By Gary M. White, MD
The nevus spilus (NS) is a cafe-au-lait macule with multiple darker pigmented macules scattered within.
The term nevus spilus refers to a pigmented patch that has a light background and multiple, darker pigmented papules or macules within. Larger lesions have been called speckled lentiginous nevus.
Very rarely, vitiligo has been reported in a “halo” configuration in the surrounding normal skin and as trichrome vitiligo “within” the congenital segmental speckled lentiginous nevus on face in a 9-year-old girl [Indian J Dermatol Venereol Leprol 2017;83:612-4].
The development of a melanoma within a nevus spilus is a rare event. One review of 25 cases found a mean age of 49 years at melanoma diagnosis. Only 12% (3/25) of the NS were < 4 cm. The following criteria associated with increased risk of developing melanoma [Ann Dermatol Venereol 2006;133:323-8]:
Referenced here [JAAD June 2011 Volume 64, Issue 6, Pages 1190–1193] is a report of melanoma arising within large segmental lentiginous nevi. Four women (mean age, 48 years; range, 38-52 years) with 7 primary melanomas (1-3 per patient). Two patients (cases 2 and 3) reported overall darkening and proliferation of pigmented lesions within the SLN in response to sun exposure. Melanomas arose only on sun-exposed SLN sites.
No treatment is usually needed. If small enough, surgical excision may be done. The patient should monitor for any change and seek help if such occurs. Any significant change in pigmentation should prompt a biopsy.
Giant Speckled Lentiginous Nevus (courtesy Michael O. Murphy, MD)
Is there background pigment? If yes, then it is a nevus spilus. If not, and the macules are lentigines, then the lesion is agminated lentiginosis. If nevi, then agminated nevi.
A tiny nevus spilus.
A nevus spilus and a cafe au lait spot.
A nevus growing within a nevus spilus.
This article reviews melanomas developing in nevus spill and has a good color photograph of one. REVISTA DERMATOLOGIA ARGENTINA 2015;21;174
This article presents several women in whom melanoma developed in large, speckled, lentiginous nevi. JAAD June 2011 Volume 64, Issue 6, Pages 1190–1193
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