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Original Investigation |

Growth-Curve Modeling of Nevi With a Peripheral Globular Pattern

Shirin Bajaj, BA1; Stephen W. Dusza, DrPH1; Michael A. Marchetti, MD1; Xinyuan Wu, BA1; Maira Fonseca, BS1; Kivanc Kose, PhD1; Johanna Brito, MD2,3; Cristina Carrera, MD2,3; Vanessa P. Martins de Silva, MD2,3; Josep Malvehy, MD2,3; Susana Puig, MD, PhD2,3; Sarah Yagerman, MD1; Tracey N. Liebman, MD1; Alon Scope, MD1,4; Allan C. Halpern, MD, MSc1; Ashfaq A. Marghoob, MD1
[+] Author Affiliations
1Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
2Melanoma Unit, Department of Dermatology, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
3Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
4Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
JAMA Dermatol. 2015;151(12):1338-1345. doi:10.1001/jamadermatol.2015.2231.
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Importance  Although nevi with a peripheral rim of globules (peripheral globular nevi [PGN]) observed with dermoscopy are associated with enlarging melanocytic nevi, their actual growth dynamics remain unknown. Because change is a sensitive but nonspecific marker for melanoma, beginning to understand the growth patterns of nevi may improve the ability of physicians to differentiate normal from abnormal growth and reduce unnecessary biopsies.

Objective  To study the growth dynamics and morphologic evolution of PGN on dermoscopy.

Design, Setting, and Participants  A total of 84 participants with 121 PGN from September 1, 1999, through May 1, 2013, were identified retrospectively. Cohorts were recruited from the Memorial Sloan Kettering Cancer Center; Melanoma Unit of the Hospital Clinic, University of Barcelona; and Study of Nevi in Children. All 3 cohorts underwent longitudinal monitoring with serial dermoscopic imaging of their PGN. Data analysis was performed from May 1, 2014, through April 1, 2015.

Main Outcomes and Measures  Establishment of the natural growth curve of PGN. The secondary aim was to establish the median time to growth cessation in those PGN for which the size eventually stabilized and/or had begun to decrease during the study period.

Results  The median duration of follow-up was 25.1 (range, 2.0-114.4) months. Most of the nevi (116 [95.9%]) enlarged at some point during sequential monitoring. The rate of increase in the surface area of PGN varied among cohorts and ranged from −0.47 to 2.26 mm2/mo (mean rate, 0.25 [95% CI, 0.14-0.36] mm2/mo). The median time to growth cessation in the 26 PGN that stabilized or decreased in size (21.5%) was 58.6 months. All lesions changed in a symmetric manner and 91 (75.2%) displayed a decrease in the density of peripheral globules over time.

Conclusions and Relevance  Nevi displaying a peripheral globular pattern enlarged symmetrically with apparent growth cessation occurring during a span of 4 to 5 years. Our results reiterate the important concept that not all growth is associated with malignancy.

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Figure 1.
Smoothed Growth Curves of Peripheral Globular Nevi

The fitted line is created from the predicted value from the regression models. HBC indicates Hospital Clinic, University of Barcelona; MSKCC, Memorial Sloan Kettering Cancer Center; and SONIC, Study of Nevi in Children.

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Figure 2.
Individual Nevus Growth Trajectories by Cohort

The fitted line is created from the predicted value from the regression models. HBC indicates Hospital Clinic, University of Barcelona; MSKCC, Memorial Sloan Kettering Cancer Center; and SONIC, Study of Nevi in Children.

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Figure 3.
Sequential Dermoscopic Images of an Enlarging Peripheral Globular Nevus With a Homogeneous Central Component

An increase in surface area is seen during 45 months of follow-up. The nevus enlarged in a symmetric manner and displayed a decrease in the density of peripheral globules over time.

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Figure 4.
Sequential Dermoscopic Images of a Stabilized Peripheral Globular Nevus With a Homogeneous Central Component

After an initial increase in surface area, the size of the nevus stabilized. By the last evaluation, nearly all of the peripheral globules had disappeared.

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