Pigmented Lesions in Children

ABSTRACT

Pigmented lesions in childhood can pose significant diagnostic and therapeutic challenges. This article examines the most common pigmented lesions encountered in childhood. Special emphasis is placed on the diagnosis and management of congenital melanocytic nevi, acquired melanocytic nevi, clonal nevi, halo nevi, atypical melanocytic nevi, Spitz nevi, recurrent nevi, childhood melanoma, blue nevi, speckled lentiginous nevi, and other melanocytic nevi such as nevus of Ota and nevus of Ito. Proper diagnosis and an understanding of the natural history of pigmented lesions in children are essential for successful outcomes.

Pigmented nevus - pediatric - Spitz nevus - congenital nevus - melanoma

REFERENCES

• 1 Gilchrest B A, Fitzpatrick T B, Anderson R R, Parrish J A. Localization of melanin pigmentation in the skin with Wood's lamp.  Br J Dermatol. 1977;  96 245-248
• 2 Borbola K, Banfalvi T, Fejos Z et al.. Etiologic factors of malignant melanoma in young adults.  Orv Hetil. 2005;  146 1481-1487
• 3 Friedman R J, Rigel D S, Silverman M K, Kopf A W, Vossaert K A. Malignant melanoma in the 1990s: the continued importance of early detection and the role of physician examination and self-examination of the skin.  CA Cancer J Clin. 1991;  41 201-226
• 4 Soyer H P, Argenziano G, Chimenti S, Ruocco V. Dermoscopy of pigmented skin lesions.  Eur J Dermatol. 2001;  11 270-276
• 5 Rigel D S. Cancer of the Skin. Philadelphia, PA; Saunders 2005
• 6 Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Sammarco E, Delfino M. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis.  Arch Dermatol. 1998;  134 1563-1570
• 7 Nachbar F, Stolz W, Merkle T et al.. The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions.  J Am Acad Dermatol. 1994;  30 551-559
• 8 Piccolo D, Ferrari A, Peris K, Diadone R, Ruggeri B, Chimenti S. Dermoscopic diagnosis by a trained clinician vs. a clinician with minimal dermoscopy training vs. computer-aided diagnosis of 341 pigmented skin lesions: a comparative study.  Br J Dermatol. 2002;  147 481-486
• 9 Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy.  Lancet Oncol. 2002;  3 159-165
• 10 Cramer S F. The origin of epidermal melanocytes. Implications for the histogenesis of nevi and melanomas.  Arch Pathol Lab Med. 1991;  115 115-119
• 11 Kincannon J, Boutzale C. The physiology of pigmented nevi.  Pediatrics. 1999;  104(4 Pt 2) 1042-1045
• 12 Gontier E, Cario-Andre M, Vergnes P, Bizik J, Surleve-Bazeille J E, Taieb A. The ‘Abtropfung phenomenon’ revisited: dermal nevus cells from congenital nevi cannot activate matrix metalloproteinase 2 (MMP-2).  Pigment Cell Res. 2003;  16 366-373
• 13 Hoffman R M. The pluripotency of hair follicle stem cells.  Cell Cycle. 2006;  5 232-233
• 14 Bartosik J, Wulf H C, Kobayasi T. Melanin and melanosome complexes in long standing stable vitiligo-an ultrastructural study.  Eur J Dermatol. 1998;  8 95-97
• 15 Machado Filho C D, Almeida F A, Proto R S, Landman G. Vitiligo: analysis of grafting versus curettage alone, using melanocyte morphology and reverse transcriptase polymerase chain reaction for tyrosinase mRNA.  Sao Paulo Med J. 2005;  123 187-191
• 16 Tannous Z S, Mihm Jr M C, Sober A J, Duncan L M. Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management.  J Am Acad Dermatol. 2005;  52 197-203
• 17 Harrison S L, MacKie R M, MacLennan R. Development of melanocytic nevi in the first three years of life.  J Natl Cancer Inst. 2000;  92 1436-1438
• 18 Valiukeviciene S, Miseviciene I, Gollnick H. The prevalence of common acquired melanocytic nevi and the relationship with skin type characteristics and sun exposure among children in Lithuania.  Arch Dermatol. 2005;  141 579-586
• 19 Brodell R, Sims D M, Zaim M T. Natural history of melanocytic nevi.  Am Fam Physician. 1988;  38 93-101
• 20 Titus-Ernstoff L, Perry A E, Spencer S K, Gibson J J, Cole B F, Ernstoff M S. Pigmentary characteristics and moles in relation to melanoma risk.  Int J Cancer. 2005;  116 144-149
