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Hori nevus, also known as acquired bilateral nevus of Ota-like macules, is a form of dermal melanocytosis found most commonly in women of East Asian heritage. It presents as discrete brown macules on the bilateral cheeks which later coalesce into confluent grey-brown macules and small patches. Herein, we report a classic case of Hori nevus and discuss the histologic findings and differential diagnosis. We also review the proposed pathophysiology, genetic considerations, and treatment options.

Purpose: To evaluate choroidal nevus demographics, clinical features, imaging features, and the rate of transformation into melanoma by race., Methods: in This Observational Case Series,: There were 3334 participants (3806 choroidal nevi) at a single tertiary-referral center evaluated between January 2, 2007, and August 7, 2017. Retrospective chart and multimodal imaging review was performed. Patient demographics, tumor features, and outcomes were compared between different races using Chi-squared test, Fisher's exact test, t-test, and analysis of variance. The main outcome measure was clinical features of choroidal nevus and the rate of transformation into melanoma by race., Results: Of the 3334 patients, there were Caucasian (n = 3167, 95%) and non-Caucasian (n = 167, 5%). The non-Caucasian races included African-American (n = 27, <1%), Hispanic (n = 38, <1%), Asian (n = 15, <1%), Asian Indian (n = 2, <1%), Middle Eastern (n = 4, <1%), and unknown (n = 83, 3%). By comparison (Caucasian versus vs. non-Caucasian), there were differences in the mean age at presentation (61 vs. 56 years,P < 0.0001), female sex (63% vs. 52%,P < 0.01), dysplastic nevus syndrome (<1% vs. 1%,P < 0.01), and previous cutaneous melanoma (5% vs. 1%,P= 0.03). A comparison of tumor features revealed differences in presence of symptoms (12% vs. 20%,P < 0.01) and ≥3 nevi per eye (3% vs. <1%,P= 0.04). A comparison of imaging features showed no differences. A comparison of outcome of nevus transformation into melanoma revealed no difference (2% vs. 3%,P= 0.29). However, of those nevi exhibiting growth to melanoma, ultrasonographic hollowness was less frequent in Caucasians (29% vs. 67%,P= 0.04)., Conclusion: In this analysis of 3334 patients with choroidal nevus, we found differences in the mean age of presentation, sex, dysplastic nevus syndrome, previous cutaneous melanoma, presence of symptoms, and multiplicity of nevus per eye by race. However, there was no difference in the rate of transformation into melanoma by race., Competing Interests: None

Background: People at high risk of developing melanoma are usually identified by pigmentary and naevus phenotypes., Objective: We examined whether associations of these phenotypes with melanoma risk differed by ambient sun exposure or participant characteristics in two population-based, case-control studies with comparable ancestry but different ambient sun exposure., Methods: Data were analysed from 616 cases and 496 controls from the Australian Melanoma Family Study and 2012 cases and 504 controls from the Leeds (UK) case-control study. Questionnaire, interview and dermatological skin examination data were collected using the same measurement protocols. Relative risks were estimated as odds ratios using unconditional logistic regression, adjusted for potential confounders., Results: Hair and skin colour were the strongest pigmentary phenotype risk factors. All associations of pigmentary phenotype with melanoma risk were similar across countries. The median number of clinically assessed naevi was approximately three times higher in Australia than Leeds, but the relative risks for melanoma associated with each additional common or dysplastic naevus were higher for Leeds than Australia, especially for naevi on the upper and lower limbs. Higher naevus counts on the head and neck were associated with a stronger relative risk for melanoma for women than men. The two countries had similar relative risks for melanoma based on self-reported naevus density categories, but personal perceptions of naevus number differed by country. There was no consistent evidence of interactions between phenotypes on risk., Conclusions: Classifying people at high risk of melanoma based on their number of naevi should ideally take into account their country of residence, type of counts (clinical or self-reported), body site on which the naevus counts are measured and sex. The presence of naevi may be a stronger indicator of a genetic predisposition in the UK than in Australia based on less opportunity for sun exposure to influence naevus development., (© 2019 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Acral lentiginous melanoma (ALM) is a rare but aggressive subtype of melanoma often associated with poor prognosis. Although overall incidence is rare, ALM accounts for a larger proportion of melanomas among black, Asian, and Hispanic individuals than among white individuals. Similarly, the proportion of acral melanocytic nevi tends to be greater in ethnic skin despite a lower overall nevi count. Dermoscopy can help differentiate between benign and malignant acral melanocytic lesions. Herein, we discuss the population trends of acral melanocytic lesions in patients with skin of color. We also examine the diagnostic challenges of acral lesions and review the dermoscopic patterns unique to acral volar skin.

Background: A variety of local and systemic processes caused exogenous and endogenous pigmentation of the oral mucosa. Solitary melanotic pigmentation is rare, hence the scarce number of studies in children and adolescents., Methods: Clinical and histopathologic features of 10 Latin American children with solitary pigmented lesions of the oral mucosa were reviewed., Results: The area most affected was the gingiva, followed by the palate. All lesions were flat and <1 cm in diameter. A brown color was observed in oral melanocytic macules and nevi. The exogenously pigmented lesion was bluish gray. Histopathology showed that the biopsied lesions corresponded to melanotic macules, junctional nevus, blue nevus, and exogenous pigmentation., Conclusion: Solitary pigmented lesions on the oral mucosa of children, from melanin pigment or exogenous pigment, may have a similar clinical presentation, but melanotic lesions such as oral melanotic macules and nevi can be differentiated from one another only with histopathologic examination., (© 2018 Wiley Periodicals, Inc.)

