Large speckled lentiginous naevus superimposed with Spitz naevi: sequential digital dermoscopy may lead to unnecessary excisions triggered by dynamic changes

Abstract

We report a 14-year-old girl with a large speckled lentiginous naevus (SLN) on her left arm and shoulder. As the occurrence of melanoma within SLN has been described previously, long-term follow-up of atypical lesions by digital dermoscopy was started at the age of 4 years. To date, nine Spitz naevi and four dysplastic compound naevi have been excised due to dynamic changes over time. No melanoma has so far been detected. We critically discuss the possibility of an 'overtreatment' because of a high rate of physiological changes within SLN of children. In conclusion, we would like to encourage a close follow-up of large SLN whenever complete excision is not an option. In order to avoid unnecessary excisions triggered by subtle dynamic changes, a standard approach with overview images, conventional dermoscopy and early excision of lesions that are rated as suspicious for melanoma by established algorithms may be recommended.