• 21 Krengel S. Nevogenesis-new thoughts regarding a classical problem.  Am J Dermatopathol. 2005;  27 456-465
• 22 Enta T, Kwan T Y. Melanocytic nevi in sun-protected Canadian Hutterite children.  Arch Dermatol. 1998;  134 379-381
• 23 Garbe C, Buttner P, Weiss J et al.. Associated factors in the prevalence of more than 50 common melanocytic nevi, atypical melanocytic nevi, and actinic lentigines: multicenter case-control study of the Central Malignant Melanoma Registry of the German Dermatological Society.  J Invest Dermatol. 1994;  102 700-705
• 24 Harrison S L, MacLennan R, Speare R, Wronski I. Sun exposure and melanocytic naevi in young Australian children.  Lancet. 1994;  344 1529-1532
• 25 Stierner U. Melanocytes, moles and melanoma-a study on UV effects.  Acta Derm Venereol Suppl (Stockh). 1991;  168 1-31
• 26 Diffey B L. Sunscreens and melanoma: the future looks bright.  Br J Dermatol. 2005;  153 378-381
• 27 Christensen D. Data still cloudy on association between sunscreen use and melanoma risk.  J Natl Cancer Inst. 2003;  95 932-933
• 28 Rigel D S. The effect of sunscreen on melanoma risk.  Dermatol Clin. 2002;  20 601-606
• 29 Bittencourt F V, Marghoob A A, Kopf A W, Koenig K L, Bart R S. Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis.  Pediatrics. 2000;  106 736-741
• 30 Kopf A W, Bart R S, Hennessey P. Congenital nevocytic nevi and malignant melanomas.  J Am Acad Dermatol. 1979;  1 123-130
• 31 Pappo A S. Melanoma in children and adolescents.  Eur J Cancer. 2003;  39 2651-2661
• 32 Rigel D S, Friedman R J, Kopf A W, Rogers G S, Heilman E R. Precursors of malignant melanoma. Problems in computing the risk of malignant melanoma arising in dysplastic and congenital nevocytic nevi.  Dermatol Clin. 1985;  3 361-365
• 33 Egan C L, Oliveria S A, Elenitsas R, Hanson J, Halpern A C. Cutaneous melanoma risk and phenotypic changes in large congenital nevi: a follow-up study of 46 patients.  J Am Acad Dermatol. 1998;  39 923-932
• 34 Silverberg N B. Update on malignant melanoma in children.  Cutis. 2001;  67 393-396
• 35 Alper J C, Holmes L B. The incidence and significance of birthmarks in a cohort of 4,641 newborns.  Pediatr Dermatol. 1983;  1 58-68
• 36 Streams B N, Lio P A, Mihm M C, Sober A J. A nonepidermal, primary malignant melanoma arising in a giant congenital melanocytic nevus 40 years after partial surgical removal.  J Am Acad Dermatol. 2004;  50 789-792
• 37 Rhodes A R, Wood W C, Sober A J, Mihm Jr M C. Nonepidermal origin of malignant melanoma associated with a giant congenital nevocellular nevus.  Plast Reconstr Surg. 1981;  67 782-790
• 38 Hale E K, Stein J, Ben-Porat L et al.. Association of melanoma and neurocutaneous melanocytosis with large congenital melanocytic naevi-results from the NYU-LCMN registry.  Br J Dermatol. 2005;  152 512-517
• 39 DeDavid M, Orlow S J, Provost N et al.. A study of large congenital melanocytic nevi and associated malignant melanomas: review of cases in the New York University Registry and the world literature.  J Am Acad Dermatol. 1997;  36(3 Pt 1) 409-416
• 40 Zaal L H, Mooi W J, Sillevis Smitt J H, van der Horst C M. Classification of congenital melanocytic naevi and malignant transformation: a review of the literature.  Br J Plast Surg. 2004;  57 707-719
• 41 Cunningham B B, Gigler V, Wang K et al.. General anesthesia for pediatric dermatologic procedures: risks and complication.  Arch Dermatol. 2005;  141 573-576
• 42 Arneja J S, Gosain A K. Giant congenital melanocytic nevi of the trunk and an algorithm for treatment.  J Craniofac Surg. 2005;  16 886-893
• 43 Ostertag J U, Quaedvlieg P J, Kerckhoffs F E et al.. Congenital naevi treated with erbium:YAG laser (Derma K) resurfacing in neonates: clinical results and review of the literature.  Br J Dermatol. 2006;  154 889-895
• 44 Foster R D, Williams M L, Barkovich A J, Hoffman W Y, Mathes S J, Frieden I J. Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children.  Plast Reconstr Surg. 2001;  107 933-941