Background: Acral lentiginous melanoma has increased mortality compared with other melanoma subtypes and disproportionately affects ethnic minorities. Acral melanocytic lesions have not been well studied in diverse populations of the United States., Objective: We sought to assess the prevalence, awareness, and dermoscopic patterns of acral melanocytic lesions in skin-of-color and non-Hispanic white patients., Methods: We prospectively examined the palms and soles of 1052 patients presenting to dermatology clinics in New York, NY, and Miami, FL, from October 2013 to April 2015., Results: Acral melanocytic lesions were observed in 36% of our cohort. Skin-of-color patients were more likely to have acral melanocytic lesions than non-Hispanic white patients (P < .01). Acral melanocytic lesions correlated with increased mole counts, particularly on non-Hispanic white patients. The majority of lesions demonstrated benign dermoscopic patterns. We observed 2 lesions with the parallel ridge pattern in our cohort, both found to be atypical nevi on biopsy specimen. Patients often lacked awareness of the presence of their lesions., Limitations: Interobserver variability in assessing dermoscopic patterns is a limitation., Conclusions: Melanocytic lesions of the palms and soles are common, particularly in a cohort of multiple ethnicities from the United States. Dermoscopy of acral lesions is an important clinical tool for diagnosis and management of these lesions., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Junctional (flat) naevi predominate on the extremities, whereas dermal (raised) naevi are found primarily on the head, neck and trunk. Few studies have investigated the anatomical site prevalence of melanocytic naevi categorized using dermoscopy., Objectives: To identify the prevalence of dermoscopic patterns and structures of naevi from the back and legs of adolescents., Methods: Dermoscopic images of acquired melanocytic naevi were obtained from the back and legs of students from a population-based cohort in Framingham, Massachusetts. Naevi were classified into reticular, globular, homogeneous or complex dermoscopic patterns. Multinomial logistic regression modelling assessed the associations between dermoscopic pattern and anatomical location., Results: In total 509 participants (mean age 14 years) contributed 2320 back naevi and 637 leg naevi. Compared with homogeneous naevi, globular and complex naevi were more commonly observed on the back than the legs [odds ratio (OR) 29·39, 95% confidence interval (CI) 9·53-90·65, P < 0·001 and OR 6·8, 95% CI 2·7-17·14, P < 0·001, respectively], whereas reticular lesions were less likely to be observed on the back than on the legs (OR 0·67, 95% CI 0·54-0·84, P = 0·001). Naevi containing any globules were more prevalent on the back than on the legs (25% vs. 3·6%, P < 0·001). Naevi containing any network were more prevalent on the legs than on the back (56% vs. 40·6%, P < 0·001)., Conclusions: These findings add to a robust body of literature suggesting that dermoscopically defined globular and reticular naevi represent biologically distinct naevus subsets that differ in histopathological growth pattern, age- and anatomical-site-related prevalence, molecular phenotype and aetiological pathways., (© 2015 British Association of Dermatologists.)

Purpose: To describe the prevalence of choroidal nevus in the US population and identify possible associated factors., Design: Cross-sectional study., Participants: A total of 5575 participants aged ≥40 years from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) who underwent retinal imaging examination., Methods: Predictor variables included a spectrum of demographic, ophthalmic, dermatologic, systemic, socioeconomic, or occupational factor variables available in NHANES., Main Outcome Measures: Choroidal nevus on retinal imaging., Results: The prevalence of choroidal nevus was 4.7% overall and increased with age (4.7%, 3.1%, 5.4%, 6.6%, and 7.5% in subjects aged 40-49, 50-59, 60-69, 70-79, and ≥80 years, respectively). The prevalence was 5.0% in men, 4.4% in women, 5.6% in whites, 2.7% in Hispanics, 0.6% in blacks, and 2.1% in others. After adjusting for age and race, the odds of choroidal nevus were 10-fold higher in whites than in blacks, 5-fold higher in Hispanics than in blacks, 4-fold higher in others than in blacks, and 2-fold higher in whites than in Hispanics. Choroidal nevus was associated with hypertension (odds ratio [OR], 1.40; 95% confidence interval [CI], 0.99-1.98); psoriasis (OR, 3.90; 95% CI, 1.57-9.66); lower high-density lipoprotein (OR, 0.99; 95% CI, 0.98-0.99); higher uric acid (OR, 1.13; 95% CI, 1.04-1.22); working in installation, maintenance, or repairs (OR, 1.42; 95% CI, 1.03-1.96); and having never worked (OR, 1.56; 95% CI, 1.03-2.37; P = 0.04). There was no association with visual symptoms, visual functioning, visual acuity, refractive error, visual field, diabetic retinopathy, age-related macular degeneration, or elevated cup-to-disc ratio on retinal imaging. There was no association with skin melanoma, other cancers, lung/liver/kidney/thyroid disease, alcohol/drug use, income/education, hemoglobin A1C, C-reactive protein, lactate dehydrogenase, electrolytes, or urine albumin., Conclusions: Among US adults, the prevalence of choroidal nevus located within two 45° areas centered on the macula and optic disc is 4.7%. The prevalence increases with age, is highest among whites (5.6%), is lowest among blacks (0.6%), and has been previously under-recognized among Hispanics (2.7%). Extrapolating to the entire fundus, the true prevalence of choroidal nevus is even higher but difficult to accurately estimate. Possible associations with cardiovascular, renal, autoimmune, and occupational risk factors warrant further investigation., (Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Distinct genetic aberrations between melanomas in different anatomical locations have been confirmed in recent years. However, the associations between immunohistochemical expression, tumor sites, and clinical parameters are not clear. We examined the correlation of protein expression and gene mutation of c-kit with clinicopathological parameters and lesion locations in patients with malignant melanoma (MM). We collected 170 melanocytic lesions, including 106 cutaneous MM from acral melanoma (AM) and nonacral melanoma (NAM) sites, 24 dysplastic nevi, and 40 common melanocytic nevi. Tissue microarray was constructed, and immunohistochemical expression for c-kit was assessed with correlation with clinical parameters. Mutation in exons 11, 13, 17, and 18 of KIT gene in genomic DNA by polymerase chain reaction sequencing was also analyzed. Immunostaining scores for c-kit were found to be statistically higher in Dysplastic Nevi than in common melanocytic nevi and MM. In addition, cytoplasmic c-kit staining was significantly correlated with poor survival in patients with AM but not in those with NAM. Twenty-nine cases of MM (including 9 NAM and 20 AM) are analyzed for mutation in exons 11, 13, 17, and 18 of KIT gene in genomic DNA by polymerase chain reaction sequencing, and no genetic mutation is found. Our findings confirm that KIT mutations, in contrast to previous white cohorts, are not common in both AM and NAM of the Chinese and do not necessarily correlate with c-kit expression. The significantly different association between the expression of c-kit immunoreactivities and the mortality risks of melanomas on acral versus nonacral sites might change site-specific targeted therapeutic concepts in melanoma in the future.

