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