Melanoma arising in segmental nevus spilus: Detection by sequential digital dermatoscopy

Background: Nevus spilus (NS) defines a cafe-au-lait macule with superimposed maculopapular speckles. Although the cafe-au-lait macule often presents at birth, the darker pigmented speckles increase in number and size during a period of several years. The need for close follow-Lip of patients with NS is underlined by reports of several cases of cutaneous melanoma developing within Such lesions. Methods: We followed up 4 adult patients (3 male, one female; mean age 38 years) with Unilateral segmental NS of the thoracic or abdominal region. The NS was present at birth in all 4 patients. Follow-up by sequential digital dermatoscopy and digital overview images was scheduled every 6 to 12 months. Results: During surveillance (mean follow-up time, 8.1.5 years), 3 melanocytic lesions were excised. in one patient focal enlargement prompted excision of two dysplastic compound nevi. In another patient new black dots and focal peripheral hyperpign-lentation were detected by comparison with previous images. Histologic analysis confirmed the diagnosis of invasive melanoma (Breslow thickness, 0.6 mm). Limitations: This observational clinical study included a small number of patients. Sequential digital dermatoscopy of large NS in children may lead to Unnecessary excisions because of physiologic changes. Conclusion: We suggest close follow-up of patients with segmental NS whenever complete excision is not possible. In adults, follow-tip by digital dermatoscopy and excision of lesions with dynamic changes may assist in the early detection of melanoma. (J Am Acad Dermatol 2009;61:337-41.)