Our aim was to examine the association between ethnicity, phenotype, sun behavior and other characteristics, and constitutive and relative facultative skin pigmentation. A total of 191 participants were recruited, with a mean age of 7.6 years (SD 3.4), during 2009-2011 from Maternal and Child Health Centres (MCHC) and schools in Melbourne, Australia. Parental questionnaire data were obtained on sun behavior and examination consisted of noting the child's natural skin, hair and eye color, ethnicity, nevi count and spectrophotometric melanin density (MD). Constitutive skin pigmentation was estimated from buttock MD. Relative facultative skin pigmentation was estimated by hand compared with buttock absorption. Ethnicity, hair color and skin color were associated with constitutive and facultative skin pigmentation on univariate analysis. Higher ambient ultraviolet radiation (UVR) in the past month, greater freckling, greater nevi and increased sun exposure over the past year were related to darker facultative skin pigmentation. Sun exposure over the life course was not. The two skin charts accounted for 39.7% and 21.4% of buttock MD, respectively. Relative facultative skin pigmentation is associated with recent UVR levels, not life-course sun exposure. Relative facultative skin pigmentation may not be a useful measure of sun exposure over the early life course. Skin color charts can be used to assess constitutive skin pigmentation if spectrophotometry is not available., (© 2013 Wiley Periodicals, Inc. Photochemistry and Photobiology © 2013 The American Society of Photobiology.)

Objective: To describe the prevalence of choroidal nevi in 4 racial or ethnic groups (white, black, Hispanic, and Chinese) in the United States., Design: Cross-sectional study., Participants: Participants of the second examination of the Multi-Ethnic Study of Atherosclerosis (MESA), involving 6176 persons 44 to 84 years of age without clinical cardiovascular disease at baseline selected from 6 United States communities., Methods: Fundus images were taken using a 45° digital camera through dark-adapted pupils and were graded for choroidal nevi using the modified Wisconsin Age-Related Maculopathy Grading System and the Blue Mountains Eye Study protocol., Main Outcome Measures: Choroidal nevi., Results: The overall prevalence of choroidal nevi in the whole cohort was 2.1%, with prevalences higher in whites (4.1%) than blacks (0.7%), Hispanics (1.2%), and Chinese (0.4%; P<0.001 for any differences among groups). The lowest prevalence of choroidal nevi occurred in those 75 to 84 years of age. The nevi were subfoveal in 4% of eyes with nevi and were not associated with a decrease in visual acuity. Characteristics of the nevi (size, shape, location, color, drusen on surface) did not differ among racial or ethnic groups. With the exception of associations with higher C-reactive protein levels (odds ratio [OR] per mg/dl on the logarithmic scale, 1.23; 95% confidence interval [CI], 1.06-1.43; P = 0.01) and lower systolic blood pressure (OR per 10 mmHg, 0.90; 95% CI, 0.82-0.99; P = 0.04), choroidal nevi were not associated with other potential risk factors (e.g., gender, smoking status, alcohol consumption, lipid levels, coagulation factors, or kidney disease)., Conclusions: Low prevalences of choroidal nevi were found in the 4 groups participating in the MESA cohort, with whites having higher prevalence than the other racial or ethnic groups. The higher prevalence in whites than in other groups was not explained by any of the factors studied. When choroidal nevi were present, their characteristics did not differ among racial or ethnic groups., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To report on the clinical features and the natural course of optic disk melanocytoma in the Korean population., Methods: A retrospective review of medical records was performed on 27 consecutive patients with optic disk melanocytoma. In cases with tumor enlargement, surface area and diameter of tumors were measured from fundus images using computer software., Results: The median age at diagnosis was 46 years with a slight female predominance (63%). The median tumor diameter and height were 3.1 mm and 1.9 mm, respectively. There were no cases with tumor-related visual loss for a median follow-up of 2 years. Tumor enlargement was observed in 4 of 21 patients (19%) that had follow-up of 1 year or more with no malignant transformation. The mean change of tumor surface area was 2.4 mm (52% increase), and the mean change of tumor diameter was 1.8 mm over a mean follow-up of 53 months in 4 cases with tumor growth. Only tumor vascularization on fluorescent angiography correlated with tumor growth (Log-rank test; P = 0.049). Kaplan-Meier survival estimated that the tumor growth was 0% at 1 year, 14% at 5 years, and 57% at 8 years., Conclusion: Optic disk melanocytoma in the Korean population tends to be superiorly located in the optic disk, and visual prognosis was excellent. Periodic ocular examination is warranted because 57% of patients were estimated to show tumor enlargement by 8 years of follow-up.

