Dysplastic Pointillist Nevus

OBSERVATION Dysplastic Pointillist Nevus

David Moreno-Ramirez, MD; Lara Ferrandiz, MD; Juan J. Rios-Martin, MD; Francisco M. Camacho, MD

Background: Three cases of pointillist nevus, which is globules on a reddish skin-colored background, and his- a distinctive clinical type of benign melanocytic nevus tologic examination demonstrated architectural disor- with variegated pigment, have been described in the lit- der with cytologic atypia. erature to date. Conclusion: To the best of our knowledge, we report a Observations: A 24-year-old man presented with an case of dysplastic pointillist nevus. acquired melanocytic lesion composed of multiple tiny pigmented dots. Dermoscopy revealed multiple brown Arch Dermatol. 2005;141:763-764

N 2001, HUYNH ET AL1 DE- brown pigmented spots with remnants of scribed 3 cases involving a dis- pigment network, globules, and dots were tinctive clinical type of “benign” observed on a remarkable erythematous melanocytic nevus with varie- background. No branched telangiec- gated pigment, which they called tasias were demonstrated, and normal- theI pointillist nevus, a clear reference to appearing skin without dermoscopic struc- the pointillist style of painting. The 3 cases tures could be seen between the brown were characterized by a pigmented lesion spots (Figure 1). The lesion was com- composed entirely of tiny, dark-brown to pletely excised, and histologic analysis was black dots on a skin-colored back- performed. The brown blotches with rem- ground, which had the appearance of nant network that were seen on dermos- “brown globules”on dermoscopy. How- copy correlated to areas of lentiginous hy- ever, despite the variegation of color and perplasia, bridging of the rete ridges, the irregular borders of the lesions, the au- fibroplasia, and cytologic atypia (Figure 2), thors concluded, on the basis of a banal all of which were particularly demon- histologic description, that this clinical pre- strated in the histologic section from the sentation involved an unusual pattern of area of confluence of the pigmented spots. a benign melanocytic lesion.1 To date, no The erythematous background was asso- other cases with this uncommon presen- ciated with ectasia of the vessels at the tation have been reported, to our knowl- middle and upper dermis. There was no evi- edge; therefore, little is known about the dence of histologic regression or an inflam- potential behavior of this lesion. matory infiltrate.

REPORT OF A CASE COMMENT

A 24-year old man presented with a 3-year In the pointillist nevus, nests of melano- history of a lesion on his upper back area. cytes or melanophages become clinically He had no history of malignant melanoma apparent as a result of the minimal Author Affiliations: or dysplastic nevus. He did not mention any amount of pigment in the rest of the Departments of Dermatology local symptoms or trauma. Clinical exami- lesion, giving rise both to the brown (Drs Moreno-Ramirez, nation revealed a 6.0-mm-diameter mela- globules observed under the dermoscope Ferrandiz, and Camacho) and nocytic lesion composed of multiple tiny and to the clinically distinctive appear- Pathology (Dr Rios-Martin), 1 Pigmented Lesion and brown dots grouped on a reddish skin- ance. In contrast to the present case, Teledermatology Clinic, colored background. The brown dots were however, no architectural disorder or University Hospital Virgen similar in size (0.2-0.5 mm), symmetrical, cytologic atypia was observed in the 3 Macarena, Seville, Spain. and uniformly pigmented, with diffuse bor- cases described by Huynh et al,1 who Financial Disclosure: None. ders (Figure 1, inset). On dermoscopy, came to the conclusion that the pointil-

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©2005 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 Figure 1. Multiple brown spots with remnants of dermoscopic pigment Figure 2. Architectural disorder, with lentiginous hyperplasia, bridging, and network, globules, and dots on an erythematous background. Areas of fibroplasia, along with cytologic atypia, was observed in the biopsy specimen normal-appearing skin between the pigmented areas were a remarkable from the area with irregular distribution of the pigmented areas (inset with finding. Inset, Clinical presentation of the dysplastic pointillist nevus with asterisk). multiple brown dots on an erythematous background.

list nevus is a benign form of the melanocytic nevus. Accepted for Publication: January 14, 2005. Our patient’s nevus showed a reddish hue, which has Correspondence: David Moreno-Ramirez, MD, Depart- also been accepted as a clinical criterion for the diagno- ment of Dermatology, Pigmented Lesion and Teleder- sis of clinically atypical nevus.2,3 This clinical and dermatology Clinic, University Hospital Virgen Macarena, moscopic finding, along with the variegation of color Avenida Dr Fedriani S/N, 41073 Seville, Spain (dmoreno and the irregular borders of the entire lesion, were suffi- @e-derma.org). cient to consider the lesion a clinically atypical nevus, a diagnosis that was later histologically confirmed. REFERENCES To the best of our knowledge, we report a case of dysplastic pointillist nevus. In addition to the 3 cases al- 1. Huynh PM, Glusac EJ, Bolognia JL. Pointillist nevi. J Am Acad Dermatol. 2001;45: ready published, the present case offers a new approach 397-400. 2. Kelly JW, Crutcher WA, Sagebiel RW. Clinical diagnosis of dysplastic melano- to the management of this type of nevus. However, more cytic nevi. J Am Acad Dermatol. 1986;14:1044-1052. cases are needed to determine the potential of these clini- 3. Tucker MA, Halpern A, Holly EA, et al. Clinically recognized dysplastic nevi: a cen- cally unusual moles. tral risk factor for cutaneous melanoma. JAMA. 1997;277:1439-1444.

Correction

Notice of Duplicate Publication of Figures. In the article titled “Successful Treatment of Invasive Squamous Cell Car- cinoma Using Topical Imiquimod” by Hengge and Schaller, published in the April 2004 issue of the ARCHIVES (2004; 140:404-406), Figure 1 and Figure 2 are the same figures as those previously published in an article by Eklind et al1 that appeared in Dermatologic Surgery. The authors were alerted to the duplicate publication of the figures. They responded that this was an un- intentional oversight produced by the availability of elec- tronic images to multiple people in an institution. The ARCHIVES has since obtained permission from the edi- tor of Dermatologic Surgery to reprint the 2 figures.

1. Eklind J, Tartler U, Maschke J, Lidbrink P, Hengge UR. Imiquimod to treat different cancers of the epidermis. Dermatol Surg. 2003; 29:890-896.

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