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July 2009

Using Dermoscopic Criteria and Patient-Related Factors for the Management of Pigmented Melanocytic Nevi

Author Affiliations

Author Affiliations: Division of Dermatology, Medical University of Graz, Graz, Austria (Dr Zalaudek); Third Division of Surgery (Dr Docimo) and Department of Dermatology (Dr Argenziano), Second University of Naples, Naples, Italy.

Arch Dermatol. 2009;145(7):816-826. doi:10.1001/archdermatol.2009.115

Objective  To review recent dermoscopy studies that provide new insights into the evolution of nevi and their patterns of pigmentation as they contribute to the diagnosis of nevi and the management of pigmented melanocytic nevi.

Data Sources  Data for this article were identified by searching the English and German literature by Medline and Journals@Ovid search for the period 1950 to January 2009.

Study Selection  The following relevant terms were used: dermoscopy, dermatoscopy, epiluminescence microscopy (ELM), surface microscopy, digital dermoscopy, digital dermatoscopy, digital epiluminescence microscopy, digital surface microscopy, melanocytic skin lesion, nevi, and pigmented skin lesions. There were no exclusion criteria.

Data Synthesis  The dermoscopic diagnosis of nevi relies on the following 4 criteria (each of which is characterized by 4 variables): (1) color (black, brown, gray, and blue); (2) pattern (globular, reticular, starburst, and homogeneous blue pattern); (3) pigment distribution (multifocal, central, eccentric, and uniform); and (4) special sites (face, acral areas, nail, and mucosa). In addition, the following 6 factors related to the patient might influence the pattern of pigmentation of the individual nevi: age, skin type, history of melanoma, UV exposure, pregnancy, and growth dynamics.

Conclusions  The 4 × 4 × 6 “rule” may help clinicians remember the basic dermoscopic criteria of nevi and the patient-related factors influencing their patterns. Dermoscopy is a useful technique for diagnosing melanocytic nevi, but the clinician should take additional factors into consideration to optimize the management of cases of pigmented lesions.

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