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I read with interest the arguments presented by Barysch and Dummer1 on how to distinguish speckled lentiginous nevi from segmental lentiginosis. I agree that such criteria are important because these disorders are sometimes confused. However, I would like to make the following annotations.
Speckled lentiginous nevi can no longer be considered a single disorder. The authors are confusing 2 distinct entities: the macular type (nevus spilus maculosus [NSM]), which is completely flat and shows a fairly even distribution of speckles; and the papular type (nevus spilus papulosus [NSP]), which is characterized by papular speckles showing a far more uneven distribution reminiscent of a star map.2 In their text, Barysch and Dummer1 report a typical case of NSM, but in the Table they describe the distinguishing features of NSP and mention a possible association with “spinal muscle atrophy and other neurological disorders in the context of speckled lentiginous nevus syndrome.”1(p954) It is important to realize that this syndrome, which may also occur as a component of phacomatosis pigmentokeratotica,3 is always associated with NSP.2,4 Hence, it has nothing to do with the NSM as reported by Barysch and Dummer. On the other hand, being unaware of the dichotomy, the authors do not mention that NSM can be associated with nevus roseus, resulting in phacomatosis spilorosea.5
Happle R. Speckled Lentiginous Nevi: No Longer One Single Disorder. Arch Dermatol. 2010;146(2):204. doi:10.1001/archdermatol.2009.393