Abstract: Speckled lentiginous naevus (synonym: naevus spilus) no longer represents one clinical entity, but rather, two different disorders can be distinguished. Naevus spilus maculosus is consistently found in phacomatosis spilorosea, whereas naevus spilus papulosus represents a hallmark of phacomatosis pigmentokeratotica. The macular type is characterized by dark speckles that are completely flat and rather evenly distributed on a light brown background, resembling a polka-dot pattern. In contrast, naevus spilus papulosus is defined by dark papules that are of different sizes and rather unevenly distributed, reminiscent of a star map. Histopathologically, the dark spots of naevus spilus maculosus show a 'jentigo' pattern and several nests of melanocytes involving the dermoepidermal junction at the tips of the papillae, whereas most of the dark speckles of naevus spilus papulosus are found to be dermal or compound melanocytic naevi. The propensity to develop Spitz naevi appears to be the same in both types of speckled lentiginous naevus, whereas development of malignant melanoma has been reported far more commonly in naevus spilus maculosus.

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