Nevi requiring special consideration
- The two component pattern and the multi-component symmetric pattern are commonly encountered in patients with the atypical mole syndrome. However, if it is an outlier lesion compared with the patient’s other nevi then one should consider a biopsy or close digital monitoring to ensure stability.
- The homogeneous tan to pink nevus is a common pattern seen in nevi in individuals with type I-II skin. However, this pattern can also be seen in amelanotic and hypomelanotic melanomas. Thus, if such lesions appear to be outliers, caution should be exercised.
- The tiered peripheral globular pattern is associated with nevi having a spitzoid morphology on dermoscopy. While the management of spitzoid lesions remains controversial, if such a lesion develops in older age, then one should consider a biopsy.
- The typical starburst pattern is associated with Reed’s nevi. While this is usually a benign pattern, on rare occasions melanoma can masquerade itself as a starburst pattern lesion. Thus, a classic starburst pattern in individuals under the age of 12 can be monitored, however, such lesion in older individuals should be viewed with suspicion.