Backgrounds: Epidemiological studies have shown a significant relationship between melanocytic nevi and cutaneous melanoma., Objective: To evaluate the development of melanocytic nevi in the pupils of a school composed primarily of children of Dutch descent and to assess the effect of environmental factors on these individuals whose phenotypic characteristics were similar to those of their ancestors., Methods: In 1999 a cohort study was initiated to count the number of melanocytic nevi in 282 pupils of 3 to 17 years of age, 53.9% of whom were boys. Five years later a repeat exam was conducted in 148 students of 8 to 22 years of age, 49.3% of whom were males. The association between the age, skin phototype, eye color, hair color and ethnic group of the pupils and their parents and the presence of melanocytic nevi was analyzed at the beginning and at the end of the study., Results: There was a significant increase in cases of melanocytic nevi and dysplastic nevi at the follow-up examination. The number of melanocytic nevi was greater in boys than in girls in both covered and exposed areas of skin. Likelihood analysis calculated using the odds ratio showed that boys were more likely to develop melanocytic nevi than girls and that the children of non-mixed and mixed race with lighter hair were more likely to develop melanocytic nevi than those of other ethnic groups and those with dark hair. Children with skin phototype I were more likely to develop melanocytic nevi in covered areas of skin compared to those with skin types II or III., Conclusions: These data show that individuals of Dutch descent were more likely to develop melanocytic nevi than individuals of other ethnic origins.

Objective: To describe the prevalence and characteristics of choroidal nevi in an Asian population and compare this with findings from a white population., Methods: The Singapore Malay Eye Study (SiMES) examined a population-based, cross-sectional, age-stratified, random sample of 3280 Malay persons (78.7% participation rate) aged 40 to 80 years living in Singapore. Comprehensive examination of participants included bilateral retinal photography. Choroidal nevi were graded from photographs using the Blue Mountains Eye Study (BMES) protocol., Results: The person-specific prevalence of choroidal nevi was 1.4%, with 50 nevi found in 45 participants. This is lower than the 6.5% prevalence seen in white persons in the BMES. However, characteristics of nevi in Malay persons in the SiMES were similar to those of white persons in the BMES by size (SiMES, 1.27 mm; BMES, 1.25 mm; P = .35), shape (P = .58), color (P = .39), location within posterior pole or periphery (P = .30), and nevus margin proximity to the optic disc (P = .29). Features previously identified as indicating growth or malignant potential (including diameter >6 mm, posterior margin touching optic disc, orange pigment, pigment clumping, and retinal edema) were not found in this sample., Conclusion: Choroidal nevi were detected in 1.4% of Malay persons. There were no significant racial or ethnic differences in nevi characteristics between Malay and white persons.

Earlier studies have shown frequent mutations in the BRAF and NRAS genes in cutaneous melanoma, but these alterations have not been examined in the rare category of melanoma from black Africans. Moreover, the frequency of epidermal growth factor receptor (EGFR) mutations in melanocytic tumors is not known. We therefore examined 165 benign and malignant melanocytic lesions (including 118 invasive melanomas and 18 metastases collected as consecutive cases from various time periods and from two different pathology departments; the 51 nodular melanomas were randomly selected from a larger, consecutive, population-based series of nodular melanomas) with respect to alterations in the EGFR, BRAF and NRAS genes. Mutations in EGFR (exons 18-21) were not detected. EGFR protein expression was observed in a subgroup of melanomas, but without associations with clinicopathologic phenotype or prognosis. Cytoplasmic EGFR expression was, however, significantly increased from benign nevi to melanomas. Mutations in BRAF and NRAS were detected in superficial melanoma (25 and 29%, respectively), nodular melanoma (29 and 28%, respectively) and lentigo maligna melanoma (15 and 16%, respectively). In a series of melanomas from black Africans (n=26), only two BRAF mutations (8%) were found, both being different from the common T1799A substitution. Moreover, melanomas from black Africans exhibited mutations in NRAS exon 1 only (12%), whereas NRAS exon 2 mutations were predominant in melanomas from Caucasians. Thus, the frequencies of BRAF and NRAS mutations were particularly low in melanomas from black Africans, supporting a different pathogenesis of these tumors.

Objective: To investigate the dermoscopic features of acquired acral melanocytic nevi (AAMN) in a white population in Turkey., Design: Prospective population-based study., Setting: University dermatology department dermoscopy unit., Patients: A total of 2625 patients admitted to our dermoscopy unit., Interventions: Patients were examined for AAMN clinically and dermoscopically with a digital imaging system, and AAMN larger than 7 mm and dermoscopically suggestive lesions were excised and examined histopathologically. For other nevi, digital dermoscopic follow-up at 6-month intervals was recommended., Results: A total of 188 AAMN were observed in 138 patients. The most common dermoscopic pattern was the parallel furrow pattern (58.5%). The other patterns seen were fibrillar (12.2%), latticelike (6.4%), homogeneous (6.4%), globulostreaklike (5.3%), reticular (4.3%), globular (2.1%), nontypical (3.2%), and the pattern suggestive of malignancy (1.6%). All 39 excised lesions (20.7%) were benign. In addition, within 1 year, some changes in dermoscopic features were observed in 24 of the 33 lesions observed on digital dermoscopic follow-up (73%)., Conclusions: There may be many variations in AAMN. In our population, although the parallel furrow pattern is the most common pattern, as reported in Japanese populations, fibrillar and latticelike patterns occurred in lower proportions. Conversely the homogeneous pattern is more frequent and may be considered one of the major patterns in the white population. In addition, changes in the dermoscopic features of AAMN may occur, even during short-term follow-up.

This study investigated the numbers of melanocytic nevi in Turkish children and adolescents. The research was conducted on 2783 subjects (age range, 7-14 yrs) at three elementary schools in Malatya, Turkey (latitude 38 degrees N). Numbers of melanocytic nevi per subject were counted using a standard international protocol. Comparisons were made with subjects categorized according to age, sex and skin type. The mean melanocytic nevus count was 1.07 +/- 2.37. A significant positive correlation was found between nevus count and age (p < 0.001). The mean count for boys was significantly higher than that for girls (p < 0.001). Subjects with skin type II had a higher mean melanocytic nevus count than the other three groups. This is the first study related to numbers of melanocytic nevi in Turkey. The findings reveal that Turkish children and adolescents have few melanocytic nevi compared to those elsewhere in the world. In line with previous reports on other populations, analysis showed that older age, skin type II, and male sex are associated with higher melanocytic nevus counts. The results underline the importance of ethnic background in melanocytic nevus development.

Individuals of Asian heritage are predisposed to congenital and acquired pigmentary disorders. Cosmetic enhancement is frequently the primary treatment goal for these benign lesions. Accurate diagnosis of the nature of the pigmentary disorder is fundamental for administering safe and effective therapy. Before the advent of modern laser technology, such reported treatments as cryotherapy, dermabrasion, chemical peeling, and surgical excision resulted in unpredictable results. This article focuses on the diagnosis of disorders of pigmentation in Asian patients and reviews laser and light treatment modalities.

Dermal melanocytoses comprise a variety of congenital and acquired conditions characterized by a sparse population of intradermal dendritic, variably pigmented, spindle-shaped melanocytes. While Mongolian spot, Ota's and Ito's nevi are usually present at birth or appear around puberty; acquired dermal melanocytoses that appear in adult life are extremely rare. They include the facial lesions of acquired bilateral nevus of Ota-like macules, also named Hori's nevus, and the acquired unilateral nevus of Ota, also known as Sun's nevus. Uncommon extrafacial examples of acquired dermal melanocytoses include lesions involving upper extremities, wrist, back, lower extremities and dorsal aspects of the hands and feet. They are more prevalent among Asian women. In general, dermal melanocytoses are rare lesions in Caucasian patients and acquired variants are exceedingly uncommon. We report a rare example of acquired Ito's nevus that appeared in a Caucasian elderly woman and review the literature about acquired dermal melanocytoses.

Background: Little is known about the use of dermoscopy in nonwhite-skinned populations and whether it can influence diagnostic performance., Objectives: To evaluate for the first time the utility and efficacy of dermoscopy in a black population for the diagnosis of pigmented cutaneous lesions., Methods: In total, 100 consecutive clinically doubtful or equivocal pigmented skin lesions in black patients were submitted to dermoscopic examination. The lesions were observed using dermoscopy by two groups of dermatologists, one in Brazil (in vivo) and the other in Italy (on slide images). Besides diagnosis, each group recorded on the same type of form the dermoscopic features present., Results: Of 100 clinically suspicious cases, 79 were Clark naevi, 15 seborrhoeic keratoses, four blue naevi, one dermatofibroma and one melanoma. The two groups of observers succeeded in identifying and classifying all the lesions to such a margin of diagnostic accuracy that only a few cases (three Clark naevi) were subjected to surgical excision to confirm diagnosis., Conclusions: Darker pigmentation of the skin does not impede the identification of single dermoscopic features. As in lighter-skinned populations, dermoscopy in black people can also lead to early and accurate diagnosis of melanoma, thereby significantly reducing the number of unnecessary excisions.

Background: Acquired, bilateral naevus of Ota-like macules or Hori naevus (HN) is a common dyschromia seen in Orientals. Other than the original report which documented the clinical spectrum in a group of 22 patients, there have not been many epidemiological reports of this condition., Objectives: To evaluate the epidemiology and clinical characteristics of HN in Asian patients., Methods: A prospective analysis of 161 patients with HN seen from June 2003 to June 2004 was performed., Results: All 161 patients in the study were women. Patients were Chinese (n = 155), Eurasian (n = 4), Malay (n = 1) and Indian (n = 1). The median age at onset was 30 years. The malar region was the most frequently affected area. Discrete brown macules were the most common early presentation. Confluent slate-grey macules occurred later. Aggravating factors included sun exposure and pregnancy. Sixty-seven patients reported a positive family history., Conclusions: We report our data on the largest series of HN in the literature so far. Predisposing factors in our study are Chinese race, female sex and positive family history. HN became progressively more confluent and grey over time, suggesting migration from the epidermis to the deeper dermis. More studies are needed to confirm the pathogenesis.

