We read with interest the article by Kittler et al1 titled "Frequency and Characteristics of Enlarging Common Melanocytic Nevi" in a recent issue of the ARCHIVES. This is an important article that demonstrates that even benign melanocytic nevi change over time and show enlargement especially in younger patients. We recently published a study titled "Two Types of Pattern Modification Detected on the Follow-up of Benign Melanocytic Skin Lesions by Digitized Epiluminescence Microscopy."2 We used digital dermoscopy for the follow-up of benign melanocytic skin lesions over a 2-year period and found modifications in 69% of the lesions (mean age of patients, 29.3 years). This is a high percentage compared with the 5.3% of modifications reported by Kittler et al (mean age of their patients, 34.2 years). We agree with Kittler et al that we had a relatively high percentage of Spitz nevi in our series, but we think that this difference might as well be due to the methodological differences in the two studies. Kittler et al used computer-assisted measurement to evaluate lesion enlargement. In a second step, the lesions that showed enlargement were screened for the presence of a rim of peripheral globules. The enlargement was the only criterion for modification. In our study we measured the enlargement; however, in addition 2 physicians (R.B. being one of them) evaluated all lesions for modifications concerning the pigment network (degree of pigmentation and grid architecture), brown globules, black dots, appearance of a blue gray veil, appearance of a whitish veil, appearance of hypopigmented areas, and appearance of red-rose areas by. We agree that this might not be as objective as computer-assisted analysis, but if Kittler et al would have considered more criteria than just enlargement, they most probably would have found a much higher percentage of modification in benign pigmented lesions. In our study the modifications were of 2 types: modifications of the degree of pigmentation of the lesion, which we called type I modifications and modifications concerning the architecture of the lesions (pigment network), which we called type II modifications. Type I modifications were mainly found in compound nevi (59% of compound nevi); type II modifications were mainly found in dysplastic nevi (68% of dysplastic nevi). We observed enlargement in both groups, but the one associated with type II modifications was different from that associated with type I modifications. After a review of our data, we confirm the observation of Kittler et al that a peripheral rim of globules is a predictive sign for enlargement of benign melanocytic lesions.
Braun RP, Saurat JH. Changes Even in Benign Melanocytic Nevi. Arch Dermatol. 2001;137(2):228. doi: