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,Level 1:The most common patterns found in nevi (excluding IDN).
The most common patterns found in nevi (excluding IDN). (2)
The most common patterns found in nevi (excluding IDN). (3)
, Network or reticular pattern:
consists of an organized network with minimal variation in its thickness and color (i.e., regular/typical
network). The holes of the network are relatively uniform in their appearance.
Patchy network/reticular pattern:
patches of typical network distributed in an organized manner. The network patches all have the same type
of network with minimal variability in the thickness and color of the lines. It is important to remember that
melanoma on sun damaged skin can sometimes appear as an isolated large lentiginous lesion with a patchy
network. The clues to the diagnosis include the age of the patient since these melanomas occur in the elderly,
the network is usually not distributed in an organized fashion, and there is usually focal granularity present.
Peripheral network with central hypopigmentation:
The peripheral network is typical/regular and the central hypopigmented area is lighter in color com-
pared to the network but darker than the surrounding skin.
Peripheral network with central hyperpigmentation.
The peripheral network is typical/regular and the central hyperpigmented area consists of a blotch.
This blotch often due to the accumulation of melanin laden corneocytes in the straum corneum (i.e.,
lamella). This lamella can usually be tape stripped off revealing an underlying typical network.
Peripheral network with central brown globules:
The peripheral network is typical/regular and the central brown globules are also regular displaying min-
imal variation in their size and color.
Globular pattern:
This pattern consists only of globules that display minimal variability in their sizes and colors (i.e.,
regular/typical) and are distributed in an organized manner within the lesion. The globules can have
different shades of brown. On rare occasion the globules can be white as seen on balloon cell nevi.
While black and blue globulescan on occasion be seen in congenital nevi, their presence should raise
suspicion for melanoma.
Cobblestone globular pattern:
This is a specific type of globular pattern that consists of large brown angulated globules that create a
pat-tern reminiscent of cobblestones. This is a pattern associated with congenital nevi.
Reticular pattern with peripheral globules:
This pattern consists of a typical network nevus that has a peripheral rim of regular brown globules.
This pattern is associated with the radial growth phase of Clark’s/dysplastic nevi and is commonly
encoun-tered in younger patients with the atypical mole syndrome.
Homogeneous blue:
A homogeneous blue color with a whitish veil that encompasses the entire lesion’s surface is the hallmark
of a blue nevus. The blue color and white veil in blue nevi will have minimal variation in hues. If there
are multiple hues (i.e, heterogeneous blue color or non-homogeneous veil) then one should consider
the di-agnosis of melanoma. In addition, the differential for blue nevi should include epidemiologic
metastasis and if nodular then one needs to consider the diagnosis of nodular melanoma.
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,Level 1:The most common patterns found in nevi (excluding IDN).
The most common patterns found in nevi (excluding IDN). (2)
The most common patterns found in nevi (excluding IDN). (3)
, Network or reticular pattern:
consists of an organized network with minimal variation in its thickness and color (i.e., regular/typical
network). The holes of the network are relatively uniform in their appearance.
Patchy network/reticular pattern:
patches of typical network distributed in an organized manner. The network patches all have the same type
of network with minimal variability in the thickness and color of the lines. It is important to remember that
melanoma on sun damaged skin can sometimes appear as an isolated large lentiginous lesion with a patchy
network. The clues to the diagnosis include the age of the patient since these melanomas occur in the elderly,
the network is usually not distributed in an organized fashion, and there is usually focal granularity present.
Peripheral network with central hypopigmentation:
The peripheral network is typical/regular and the central hypopigmented area is lighter in color com-
pared to the network but darker than the surrounding skin.
Peripheral network with central hyperpigmentation.
The peripheral network is typical/regular and the central hyperpigmented area consists of a blotch.
This blotch often due to the accumulation of melanin laden corneocytes in the straum corneum (i.e.,
lamella). This lamella can usually be tape stripped off revealing an underlying typical network.
Peripheral network with central brown globules:
The peripheral network is typical/regular and the central brown globules are also regular displaying min-
imal variation in their size and color.
Globular pattern:
This pattern consists only of globules that display minimal variability in their sizes and colors (i.e.,
regular/typical) and are distributed in an organized manner within the lesion. The globules can have
different shades of brown. On rare occasion the globules can be white as seen on balloon cell nevi.
While black and blue globulescan on occasion be seen in congenital nevi, their presence should raise
suspicion for melanoma.
Cobblestone globular pattern:
This is a specific type of globular pattern that consists of large brown angulated globules that create a
pat-tern reminiscent of cobblestones. This is a pattern associated with congenital nevi.
Reticular pattern with peripheral globules:
This pattern consists of a typical network nevus that has a peripheral rim of regular brown globules.
This pattern is associated with the radial growth phase of Clark’s/dysplastic nevi and is commonly
encoun-tered in younger patients with the atypical mole syndrome.
Homogeneous blue:
A homogeneous blue color with a whitish veil that encompasses the entire lesion’s surface is the hallmark
of a blue nevus. The blue color and white veil in blue nevi will have minimal variation in hues. If there
are multiple hues (i.e, heterogeneous blue color or non-homogeneous veil) then one should consider
the di-agnosis of melanoma. In addition, the differential for blue nevi should include epidemiologic
metastasis and if nodular then one needs to consider the diagnosis of nodular melanoma.