• 45 Strungs I. Common and uncommon variants of melanocytic naevi.  Pathology. 2004;  36 396-403
• 46 Ball N J, Golitz L E. Melanocytic nevi with focal atypical epithelioid cell components: a review of seventy-three cases.  J Am Acad Dermatol. 1994;  30(5 Pt 1) 724-729
• 47 Huynh P M, Glusac E J, Bolognia J L. The clinical appearance of clonal nevi (inverted type A nevi).  Int J Dermatol. 2004;  43 882-885
• 48 Bolognia J L, Lin A, Shapiro P E. The significance of eccentric foci of hyperpigmentation (‘small dark dots’) within melanocytic nevi. Analysis of 59 cases.  Arch Dermatol. 1994;  130 1013-1017
• 49 Herd R M, Hunter J A. Familial halo naevi.  Clin Exp Dermatol. 1998;  23 68-69
• 50 Gordeladze A S, Pavlova T A. Multiple halo nevi: their differential diagnosis from malignant melanoma.  Arkh Patol. 1990;  52 66-69
• 51 Musette P, Bachelez H, Flageul B et al.. Immune-mediated destruction of melanocytes in halo nevi is associated with the local expansion of a limited number of T cell clones.  J Immunol. 1999;  162 1789-1794
• 52 Lerner A B, Kirkwood J M. Vitiligo and melanoma: can genetically abnormal melanocytes result in both vitiligo and melanoma within a single family?.  J Am Acad Dermatol. 1984;  11(4 Pt 1) 696-701
• 53 Albert D M, Todes-Taylor N, Wagoner M, Nordlund J J, Lerner A B. Vitiligo or halo nevi occurring in two patients with choroidal melanoma.  Arch Dermatol. 1982;  118 34-36
• 54 Weaver P C. The black cancer-malignant melanoma.  Nurs Times. 1976;  72 582-584
• 55 Munro D D. Multiple active junctional naevi with family history of malignant melanoma.  Proc R Soc Med. 1974;  67 594-595
• 56 Clark Jr W H, Reimer R R, Greene M, Ainsworth A M, Mastrangelo M J. Origin of familial malignant melanomas from heritable melanocytic lesions. ‘The B-K mole syndrome’.  Arch Dermatol. 1978;  114 732-738
• 57 Lynch H T, Fusaro R M, Danes B S, Kimberling W J, Lynch J F. A review of hereditary malignant melanoma including biomarkers in familial atypical multiple mole melanoma syndrome.  Cancer Genet Cytogenet. 1983;  8 325-358
• 58 Greene M H, Clark Jr W H, Tucker M A et al.. Precursor naevi in cutaneous malignant melanoma: a proposed nomenclature.  Lancet. 1980;  2 1024
• 59 Kang S, Barnhill R L, Mihm Jr M C, Fitzpatrick T B, Sober A J. Melanoma risk in individuals with clinically atypical nevi.  Arch Dermatol. 1994;  130 999-1001
• 60 Naeyaert J M, Brochez L. Clinical practice. Dysplastic nevi.  N Engl J Med. 2003;  349 2233-2240
• 61 Bonerandi J J, Grob J J. Melanoma and its risk factors. Epidemiology and consequences in detection and prevention.  Ann Dermatol Venereol. 1989;  116 411-417
• 62 Steijlen P M, Bergman W, Hermans J, Scheffer E, Van Vloten W A, Ruiter D J. The efficacy of histopathological criteria required for diagnosing dysplastic naevi.  Histopathology. 1988;  12 289-300
• 63 Ferrone C R, Ben Porat L, Panageas K S et al.. Clinicopathological features of and risk factors for multiple primary melanomas.  JAMA. 2005;  294 1647-1654
• 64 Hammer H, Toth-Molnar E, Olah J, Dobozy A. Connection between uveal melanoma and dysplastic naevus syndrome.  Magy Onkol. 2005;  49 15-18
• 65 Halpern A C, Guerry D T, Elder D E et al.. Dysplastic nevi as risk markers of sporadic (nonfamilial) melanoma. A case-control study.  Arch Dermatol. 1991;  127 995-999
• 66 Marghoob A A, Slade J, Kopf A W, Salopek T G, Rigel D S, Bart R S. Risk of developing multiple primary cutaneous melanomas in patients with the classic atypical-mole syndrome: a case-control study.  Br J Dermatol. 1996;  135 704-711
• 67 Elder D E. Precursors to melanoma and their mimics: nevi of special sites.  Mod Pathol. 2006;  19(suppl 2) S4-20
• 68 Rivers J K, Cockerell C J, McBride A, Kopf A W. Quantification of histologic features of dysplastic nevi.  Am J Dermatopathol. 1990;  12 42-50
• 69 Langer K, Rappersberger K, Steiner A, Konrad K, Wolff K. The ultrastructure of dysplastic naevi: comparison with superficial spreading melanoma and common naevocellular naevi.  Arch Dermatol Res. 1990;  282 353-362
• 70 Hussein M R, Roggero E, Sudilovsky E C, Tuthill R J, Wood G S, Sudilovsky O. Alterations of mismatch repair protein expression in benign melanocytic nevi, melanocytic dysplastic nevi, and cutaneous malignant melanomas.  Am J Dermatopathol. 2001;  23 308-314
• 71 Tucker M A, Goldstein A M. Melanoma etiology: where are we?.  Oncogene. 2003;  22 3042-3052
• 72 Rigel D S, Friedman R J. The management of patients with dysplastic and congenital nevi.  Dermatol Clin. 1985;  3 251-255
• 73 Marghoob A A, Kopf A W, Rigel D S et al.. Risk of cutaneous malignant melanoma in patients with ‘classic’ atypical-mole syndrome. A case-control study.  Arch Dermatol. 1994;  130 993-998
• 74 Tiersten A D, Grin C M, Kopf A W et al.. Prospective follow-up for malignant melanoma in patients with atypical-mole (dysplastic-nevus) syndrome.  J Dermatol Surg Oncol. 1991;  17 44-48
• 75 Ko C B, Walton S, Wyatt E H, Bury H P. Spitz nevus.  Int J Dermatol. 1993;  32 354-357
• 76 Morgan C J, Nyak N, Cooper A, Pees B, Friedmann P S. Multiple Spitz naevi: a report of both variants with clinical and histopathological correlation.  Clin Exp Dermatol. 2006;  31 368-371
• 77 Calista D. Spitz naevus arising within congenital naevus spilus.  J Eur Acad Dermatol Venereol. 2005;  19 137-138
• 78 Kapur P, Selim M A, Roy L C, Yegappan M, Weinberg A G, Hoang M P. Spitz nevi and atypical Spitz nevi tumors: a histologic and immunohistochemical analysis.  Mod Pathol. 2005;  18 197-204
• 79 Gill M, Cohen J, Renwick N, Mones J M, Silvers D N, Celebi J T. Genetic similarities between Spitz nevus and Spitzoid melanoma in children.  Cancer. 2004;  101 2636-2640
• 80 Murphy M E, Boyer J D, Stashower M E, Zitelli J A. The surgical management of Spitz nevi.  Dermatol Surg. 2002;  28 1065-1069 discussion 1069
• 81 Park H K, Leonard D D, Arrington III J H, Lund H Z. Recurrent melanocytic nevi: clinical and histologic review of 175 cases.  J Am Acad Dermatol. 1987;  17 285-292
• 82 Sohn S, Kim S, Kang W H. Recurrent pigmented macules after q-switched alexandrite laser treatment of congenital melanocytic nevus.  Dermatol Surg. 2004;  30 898-907
• 83 Hoang M P, Prieto V G, Burchette J L, Shea C R. Recurrent melanocytic nevus: a histologic and immunohistochemical evaluation.  J Cutan Pathol. 2001;  28 400-406
• 84 Patterson W M, Lefkowitz A, Schwartz R A, Lambert W C, Rao B K. Melanoma in children.  Cutis. 2000;  65 269-272, 275
• 85 Ferrari A, Bono A, Baldi M et al.. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution.  Pediatrics. 2005;  115 649-654
• 86 Leman J A, Evans A, Mooi W, MacKie R M. Outcomes and pathological review of a cohort of children with melanoma.  Br J Dermatol. 2005;  152 1321-1323
• 87 Barnhill R L. The Spitzoid lesion: rethinking Spitz tumors, atypical variants, ‘Spitzoid melanoma’ and risk assessment.  Mod Pathol. 2006;  19(suppl 2) S21-S33
• 88 Gonzalez-Campora R, Galera-Davidson H, Vazquez-Ramirez F J, Diaz-Cano S. Blue nevus: classical types and new related entities. A differential diagnostic review.  Pathol Res Pract. 1994;  190 627-635
• 89 Boni R, Panizzon R, Huch Boni R A, Steinert H, Dummer R. Malignant blue naevus with distant subcutaneous metastasis.  Clin Exp Dermatol. 1996;  21 427-430
• 90 Calista D, Schianchi S, Landi C. Malignant blue nevus of the scalp.  Int J Dermatol. 1998;  37 126-127
• 91 Hofmann U B, Ogilvie P, Mullges W, Brocker E B, Hamm H. Congenital unilateral speckled lentiginous blue nevi with asymmetric spinal muscular atrophy.  J Am Acad Dermatol. 1998;  39 326-329
• 92 Chan H H, Kono T. Nevus of Ota: clinical aspects and management.  Skinmed. 2003;  2 89-96
• 93 Hidano A, Kajima H, Ikeda S, Mizutani H, Miyasato H, Niimura M. Natural history of nevus of Ota.  Arch Dermatol. 1967;  95 187-195
• 94 Suh D H, Hwang J H, Lee H S, Youn J I, Kim P M. Clinical features of Ota's naevus in Koreans and its treatment with Q-switched alexandrite laser.  Clin Exp Dermatol. 2000;  25 269-273