Purpose: To evaluate the various forms of clinical presentation, the potential of growth, the risk of functional loss and the possibility of malignant transformation of optic disk melanocytomas in European patients., Design: Retrospective observational case control study., Methods: Evaluation of 37 cases of optic disk melanocytomas identified in the computer files of the ocular oncology unit of Jules Gonin Hospital to determine the clinical presentation of these tumors and the risk of complications., Results: The tumor was asymptomatic in 28 cases. Visual acuity was normal in 26 cases, subnormal in 10 cases, and in one case it was reduced to 0.1. Visual field defects were observed in 19 cases; the size and extent of the tumor and the degree of papilledema appeared to influence the severity of the visual field defect. Tumor growth was demonstrated in 6 of the 9 cases in which follow-up was for at least six years. In two cases there was presumed malignant transformation that was treated by accelerated proton beam radiotherapy., Conclusions: Melanocytomas in white Europeans and those of European derivation are rarely symptomatic, have only a moderate effect on visual function and show a low rate of progression over long observation. The risk of tumor progression, although sometimes occurring as much as several years after the initial diagnosis, justifies a cautious approach with long-term regular surveillance of these patients.

Objectives: To describe the clinical features of a conjunctival nevus and to evaluate the lesion for changes in color and size over time., Design: Retrospective, observational, noncomparative case series., Participants: Four hundred ten consecutive patients with conjunctival nevi., Main Outcome Measures: The 2 main outcome measures were changes in tumor color and size., Results: Of the 410 patients, 365 (about 89%) were white, 23 (about 6%) were African American, 8 (2%) were Asian, 8 (2%) were Indian, and 6 (1%) were Hispanic. The iris color was brown in 55% (229/418), blue in 20% (85/418), green in 20% (83/418), and not indicated in 5% (21/418). The nevus was brown in 65%, tan in 19%, and completely nonpigmented in 16%. The anatomical location of the nevus was the bulbar conjunctiva (302 eyes, 72%), caruncle (61 eyes, 15%), plica semilunaris (44 eyes, 11%), fornix (6 eyes, 1%), tarsus (3 eyes, 1%), and cornea (2 eyes, <1%). The bulbar conjunctival lesions most commonly abutted the corneoscleral limbus. The nevus quadrant was temporal (190 eyes, 46%), nasal (184 eyes, 44%), superior (23 eyes, 6%), and inferior (21 eyes, 5%). Additional features included intralesional cysts (65%), feeder vessels (33%), and visible intrinsic vessels (38%). Cysts were clinically detected in 70% of histopathologically confirmed compound nevi, 58% of the subepithelial nevi, 40% of the junctional nevi, and 0% of the blue nevi. Of the 149 patients who returned for periodic observation for a mean of 11 years, the lesion color gradually became darker in 5% (7 patients), lighter in 8% (12 patients), and was stable in 87% (130 patients). The lesion size was larger in 7% (10 patients), appeared smaller in 1% (1 patient), and was stable in 92% (137 patients). There were 3 patients who developed malignant melanoma from a preexisting compound nevus (2 cases) or blue nevus (1 case) over a mean interval of 7 years., Conclusions: Conjunctival nevus is a benign tumor most often located at the nasal or temporal limbus and rarely in the fornix, tarsus, or cornea. Over time, a change in tumor color was detected in 13% (20/149) and a change in tumor size was detected in 8% (12/149).

Background: Laser surgery for Asians differs from that for Caucasians in several important respects. In Asians, some conditions such as nevus of Ota are frequently seen and certain adverse reactions, especially postinflammatory hyperpigmentation, tend to be more common., Objective: This article reviews the use of different types of lasers and intense pulsed light (IPL) sources for the treatment of Asian patients., Methods: Various cutaneous conditions amenable to laser treatment, including lentigines, nevus of Ota, acquired bilateral nevus of Ota-like macules, port-wine stains, and acne scarring, are discussed. Strategies for the management of postinflammatory hyperpigmentation are offered., Results: Appropriate selection and careful planning of the treatment can lead to excellent clinical outcome., Conclusion: Lasers and intense pulsed light sources are important tools for the treatment of a wide range of cutaneous conditions in Asians.

Recent advances in estimating the density of cutaneous melanin by spectrophotometry and the concentration of the two types of melanin (eumelanin and phaeomelanin) in hair offer the potential to define the risk of skin cancer in individuals more accurately. The presence of common melanocytic naevi on the arm is associated with an increased risk of melanoma, and in this study the associations of arm naevi with melanin density at the upper inner arm and with melanin type in hair samples were examined in a representative sample (n = 267) of 19-20 year olds of northern European ancestry. Particularly in men, the association with naevus count was stronger for cutaneous melanin density than for follicular melanin type. Adjusted for recreational sun exposure, the rank correlation coefficients were r = -0.25, 0.12 and 0.01 for men, and r = -0.17, -0.12 and 0.14 for women, for cutaneous melanin, hair eumelanin and hair phaeomelanin, respectively. The associations with less objective markers of phenotype (hair colour, eye colour, nurse-assessed skin colour, and self-reported skin reaction to unaccustomed sun) were weaker. These findings provide important new information that human susceptibility to mutations of melanocytes can be estimated by objective biological measures. The next step is to determine whether these measures also predict the risk of melanoma.

