Speckled Lentiginous Nevus Workup

  • Author: Rossitza Lazova, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 17, 2011
 

Procedures

  • Biopsy is necessary to rule out cytologic atypia, which may develop in a speckled lentiginous nevus.
  • Electron microscopic studies show melanosomes that are fully melanized and a few premelanosomes in junctional melanocytes.
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Histologic Findings

Increased pigmentation in the basal layer of the epidermis and lentiginous epidermal hyperplasia are present in the background macule or patch of hyperpigmentation; these findings are similar to those of lentigo simplex.

Prominent basal layer pigmentation similar to thatProminent basal layer pigmentation similar to that seen in lentigo simplex (hematoxylin-eosin stain, original magnification X200).

The number of melanocytes in these areas may be increased. Small nests of melanocytes are occasionally seen, and these are sometimes referred to as nevus incipiens.

Elongated rete ridges and lentiginous proliferatioElongated rete ridges and lentiginous proliferation of melanocytes at the dermal-epidermal junction (hematoxylin-eosin stain, original magnification X200).

Biopsy samples of the speckled regions show variable findings, including junctional lentiginous nevi (see Media file 5), compound and intradermal nevi (see Media file 6), as well as compound or intradermal nevi with congenital features.

Junctional melanocytic nevus composed of small nesJunctional melanocytic nevus composed of small nests of melanocytes and lentiginous melanocytic proliferation at the dermal-epidermal junction (hematoxylin-eosin stain, original magnification X100). Compound melanocytic nevus with nests of uniform mCompound melanocytic nevus with nests of uniform melanocytes in the epidermis and the dermis (hematoxylin-eosin stain, original magnification X200).

Spitz nevi, blue nevi, and nevi with cytologic atypia (ie, dysplastic nevi) can also be seen. Collections of dermal melanophages without an inflammatory infiltrate are sometimes present.

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Contributor Information and Disclosures
Author

Rossitza Lazova, MD  Associate Professor of Dermatology and Pathology, Director of Dermatopathology Residency and Fellowship Program, Yale University School of Medicine; Consulting Pathologist/Dermatopathologist, Veterans Affairs Medical Center, West Haven, Connecticut

Rossitza Lazova, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and International Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Pelle, MD  Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California at San Diego

Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

Acknowledgments

The author would like to thank Dr. Jean Bolognia for generously providing the clinical photos.

References

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A large unilateral speckled lentiginous nevus that contains numerous small dark macules.
Extensive speckled lentiginous nevus.
Prominent basal layer pigmentation similar to that seen in lentigo simplex (hematoxylin-eosin stain, original magnification X200).
Elongated rete ridges and lentiginous proliferation of melanocytes at the dermal-epidermal junction (hematoxylin-eosin stain, original magnification X200).
Junctional melanocytic nevus composed of small nests of melanocytes and lentiginous melanocytic proliferation at the dermal-epidermal junction (hematoxylin-eosin stain, original magnification X100).
Compound melanocytic nevus with nests of uniform melanocytes in the epidermis and the dermis (hematoxylin-eosin stain, original magnification X200).
 
 
 
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