Eccentric hyperpigmented nevus

A 27-year-old woman consulted for pigmented lesion on her back. The lesion had a darker area on the upper right quadrant.


Dermoscopy revealed a central globular pattern and a peripheral atypical reticular pattern with branched streaks.



Atypical reticular pattern (rectangle) and branched streaks (circle).

The lesion was excised and pathology revealed a compound nevus.

Atypical nevi with eccentric hyperpigmentation are atypical nevi of the utmost importance, the main differentiel diagnoses being melanomas in situ or early invasive melanomas.

Compound melanocytic nevus

15-year-old girl with an enlarging pigmented lesion on her back.


Dermoscopy revealed a central part with exophytic papillary structures and a peripheral typical reticular pattern in favor of a benign compound melanocytic nevus.



Exophytic papillary structures (blue circle) and reticular pattern (square).

Compound melanocytic nevus

A 14-year-old girl consulted for an enlarging melanocytic nevus on her back. One of her sister, aged 24, had been operated for a superficial spreading melanoma 2 years before, and she was very anxious. The lesion was larger than 6 mm and had an irregular border.


Dermoscopy revealed a central homogeneous pattern and a peripheral typical reticular pattern, and peripheral globules, but no signs for a SSM.
The lesion was removed and pathology was in favour of a compound melanocytic nevus.

Nevus spilus

A 25-year-old woman consulted for a pigmented lesion on her right arm.
The lesion was a lentiginous patch with darker brown pigmented macules in favor of a nevus spilus.
Dermoscopy revealed darker brown areas with a reticulo-globular pattern in favor of melanocytic nevi. The background was light brown and reticular.

Nevus spilus are present at birth or childhood. On histology they correspond to a lentigo with surimposed junctional or compound nevi.
Main differential diagnosis is agminated nevus which correspond to lentiginous compound melanocytic nevi without light background pigmentation.

Reference: Bragg et al. Agminated acquired melanocytic nevi of the common and dysplastic type. J Am Acad Dermatol 2005;52:67-73

Compound melanocytic nevus

A 34-year-old woman consulted for an atypical pigmented lesion on her back.
Dermoscopy revealed an atypical broadened pigment network and a structureless area without other criteria for a melanoma.
It was excised and pathology revealed a compound melanocytic nevus with a lateral junctional extension.

Acral melanocytic nevus

A 39-year-old woman (phototype V) noticed a pigmented lesion on her 5th left toe.
Dermoscopy revealed a uniform black homogeneous pattern with whitish dots (eccrine pores) and some streaks.
The lesion was excised and pathology revealed a compound melanocytic nevus.

Other cases of acral nevi:

1  2  3  4  5  6  7  8  9  10  11  

Eccentric hyperpigmented area

This pigmented lesion was asymetrically pigmented. Dermoscopy revealed a globular pattern in the center and a reticular pattern at the periphery with an eccentric hyperpigmented area (circle)
There were no dermoscopic criteria for a melanoma. We have to be very careful with this dermoscopic feature of eccentric hyperpigmented area because it is observed in atypical nevus but also in melanoma in situ and early invasive melanoma. Two attitudes could have been proposed: 3-month dermoscopic follow-up or immediate excision. In our case we choose to cut it off and pathology revealed a benign compound nevus (dermal and junctional

The wobble sign

This melanocytic nevus has a papillomatous central part with exophytic papillary structures.
When the dermoscope is pushed from site to site, we can see that the papillomatous nevus is moving: this is the wobble sign.
It is an extra sign to distinguish papillomatous dermal nevus from seborrheic keratosis which do not wobble.

Atypical congenital nevus

A 14 weeks-old child presented an atypical congenital nevus on her left arm.

Dermoscopy showed an asymetric lesion with blue white veil and irregular dots at the periphery.

The lesion was excised and pathology revealed a benign congenital compound nevus.

Atypical nevus

A 40-year-old man consulted for this atypical mole of the intermammary region, without recent changing.
Dermoscopy (x20) showed a combination of two patterns:

1-on the left: an homogenous pattern with comma vessels

2- on the right: a reticular pattern with blue white veil




The lesion was removed and pathology revealed a benign irritated compound nevus with lateral junctionnal extension