We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Anatomic Transitions and the Histopathologic Features of Melanocytic Nevi

Toshiaki Saida, MD, PhD; Shigeo Kawachi, MD, PhD; Hiroshi Koga, MD
Arch Dermatol. 2008;144(9):1232-1233. doi:10.1001/archderm.144.9.1232.
Text Size: A A A
Published online


In their letter, Braun et al1 reported a case of an acral melanocytic lesion that exhibited a completely benign dermoscopic pattern but was histopathologically diagnosed as melanoma in situ. As previously noted,2 despite benign clinical features, melanocytic nevi located in transition sites between glabrous and nonglabrous skin and in interdigital areas often histopathologically exhibit a random, irregular distribution of melanocytes as solitary units and in nests within the epidermis (Figure). The lesion described by Braun et al1 may be such a case. At first, we diagnosed these cases as malignant melanoma. Later, we noticed that most of melanocytic lesions affecting these anatomic sites showed a random, irregular distribution of melanocytes as solitary units and in nests within the epidermis. Noteworthy is that most patients with this presentation were young, ranging in age from 10 to 30 years. Malignant melanomas on acral skin mostly affect older persons. Furthermore, most of the lesions were clinically benign: small and regular in color (unpublished data, 2007), though some were larger, as in the case reported by Braun et al.1 These findings prompted us to consider that these lesions were not melanomas but rather melanocytic nevi. And now we believe that most melanocytic nevi located on the transition areas show histopathologic features mimicking those of malignant melanoma.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

Clinical and histopathologic features of a melanocytic nevus located on a transition area (the fourth interdigital area of the right foot) of a 23-year-old woman. A, This brownish black macule, 5 mm in diameter, shows virtually no irregularity in shape or color. B-D, In all of the histopathologic photographs (hematoxylin-eosin), we see that melanocytes proliferate mainly as solitary units within the epidermis, and many of them are situated above the dermoepidermal junction, mimicking histopathologic features of melanoma in situ. However, overall distribution of melanocytes within the lesion is mostly symmetrical and orderly. The nuclei of melanocytes are relatively large but not hyperchromatic; instead, they are vesicular. In addition, there is virtually no inflammatory cell infiltrate in the dermis. The original magnifications are ×12, ×38, and ×84 for panels B, C, and D, respectively.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles