1 Considering that eccentric foci of hyperpigmentation can also be found in combined nevi, Clark nevi, 3, 4 and in other types of nevi, we suggest that the name “Bolognia sign” can be given to eccentric foci of hyperpigmentation within nevi. About 3% of the small dark dots represent a focus of melanoma within a preexisting nevus. Another cause for the small dark dots is the increase of melanophages and/or increase of melanin in melanocytes in the papillary dermis and the upper reticular dermis.
#Bolognia Dermatology Free Pdf series
1 Histopathologically, the eccentric focal hyperpigmentation is due in most cases (nearly 70% of the cases in the original series of Bolognia et al 1) to an increase in the melanin content of the epidermal melanocytes and/or keratinocytes, which usually involves an increased number of superficial dermal melanophages. 2 Clinically, eccentric small dark dots appear as roundish areas of brown to black hyperpigmentation 3 mm or smaller localized peripherally a few also have a slightly blue-gray hue. The rationale for this assumption is that eccentric peripheral hyperpigmentation has also often been found in melanoma. Melanocytic nevi with eccentric foci of hyperpigmentation, described in 1994 by Bolognia et al 1 as “small dark dots,” can be considered as a melanoma-simulating type of acquired melanocytic nevus. Conversely, in adults, when dermoscopic follow-up of melanocytic nevi reveals eccentric foci of hyperpigmentation, surgical excision of the lesion is indicated. The histopathologic diagnoses of 2 lesions were consistent with a compound type of acquired melanocytic nevus with eccentric foci of hyperpigmentation.Ĭonclusions Dermoscopy allows identification of a morphologic pathway of modifications, probably typical for this type of melanocytic nevus in children, and therefore enables avoidance of surgical excision with attendant hypertrophic scarring in children. A nearly identical situation was observed in 5 other melanocytic nevi, underlining the involution of the pigmented foci in these nevi. After 39 months, a globular type of acquired melanocytic nevus was detectable, which clinically and dermoscopically appeared to be completely benign. The eccentric focus of the hyperpigmentation corresponded dermoscopically to a blue-gray area of pigmentation associated with irregular brown-black globules or dots and partially with a superficial black network.
Observations A 5-year-old girl had a 4-mm brown papule with a peripheral blue-black area on her right upper arm. We report on the morphologic changes of this type of melanocytic nevus over a 39-month period of dermoscopic follow-up.
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