Table of Contents
Definition / general | Terminology | Epidemiology | Clinical features | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Hale CS. Lentiginous nevus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumormelanocyticlentiginousmelanocyticnevus.html. Accessed March 4th, 2021.
Definition / general
- Common type of agminate (clustered) nevus with multiple pigmented macules or papules within a pigmented patch (Cutis 2007;80:465, eMedicine: Speckled Lentiginous Nevus)
- May be congenital or acquired (Arch Dermatol 2001;137:172)
Terminology
- Also called "speckled lentiginous nevus" (see also speckled lentiginous nevus) or "nevus spilus"
- NOT related to "acral lentiginous nevus" (see acral nevi)
Epidemiology
- Speckled lentiginous nevus syndrome: hyperhidrosis, muscular weakness, dysesthesia or other neurological abnormalities
Clinical features
- Often benign mole with increase in size, formation of irregular borders or peripheral change in color
- May be due to "reactivation" of radial proliferation
- Usually 5 mm or less
- Note: atypia often present in childhood acral lesions (Pediatr Dev Pathol 1998;1:388)
Case reports
- 42 year old man with speckled lentiginous nevus on trunk (Dermatology 2004;209:228)
- 45 year old man with melanoma (Int J Dermatol 2006;45:1362)
Treatment
- Excision of speckles or entire lesion
Clinical images
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Microscopic (histologic) description
- "Shoulder" area of lentiginous junctional melanocytic proliferation beyond lateral border of underlying dermal nevus
- Elongation of rete ridges with small nests of melanocytes at tips of rete
- Individual unit melanocytes extending along sides of rete, often mild lymphohistiocytic infiltrate with pigment incontinence
- No atypia, no pagetoid spread and no dermal fibrosis
- Acral lesions: resemble dysplastic nevus due to elongation of rete ridges, continuous proliferation of melanocytes at dermoepidermal junction, single scattered melanocytes or less commonly small clusters within the upper epidermis; poor or absent lateral circumscription, melanocytes with abundant pale cytoplasm and round / oval, sometimes hyperchromatic nuclei and prominent nucleoli present at the dermoepidermal junction; however, unlike dysplastic nevi, they lack anastomosing rete ridges, cytological atypia and well-formed lamellar fibroplasia (Histopathology 1995;27:549)
- Variants:
- Macular variant: "jentigo" pattern (lentiginous pattern plus nests of melanocytes at dermal-epidermal junction) in the darker speckles and by some nests of melanocytes at the dermoepidermal junction at the tips of the papillae, but background pigmentation has microscopic features of lentigo; tan-brown background with dark flat speckles in relatively even distribution resembling polka dots; associated with phacomatosis pigmentovascularis
- Papular variant: dermal or compound melanocytic nevi; light-brown macule superimposed by multiple melanocytic nevi in the form of papules or nodules that show a more uneven distribution reminiscent of a star map; small dark macules may be present; associated with phacomatosis pigmentokeratotica or speckled lentiginous nevi syndrome (Dermatology 2006;212:53)
Microscopic (histologic) images
Differential diagnosis
- Dysplastic nevus
- Lentigines: no nests, may be nevi if examine serial sections (Am J Dermatopathol 1985;7 Suppl:5)
- Superficial spreading or lentiginous melanoma: pagetoid lateral spread, mitotic activity in deep dermis and no maturation (Mod Pathol 2005;18:1397)