Background: Hori's nevus is an acquired pigmented lesion involving bilateral blue-brown facial macules. There has been a dearth of reported treatment modalities for this condition., Objective: The purpose of this study was to evaluate the efficacy of the Q-switched Nd:YAG laser for the treatment of Hori's nevus., Methods: The Q-switched Nd:YAG laser was used to treat Hori's nevus in 66 Asian patients. Patients were treated up to seven times. The follow-up time after the final treatment ranged from 3 to 44 months., Results: Twenty six percent of patients showed good to excellent clearing after one to two treatments. Fifty percent of patients who underwent more than two treatments received good to excellent results., Conclusion: The Q-switched Nd:YAG laser can be used to treat Hori's nevus. Results are not as good as those seen with nevus of Ota.

Objective: To determine the prevalence, morphologic characteristics, associations, and frequency of features reported to predict growth of choroidal nevi in a large population-based sample., Methods: A total of 3654 subjects aged 49 to 97 years participating in the Blue Mountains Eye Study had a detailed eye examination, including photography of 6 standard retinal fields. Nevi were graded from photographs., Results: Nevi were present in 6.5% of the population (n = 232), and were distributed equally between eyes. There was a slight decrease in nevus prevalence with increasing age. Nevus prevalence was higher in women than men, but this difference was not statistically significant. The mean nevus diameter was 1.25 mm (SD, 0.72 mm; range, 0.5 to >4.5 mm). Eighty-seven percent of nevi were blue gray and 6% had a hypomelanotic or amelanotic appearance. There were no significant associations between nevi and iris or skin color or sun-induced skin damage, but nevi were significantly less frequent in persons with blond hair. No nevus associations were found with visual impairment, cataract, or glaucoma. Clearly visible drusen were seen on 42% of nevi and were larger and more centrally distributed as nevus size increased. Features previously identified as predicting nevus growth, such as serous elevation and orange or other pigment, were seen rarely., Conclusion: Choroidal nevi in the general population are frequent, small, have few features that are commonly reported to indicate potential for growth, and rarely affect visual acuity.

The role of host and environmental factors in the pathogenesis of multiple melanocytic nevi, atypical nevi, and freckles was studied in 1989 in a random sample of 3,040 Israeli males aged 17 years. Multiple melanocytic nevi were significantly associated with family history of melanoma or multiple melanocytic nevi (odds ratio (OR) = 15.0), fair or lightly pigmented skin color (OR = 2.7 and 2.3, respectively), and affiliation to the high or heterogenous melanoma risk group, determined by the incidence rates of melanoma in Jewish migrants from corresponding origin (OR = 3.1 and 2.1, respectively). An environment-related effect may account for the increased multiple melanocytic nevi risk among second- (OR = 8.2) compared with first-generation, native-born recruits (OR = 3.0) from the high melanoma risk group whose families had been living in Israel the longest. Atypical nevi were associated with fair (OR = 6.1) and lightly pigmented (OR = 3.5) skin color, high and moderate sunburn susceptibility (OR = 4.7 and 2.5, respectively), and family history of melanoma or multiple melanocytic nevi (OR = 4.7). Freckles were significantly associated with sun-sensitive phenotype, family history of melanoma or multiple melanocytic nevi (OR = 1.5). Conservative (OR = 1.9) or nonreligious status (OR = 1.9), and high (OR = 2.4) or heterogenous melanoma risk groups (OR = 1.8). These findings indicate that environmental factors may modify the occurrence of multiple melanocytic nevi and freckles in genetically susceptible ethnic groups.

A survey of benign melanocytic nevi was conducted among schoolchildren in Perth, Western Australia, in 1985, with the aim of describing the prevalence and causes of nevi. Children were recruited from Perth public schools that were chosen to be representative of the socioeconomic and geographic distribution of the population. Of 4,898 eligible children, 2,595 (53%) had all of their nevi counted by one member of a team of five nurses. Analysis was restricted to 2,552 children aged 5-14 years. Children of European origin (i.e., white children), who comprised the majority of the sample (2,376 children), had many more nevi than did children of other ethnic origins. Among white children, the prevalence of nevi increased progressively with age, although the number of nevi per unit of skin area reached a plateau at about 9 years of age. Boys had more nevi at all ages than did girls. The number of nevi per unit of area was highest on the lateral surfaces of the upper limbs and the face and neck, and was lowest on the lower limbs. Children whose parents had been born in Southern Europe were likely to have few nevi. Children with red hair had relatively few nevi, but children with light skin generally had more nevi than children with darker skin. Ability to tan and propensity to burn were also associated with number of nevi, although not in a simple fashion; numbers of nevi were highest in intermediate categories of these two variables. The relation with freckling was also complex; the mean number of nevi increased with increasing freckling until the freckling became moderate to heavy, after which it fell.

The presence of various types of birthmarks was determined in 3,345 Chinese infants under 48 hours of age. Mongolian spots were present in 86.3% of the studied infants. Vascular lesions included salmon patch (22.6%), port-wine stain (0.4%), and strawberry marks (0.7%). Nevocellular nevi (1%), sebaceous nevi (0.1%), and café au lait spots (0.4%) were also found. The following non-birthmark skin changes were observed: erythema toxicum neonatorum (33.7%), preauricular tags (1.3%), preauricular pits (2.5%) and a hyperpigmented scrotum (31.3%; in 1,727 male infants), which was related to the presence of mongolian spots.

