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Nevus (Moles) in Children

by Brian Alverson, MD
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    00:00 So let's look at another case. "A full-term infant is born and you notice a light brown pigmented macule on his arm. His mother is worried about this spot but another physician assured mom that there is nothing to worry about." What do you think this is? It's probably a nevus. So let's go through nevi. There are many different types of nevi and I want to go through the basic types. The first is congenital nevomelanocytic nevi. So these are present at birth. They often may have an associated hair or something else growing on them and they do have some malignant potential so we want to keep an eye on this. Generally, what we recommend is an annual exam by a dermatologist. In children with a lot of this, they may take digital maps of patients' bodies and compare their exams every year. Another type of nevus is an acquired nevomelanocytic nevi. So these are circular lesions, they are macular, they are not raised and they're mid dark to brown and reasonably well circumscribed. This is called a junctional; however, sometimes they are compound and intradermal. The compound ones have an intradermal extension, they go deeper down. They can form nodules, generally are less than 1 cm and they're often hairy and they have smooth cerebriform or hyperkeratotic appearance. Next let's look at melanomas.

    01:42 Melanomas obviously have malignant potential. We don't see them that commonly in children, it's more common in adults but we can see them in children who have a lot of sun exposure or adolescents who use tanning beds. They may occur in isolation or within a giant congenital nevus. So we have to keep an eye on those nevi to make sure they don't become melanomas.

    02:07 Generally, these are dysplastic nevi and they are direct precursors. Multiple lesions are a marker for increased risk. So when we see a lesion and we're concerned about whether it's melanoma, there's an easy way to remember whether this is a concerning melanoma, which is A, B, C, D, E.

    02:29 We use A as the appearance. Generally, if any lesion is changing rapidly in appearance or shape or outline, that's a concern. Next is borders. Melanomas tend to have irregular borders. They are not perfectly round and circumscribed as much. Next is color and in particular a change in color of a lesion or a mixture of different colors is concerning. You can see that here. It's got both some black and some red. Next is discomfort. If these lesions are burning, itching, or tender they may be invading deeper and getting into some nerves and that's a sign that this may be a melanoma. Last is elevation. If there's any change in a surface elevation of one of these nevi, maybe it's not a nevus, maybe it's now a melanoma. Okay, let's move on to the blue nevus. The blue nevus is acquired, it comes a little bit later and completely benign. They are small, dark blue or black little papules. You can see some examples here on this patient's ear.

    03:37 Next is the halo nevus. The halo nevus is usually benign. We call the halo nevus. As you can see around the nevus there's a little pale area, almost like a little halo. Generally, this is a nevus that gradually become surrounded by this depigmented area. This is usually not concerning.

    04:01 Next is nevus spilus. These are benign. They're generally a brown macule with lots of small dark brown to black macules or papules and a little collection. They look like a patch of dark freckles like you can see here and they appear on the torso and the extremities. Again, these are benign.

    04:25 The Spitz nevus is another type of nevus we should know about. The Spitz nevus is also benign.

    04:31 It's sort of red and dome-shaped like you can see in this picture. Generally, it's a fascicular growth. It's quite common in children and it may be confused with having angioma but these are benign as well. Next, freckles or ephelides but let's call them freckles because that's what everyone calls them. So these are light brown macules that occur most often on sun-exposed skin, they are certainly as a genetic determination. This is the most common pigmented lesion of childhood in lightly pigmented individuals and generally they become more hyperpigmented upon sun exposure from an increased melanin in the basal keratinocytes. Here are patients with freckles. These are benign. Lastly, let's cover nevus sebaceous of Jadassohn. This is an unusual lesion but we see it off that does have some malignant potential, although we're coming away from mandatory excision and now people are sometimes choosing to watch them. They are hairless and they are generally a skin-colored plaque, almost rubbery in nature. They often appear on the scalp or the face or the neck. So that's nevus sebaceous of Jadassohn. So that's a a brief summary of Hemangiomas and Nevi in Children. Thanks for your time.


    About the Lecture

    The lecture Nevus (Moles) in Children by Brian Alverson, MD is from the course Pediatric Dermatology.


    Included Quiz Questions

    1. Change in surface elevation
    2. Stability of outline
    3. Regular even border
    4. Monochromic lesion
    5. Asymptomatic lesions
    1. Junctional nevi are circular, macular and mid dark brown in nature.
    2. Junctional nevi are raised lesions.
    3. Compound nevi are > 1cm in diameter.
    4. Compound nevi are never hairy.
    5. Compound nevi are macular, circular in nature.
    1. Nevus spillus.
    2. Spider angioma.
    3. Spitz nevus.
    4. Cavernous hemangioma.
    5. Melanoma.
    1. These never change in size.
    2. Asymmetrical lesion.
    3. Irregular border.
    4. Mixture of colour.
    5. Diameter > 6mm.

    Author of lecture Nevus (Moles) in Children

     Brian Alverson, MD

    Brian Alverson, MD


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