Nevus Spilus With Malignant Melanoma in a Patient With Neurofibromatosis

To the Editor.—  According to Cohen et al,¹ we regard nevi spili as congenital melanotic macules with dark maculopapular spots. The clinical follow-up of these lesions has yet to be determined, because there are only a few reports of malignant melanomas arising in nevi spili,^2,3 or so-called speckled lentiginous nevi, which we regard as a synonym.Neurofibromatosis is a systemic disease with an elevated risk for developing malignant tumors, most of them from neural crest origin. Silverman et al⁴ suggested an association between malignant melanoma and neurofibromatosis. We describe a patient with neurofibromatosis and a superficial spreading melanoma on a congenital nevus spilus.

Report of a Case.—  A 50-year-old woman presented with a clinical picture of neurofibromatosis: axillary freckling, neurofibromas, cafe-au-lait spots, and Lisch's nodules. Since birth she had had a large pigmented lesion with dark speckles on the left lower leg (Fig 1). She did not