Plantar Pigmented Lesion: Should This Be Excised?
Article Outline
A 7-year-old boy had a pigmented lesion on the right sole. The lesion, which was neither tender nor pruritic, was present at birth and increased in size progressively. According to the clinical and dermoscopy image, should this lesion be excised?
No. Although, melanoma in childhood is rare, particulary before puberty,1 melanocytic nevi are important in relation with the differential diagnosis with melanoma. Acral location is the most prevalent site of melanoma in the non-Caucasian pediatric population,2 and because of the difficulty to control them, nevi at this location should be considered carefully. Dermoscopy features helps to distinguish acral nevi from acral melanoma. The parallel furrow pattern is associated with acral nevi: parallel pigmentation is observed along the skin furrows, as in our case (Figure, red arrows). The distal portions of eccrine ducts (Figure, blue arrows) are free of pigment and can be observed easily as linear white dots. In addition, brown globules can be seen regularly distributed beside of eccrine ducts. Although in a parallel ridge pattern, the bands of pigmentation are located over the ridges, and the eccrine ducts are covered by pigmentation and disappeared. This pattern corresponds to melanoma, with high sensitivity (86%) and specificity rates (99%).2 Thus, the pigmentation pattern is completely opposite between acral nevi and acral melanoma: pigmentation along furrows in acral nevus and pigmentation on ridges in acral melanoma. This simple morphological difference is very interesting to the field of pediatrics, as long as helps detect melanoma in early stages.
Figure.
A pigmented lesion on the right sole of a 7-year-old. Left, The lesion was asymptomatic. Right, The dermoscopy features show the characteristic parallelic furrow pattern with longitudinal pigmentation along the skin furrows (red arrows). The ecrine conducts (blue arrows) are free of pigmentation.
References
PII: S0022-3476(11)00776-1
doi:10.1016/j.jpeds.2011.07.047
© 2011 Mosby, Inc. All rights reserved.
