Dermatologic Physical Exam

Primary Lesions

Junctional nevi: These are pigmented macules usually, 5 mm or less, which vary from tan to very dark brown. Skin surface lines are retained and the margins are even. Color is uniform and the shape is round to oval (see Photos 7,17).

Early compound nevi: These are dome-shaped papules that may retain skin lines or may have a smooth effaced surface. In early lesions, the macular junctional origin is evident at the margin of the central papular compound portion. Color in the raised region may be uniformly lighter because of relative dilution of pigment over the larger surface area (see Photo 8).

Developed compound nevi: These are minimally raised plaques, round to oval in shape. They are evenly colored tan to dark brown, and may have diminished, normal, or accentuated skin markings. Margins are usually smooth and distinct. Size is usually 6 mm or less (see Photo 7).

Mature compound and developed dermal nevi: Both types of moles may have a clinically identical appearance consisting of round or oval dome-shaped sharply demarcated papules with a smooth shiny surface and effaced skin lines. Color may vary from white to flesh-toned to medium brown. Shades of light tan are most common (see Photo 8).

Mature dermal nevi: These are pedunculated, soft papules with a wrinkled, flaccid appearance. Color may vary from flesh tones to medium tan, with light tan shades most common. Distinction from fleshy skin tags may not be possible on clinical grounds alone (see Photos 9,10).

Secondary Lesions

Papillomatosis: Some compound nevi have a pebbly or mammillated surface due to distortion of the epidermis by the dermal nevus cells. In its extreme form, this can cause clefting and give a cerebriform appearance. This surface change is especially common with compound nevi located on the scalp (see Photo 11).

Scale: A fine hyperkeratotic scale may be a normal finding in some compound moles (see Photo 12).

Hair growth: The presence of coarse, dark hairs longer than those in the adjacent skin is a normal finding and indicates a mature nevus (see Photo 13).

Comedo: Comedo formation in hair follicles may produce surface irregularity and speckling, but is a benign incidental change (see Photo 14).

Distribution

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