Medical Care

Photography and observation are the best clinical approaches for assessing the development of atypical features or the transformation to cutaneous melanoma.

Speckled lentiginous nevi are evaluated and treated with the same level of concern as would be warranted for congenital nevi of similar size. Atypical lesions should be examined with biopsy and histologic evaluation.

Surgical Care

Surgical removal is a therapeutic option for some patients. The entire area of hyperpigmentation must be excised to prevent recurrence because speckled lentiginous nevus represents a "field defect," ie, a defect in the melanoblasts that populate a localized area of the skin. Large scars can result.^[21]

The Q-switched ruby or Q-switched Nd:YAG lasers have been used to treat both the background hyperpigmentation and the speckles of speckled lentiginous nevi. Results have not been promising from a cosmetic standpoint. Laser treatment of melanocytic nevi, including speckled lentiginous nevi, remains controversial.

Consultations

Consult a dermatologist when diagnostic and/or therapeutic uncertainty exists regarding melanocytic neoplasms in general and speckled lentiginous nevus specifically.

Schaffer JV, Orlow SJ, Lazova R, Bolognia JL. Speckled lentiginous nevus: within the spectrum of congenital melanocytic nevi. Arch Dermatol. 2001 Feb. 137(2):172-8. [Medline].
Torrelo A, de Prada I, Zambrano A, Happle R. Extensive speckled lentiginous nevus associated with giant congenital melanocytic nevus: an unusual example of twin spotting?. Eur J Dermatol. 2003 Nov-Dec. 13(6):534-6. [Medline].
Jeong NJ, Park SB, Lee Y, Seo YJ, Lee JH, Im M. Congenital melanocytic nevus admixed with speckled lentiginous nevus. Indian J Dermatol. 2013 Mar. 58(2):161. [Medline]. [Full Text].
Altman DA, Banse L. Zosteriform speckled lentiginous nevus. J Am Acad Dermatol. 1992 Jul. 27(1):106-8. [Medline].
Chen W, Fan PC, Happle R. Partial unilateral lentiginosis with ipsilateral Lisch nodules and axillary freckling. Dermatology. 2004. 209(4):321-4. [Medline].
Liu X, Zhao Z, Xu Q, Cai L, Zhang J. Speckled lentiginous nevus syndrome associated with an abnormality of tongue. J Dermatol. 2015 Apr. 42 (4):433-4. [Medline].
Mendiratta V, Jabeen M, Barara M, Varshney M. Speckled lentiginous nevus syndrome with median nerve paresis: A rare syndrome with a new association. Indian Dermatol Online J. 2013 Jul. 4 (3):234-5. [Medline].
Boente Mdel C, Asial RA, Happle R. Phacomatosis pigmentokeratotica: a follow-up report documenting additional cutaneous and extracutaneous anomalies. Pediatr Dermatol. 2008 Jan-Feb. 25(1):76-80. [Medline].
Happle R. Dohi Memorial Lecture. New aspects of cutaneous mosaicism. J Dermatol. 2002 Nov. 29(11):681-92. [Medline].
Happle R. Speckled lentiginous naevus: which of the two disorders do you mean?. Clin Exp Dermatol. 2009 Mar. 34(2):133-5. [Medline].
Happle R. Speckled lentiginous nevus syndrome: delineation of a new distinct neurocutaneous phenotype. Eur J Dermatol. 2002 Mar-Apr. 12(2):133-5. [Medline].
Jordaan HF, Happle R. Phacomatosis spilorosea associated with lymphoedema. Br J Dermatol. 2008 Aug. 159(2):489-91. [Medline].
Kopf AW, Levine LJ, Rigel DS, Friedman RJ, Levenstein M. Prevalence of congenital-nevus-like nevi, nevi spili, and cafe au lait spots. Arch Dermatol. 1985 Jun. 121(6):766-9. [Medline].
Borrego L, Hernandez Santana J, Baez O, Hernandez Hernandez B. Naevus spilus as a precursor of cutaneous melanoma: report of a case and literature review. Clin Exp Dermatol. 1994 Nov. 19(6):515-7. [Medline].
Brufau C, Moran M, Armijo M. [Nevus on nevus. Apropos of 7 case reports, 3 of them associated with other dysplasias, and 1 with an invasive malignant melanoma]. Ann Dermatol Venereol. 1986. 113(5):409-18. [Medline].
Martinez-Menchon T, Mahiques Santos L, Vilata Corell JJ, Febrer Bosch I, Fortea Baixauli JM. Phacomatosis pigmentokeratotica: a 20-year follow-up with malignant degeneration of both nevus components. Pediatr Dermatol. 2005 Jan-Feb. 22(1):44-7. [Medline].
Rhodes AR, Mihm MC Jr. Origin of cutaneous melanoma in a congenital dysplastic nevus spilus. Arch Dermatol. 1990 Apr. 126(4):500-5. [Medline].
Vaidya DC, Schwartz RA, Janniger CK. Nevus spilus. Cutis. 2007 Dec. 80(6):465-8. [Medline].
Gescheidt-Shoshany H, Weltfriend S, Bergman R. Nodular Melanoma Arising in a Large Segmental Speckled Lentiginous Nevus. Am J Dermatopathol. 2015 Aug. 37 (8):663-4. [Medline].
Torres KG, Carle L, Royer M. Nevus Spilus (Speckled Lentiginous Nevus) in the Oral Cavity: Report of a Case and Review of the Literature. Am J Dermatopathol. 2017 Jan. 39 (1):e8-e12. [Medline].
Casanova D, Bardot J, Aubert JP, Andrac L, Magalon G. Management of nevus spilus. Pediatr Dermatol. 1996 May-Jun. 13(3):233-8. [Medline].
Bolognia JL. Speckled lentigenous nevus (nevus spilus). Nordlund JJ, Boissy RE, Hearing VJ, et al, eds. The Pigmentary System. London, England: Blackwell Science; 1998. 958-66.

Media Gallery

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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Speckled Lentiginous Nevus Treatment & Management

Medical Care

Surgical Care

Consultations

References

Tables

Contributor Information and Disclosures

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