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