Background: Reed's nevi are distinguished from Sptiz tumors by their significant melanogenesis and growth pattern. They may be confused with melanoma on clinical and histologic grounds., Case Report: An unusual case in which multiple agminated Reed's nevi mimicked acral lentiginous malignant melanoma in an African-American girl is presented. A critical review of the literature is presented to assist in the diagnosis., Conclusions: Awareness of this entity and of its possible clinical presentations and judicious application of conventional hematoxylin-eosin microscopic criteria remain the most useful methods to bring the correct diagnosis in most instances. Mutilating or excessive surgery may be avoided for most cases of pigmented spindle and epithelioid cell nevus.

Background and Methods: Prevalence of benign melanocytic nevi (moles) has been shown to be a major predictor of malignant melanoma. In this study the prevalence of moles in a group of 2140 children, aged 4 to 11 years, was determined. A standard questionnaire was completed by the parents of each child and included information on environmental and life-style factors. Examination data for each child were linked to the data obtained from the questionnaire., Results: Prevalence increases rapidly throughout childhood and studies of children may indicate which factors contribute to mole development. Boys had more moles than girls, as did white children when compared with other ethnic groups. Prevalence of moles increased with age in children of both sexes. Among whites, skin color had little influence on mole prevalence. The following characteristics, however, were associated with an increased prevalence of moles: a propensity to burn rather than tan, a history of sunburn, a tendency to freckle, and a life-style involving increased sun exposure. A striking positive association between prevalence of moles and number of foreign holidays in a hot climate was observed. This association was independent of a history of sunburn., Conclusions: The study supports the hypothesis that environmental factors influence the prevalence of moles in childhood.

Melanocytic nevus density in 378 Asian and 68 Indo-Pakistani school children 6 to 18 years of age was compared with that in 1146 white children of the same age range. At all ages, the number of melanocytic nevi 2 mm or larger per square meter of body surface area was substantially lower in Asians and Indo-Pakistanis than in white persons. Among white persons characteristics associated with a higher risk of cutaneous melanoma in adults, that is, light skin color, a propensity to burn rather than tan in the sun, and a history of numerous or severe sunburns, are also associated with the highest melanocytic nevus density in children. Examination of these same host pigmentation and sunburn factors among Asian children revealed no association with nevus density.

In a group of 211 schoolchildren in Queensland less than 12 years of age, the mean total melanocytic nevus (mole) count was 28 (median 19), and the mean count for raised nevi was 11 (median 8). The upper aspect of the back and chest were the most commonly affected sites, with the neck being the third. Boys had significantly (p less than 0.01) more melanocytic nevi than girls, and prevalence was highest in children with pale skin and light-colored hair. Nonwhite heritage had a protective effect independent of pigmentary characteristics. Total numbers of nevi on children also were related to maternal tendency to large numbers of moles and to family history of melanoma. The only significant association observed for the presence of large (greater than 5 mm) nevi on children was a family history of melanoma. The children studied come from a general population that has the highest known risk of melanoma. In Australia they have been shown to have the highest prevalence of nevi ever reported in the prepubertal age group. These descriptive data, together with the specific pigmentary and family associations described, extend the known links between benign nevi and malignant melanoma.

A 69-year-old man of mixed racial background was discovered to have a large, deeply pigmented mass in his left eye with a history of rapid growth during the previous 6 months. The eye was enucleated, and histopathological examination revealed an epithelioid malignant melanoma arising from a melanocytoma.

The relationship between cutaneous malignant melanoma (MM) and possible risk factors was assessed in a case-controlled study. Two hundred patients and 200 non-melanoma controls of German origin matched for age and sex were interviewed and examined for pigmented moles and pigmentation characteristics. In patients with MM significantly more melanocytic nevi greater than or equal to 2 mm (MCN) were found (mean, 53 MCN) compared to control cases (mean, 18 MCN). For persons with greater than 60 MCN the relative risk (RR) for developing MM increased 15 times compared to less than or equal to 10 MCN. Additional independent markers for an increased risk were presence of atypical MCN (RR = 7 vs. none) found in 45% of patients and in 5% of the control group, moderate to large numbers of actinic lentigines (RR = 6.2 vs. none), and lack of tanning as well as a tendency to sunburn (skin type I; RR = 2.2 vs skin type IV) No significant correlation was found between the relative risk for MM and hair color, eye color, duration of free time sun exposure and number of sunburns. Individuals with permanent outdoor profession and sun exposure, however, showed a clearly increased relative risk for developing MM.

Mole counts were studied in relation to skin complexion in various racial groups. White children had a median total number of naevocytic naevi of 17.0, versus 2.5 in non-white children (p less than 0.001). Young white adults showed a similar mole proneness to that of coloured subjects (61.0 versus 16.0; p less than 0.001). With regard to moles greater than 2 mm diameter in the young-adult group, white subjects again exhibited a higher median count than non-white subjects (5.5 versus 1.0; p less than 0.001). There was an inverse gradient of mole counts in young adults from subjects of white complexion through those of mixed ancestry, Oriental ancestry, to those of Negroid descent. This study indicates that there is a strong racial background predisposing to the development of naevocytic naevi.