Speckled Lentiginous Nevus Workup

Updated: Apr 07, 2017
  • Author: Rossitza Lazova, MD; Chief Editor: Dirk M Elston, MD  more...
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Workup

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. See the image below.

Prominent basal layer pigmentation similar to that Prominent 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. See the image below.

Elongated rete ridges and lentiginous proliferatio Elongated 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, compound and intradermal nevi, as well as compound or intradermal nevi with congenital features.

See the images below.

Junctional melanocytic nevus composed of small nes 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 m Compound 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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