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BACKGROUND Junctional melanocytic nevi are common. Furthermore, surgical treatment of these nevi can be challenging due to scar formation. AIMS The study aims to detect the efficacy and safety of the CO2 fractional laser for treating acquired junctional melanocytic nevi and usefulness of dermatoscopy for the monitoring of the nevus. METHODS We conducted a retrospective review of 618 patients with 1545 facial junctional melanocytic nevi. CO2 fractional laser was applied to 2-month intervals until complete clearance was reached. The effect of the therapy was monitored by clinical and dermatoscopy. The Global Assessment Scale (GAS) scores were used to assess the results. RESULTS 1320 nevi (85%) were treated in just one session. In addition, 120 (8%) and 75 (5%) required second and third sessions, respectively. Only thirty nevi (2%) need more than three sessions. Consequently, at the end of one-year follow-up, patients' (97%) and physicians' (95%) GAS scores were rated as excellent and good, respectively. Moreover, hyper/hypopigmentation, fibrosis, dimples, erythema, and scars were observed as side effects at the 1-year follow-up. CONCLUSIONS CO2 laser is effective in completely removing small acquired junctional melanocytic nevus. Furthermore, dermatoscopy appears to be helpful for monitorization of the nevi in the follow-up period.

We present a rare case of intraoral atypical lentiginous melanocytic lesion affecting a pediatric patient, in which the diagnosis of lentiginous junctional melanocytic nevus with cytologic atypia was favored. The main differential diagnosis is lentiginous melanoma, which is a slowly progressing lesion, affecting mainly older adults, and microscopically presenting lentiginous growth pattern of moderately atypical melanocytes, with focal nesting and pagetoid spread. It is strongly recommended that melanocytic lesions showing features of atypical lentiginous growth pattern should be treated with wide excision; however, the impact of these guidelines on pediatric patients needs to be better defined with the report of further cases.

Oral melanocytic nevi (OMNs) are uncommon benign melanocytic proliferations. Clinically, OMNs are small, well-circumscribed, flat lesions, but not uncommonly appear as slightly raised papules. They can be brown, bluish-gray, or almost black, and occasionally non- pigmented. Regarding the OMN etiology and pathogenesis, most studies have focused on its cutaneous counterpart. We present a case of OMN in a pediatric patient. A 4-year-old male was referred presenting a dark macule with regular borders, measuring 6 mm in greater diameter, located on the right retromolar pad, with a time of evolution of 15 days. The clinical diagnoses were melanotic macule and OMN. After excisional biopsy, the microscopic examination revealed junctional melanocytic nevus with lentiginous hyperplasia containing focal melanocytic atypia. After 4 months of follow-up, there is no recurrence or alteration. Thus, lentiginous junctional melanocytic proliferation with focal atypia may be observed in OMN, which should be interpreted with caution, especially in pediatric patients.

One of the most confounding characteristics, commonly seen in malignant, but even in benign melanocytic nevi, is represented by the regression phenomenon. The identification of regression, through dermoscopical observation, can be predictive of a tricky histopathological examination. Therefore, this feature should be an alert to a meticulous clinical, dermoscopical and histopathological correlation for correct analysis of melanocytic skin lesions. A 26-year-old man was referred to our department for a pigmented skin lesion localized on his trunk. It was clinically and dermoscopically diagnosed as atypical melanocytic nevus with central regression. After 1 year the lesion underwent considerable changes, leading to a nearly complete regression. The lesion was excised and, on the basis of clinical, dermoscopical and histopathological correlation, was interpreted as a junctional melanocytic nevus with regression. In our case the association of clinical, dermoscopical and histopathological experience, resulted an important and useful method, in order to proper interpret and correctly diagnose an atypical melanocytic skin lesion.

Lichen sclerosus is found in children with an estimated prevalence of at least 1 in 900. Pigmentation in lichen sclerosus is infrequent and melanocytic proliferations in lichen sclerosis are rare and difficult to interpret. In this report, we describe the case of a prepubertal girl presenting with a junctional melanocytic nevus of the labia minora superimposed by lichen sclerosus. The lesion was completely excised and free margins confirmed by histological examination. After a 3 months course of topical clobetasol treatment the girl remained asymptomatic. No local recurrence was notified with a follow-up time of 12 months.

Tinea nigra is an asymptomatic superficial fungal infection caused by Phaeoannelomyces werneckii, generally affecting the skin of the palms and characterized by deeply pigmented macular non-scaly patches. These lesions are quite characteristic. However, they can be misdiagnosed as a malignant melanoma or a junctional melanocytic nevus and unnecessary biopsies may be performed. Thus, dermoscopy is a fast, useful, clinical adjunctive tool in differentiating tinea nigra from melanocytic lesion.