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Harald Kittler, MD; Markus Seltenheim, MD; Markus Dawid, MD; Hubert Pehamberger, MD; Klaus Wolff, MD, FRCP; Michael Binder, MD

Arch Dermatol. 2000;136:316-320.

Objective  To analyze the frequency and characteristics of enlarging common melanocytic nevi.

Design  Cohort study using digital epiluminescence microscopy (ELM) for documentation and follow-up, with a median follow-up interval of 11.4 months.

Setting  A dermatology department at a university hospital in Vienna, Austria.

Patients  One thousand six hundred twelve melanocytic nevi appearing clinically as common nevi, obtained from 385 patients (mean [±SD] age, 34.2 ± 14.8 y; 55.6% female).

Interventions  Follow-up examination and documentation by digital ELM.

Main Outcome Measures  Frequency of enlarging nevi according to age and comparison of ELM features observed in enlarging and nonenlarging nevi.

Results  Enlargement was found in 5.3% (n=86) of nevi. The frequency of enlarging nevi was inversely related to age (P<.001), in that enlarging nevi were common in patients younger than 20 years and relatively rare in older age groups. Epiluminescence microscopy revealed a peripheral rim of brown globules in 48.8% (n=42) of enlarging nevi. In contrast, a peripheral rim of brown globules was found in only 0.7% (n=11) of nevi without enlargement (P<.001). Enlarging nevi that were excised in children and adolescents showed no histological signs of atypia. In older age groups, 48.1% of excised enlarging nevi that were clinically diagnosed as common nevi showed some histological signs of atypia. None of the excised enlarging lesions was histologically diagnosed as melanoma.

Conclusions  The frequency of enlarging common nevi is inversely related to age. In the absence of clinical signs of atypia, enlargement alone does not indicate malignancy. A peripheral rim of brown globules is a characteristic ELM feature of symmetrically enlarging melanocytic nevi.

From the Division of General Dermatology, Department of Dermatology, University of Vienna Medical School (Drs Kittler, Seltenheim, Dawid, Pehamberger, Wolff, and Binder), and Ludwig Boltzman Institute for Clinical and Experimental Oncology (Dr Pehamberger), Vienna, Austria. Drs Pehamberger, Wolff, and Binder have been involved in the development of the MoleMax II and serve as consultants to Derma Instruments, Vienna.

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