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Physicians recognize the implied danger of the facial hemangioma. Solomon recently emphasized the epidermal nevus syndrome. Linear epidermal nevi, linear scleroderma, and other linear skin lesions warn of possible growth defects. Implications of the hyperpigmented macule have not been well advertised. These two articles approach the problem from different lesions but include most of the diagnostic possibilities. The spectrum of the large hyperpigmented macule extends from a harmless cosmetic defect to the first sign of a disabling syndrome of malformation, Albright's syndrome, or the growth of benign and rarely malignant tumors, neurofibromatosis.
Recognition of the danger does not produce completely accurate prognostication. Combined clinical and microscopic evaluation is desirable. An adequate tissue specimen is necessary for evaluation of pigmented lesions. The 4-mm punch biopsy specimen is a minimum and variegated lesions should have specimens removed from each color.
The nevus cell nevus and the Becker nevus can usually be diagnosed
Becker SW. The Large Melanotic Macule. Arch Dermatol. 1970;102(4):353. doi:10.1001/archderm.1970.04000100001001