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Nevi of Ota and Ito Differential Diagnoses

  • Author: William A Berger; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 02, 2016
Contributor Information and Disclosures

William A Berger Frank H Netter, MD, School of Medicine at Quinnipiac University

William A Berger is a member of the following medical societies: American Chemical Society, American Medical Association

Disclosure: Nothing to disclose.


Justin J Finch, MD, FAAD Assistant Professor, Director of Clinical Photography, Director of the Center for Cutaneous Laser Surgery, Department of Dermatology, University of Connecticut Health Center

Justin J Finch, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Society for Pediatric Dermatology, New England Dermatological Society, Connecticut Society of Dermatology and Dermatologic Surgery, Midwest Arts in Healthcare Network, Arts & Health Alliance

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Harvey Lui, MD, FRCPC Professor and Head, Department of Dermatology and Skin Science, Vancouver General Hospital, University of British Columbia; Medical Director, The Skin Centre, Lions Laser Skin Centre and Psoriasis and Phototherapy Clinic, Vancouver General Hospital

Harvey Lui, MD, FRCPC is a member of the following medical societies: Canadian Medical Association, American Society for Photobiology, Photomedicine Society, European Academy of Dermatology and Venereology, National Psoriasis Foundation, Canadian Dermatology Association, College of Physicians and Surgeons of British Columbia, North American Hair Research Society, Canadian Dermatology Foundation, American Academy of Dermatology, American Society for Laser Medicine and Surgery

Disclosure: Received consulting fee from Astellas for review panel membership; Received consulting fee from Amgen/Wyeth for speaking and teaching; Received honoraria from LEO Pharma for speaking and teaching; Received grant/research funds from LEO Pharma for investigator; Received grant/research funds from Galderma for other.

Sungnack Lee, MD Vice President of Medical Affairs, Professor, Department of Dermatology, Ajou University School of Medicine, Korea

Sungnack Lee, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Youwen Zhou, MD, PhD, FRCPC Associate Professor, Department of Dermatology and Skin Science, University of British Columbia Faculty of Medicine; Director, Hyperhidrosis Specialty Clinic, Co-Director, Psoriasis and Phototherapy Centre, Consulting Physician, Department of Dermatology, Vancouver General Hospital; Co-Director, Vitiligo and Pigmentation Clinic, Oncologist Consultant, Skin Tumor Program, BC Cancer Agency

Youwen Zhou, MD, PhD, FRCPC is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Soodabeh Zandi, MD Fellow, Department of Dermatology and Skin Science, University of British Columbia School of Medicine

Soodabeh Zandi, MD is a member of the following medical societies: American Academy of Dermatology, Photomedicine Society, European Academy of Dermatology and Venereology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Abbvie; Celgene;LEO<br/>Serve(d) as a speaker or a member of a speakers bureau for: Abbvie;Celgene;LEO.

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Table. Clinical and Histologic Features for Differential Diagnoses of Nevi of Ota and Ito
Nevi of Ota and ItoBirth or early adolescenceBlue or gray speckled coalescing macules or patchesNevus of Ota: Unilateral, rarely bilateral, on forehead, temple, zygomatic, or periorbital areas

Nevus of Ito: Shoulder and upper arm areas

Increased dermal melanocytes, with surrounding fibrosis and melanophages
Mongolian spotBirthPoorly demarcated large blue-to-gray patches that tend to spontaneously resolve by age 3-6 yMost frequently on lumbosacral areas, buttocks, and rarely, other areasIncreased dermal melanocytes; no surrounding fibrosis
Blue nevusCongenital or acquiredBlue papules or plaquesAnywhere on skinDermal nodular proliferation of heavily pigmented spindle cells
Acquired nevus of Ota-like macules (Hori nevus)Acquired, presenting in adulthoodGray macules or patchesUsually bilateral and symmetrical; over the cheeks, temples, root of the nose, alae nasi, eyelids, and foreheadDiffuse upper-dermal melanocytosis
MelasmaAcquired; may be associated with pregnancy and other estrogen excess stagesWell-to-poorly demarcated and irregularly outlined brown-to-gray brown patchesMaxillary and zygomatic areas on faceNo increase in dermal melanocytes; presence of melanophages
Lentigo malignaAcquired; presenting usually after fifth decade of lifeBrown patches, usually with pigmentary variegationPhotodistribution, particularly within zygomaticomaxillary areasAtypical melanocytes in nests at dermal-epidermal junction, with pagetoid spread
Actinic lentigoAcquired; usually after fifth decade of lifeWell-demarcated brown papules or plaquesPhotodistribution, especially on faceElongation of rete ridges; basal layer hyperpigmentation; slight increase of melanocyte number along basal layer
PhytophotodermatitisAcquired; exposure to certain plants or cosmeticsGray-to-brown macules and patchesPhotodistribution, according to sites of contact with photosensitizerDermal melanophages
Drug-induced hyperpigmentationAcquired; following drug exposure (eg, minocycline, amiodarone, gold)Variable according to offending drugsVariable according to specific offending drugsVariable but may involve presence of dermal melanophages; pigmentation of basal keratinocytes
Exogenous ochronosis (rare)Adulthood; following topical application of hydroquinoneIrregularly shaped blue-to-gray patches or maculesAreas corresponding to exposure to hydroquinoneYellow banana-shaped spindle cells in papillary dermis
Ochronosis (alkaptonuria, rare)First decade of lifeBlue-gray discoloration of ear cartilage, tip of nose, and scleraSymmetrical distribution over cartilage, nose, cheeks, and extensor tendons of hands, as well as flexural areasYellow-to-brown pigmentary granules within dermal macrophages
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