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Last reviewed: 18 Mar 2025
Last updated: 20 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • presence since birth
  • asymmetrical, indistinct or irregularly bordered, variably coloured papules with diameter >5 mm
  • history of change in shape and colour
  • asymptomatic (usually)
  • multiple lesions
  • flat, brown macule
  • dome-shaped papule
  • light brown background with speckled darker brown spots within
  • blue-grey dome-shaped papule
  • central pink-to-brown papule with a surrounding depigmented white ring
  • pinkish-brown papule

Risk factors

  • genetic predisposition
  • ultraviolet exposure
  • fair skin
  • age: older children and young adults

Diagnostic investigations

Investigations to consider

  • non-invasive imaging technologies
  • total body photography
  • biopsy

Emerging tests

  • whole genome sequencing
  • pigmented lesion assay (PLA)

Treatment algorithm

Contributors

Authors

Jason B. Lee, MD
Jason B. Lee

Professor of Dermatology & Cutaneous Biology

Clinical Vice-Chair

Director of Dermatopathology Fellowship

Director of Pigmented Lesion Clinic

Thomas Jefferson University

Philadelphia

PA

Disclosures

JBL declares that he has no competing interests.

Acknowledgements

Dr Jason B. Lee would like to gratefully acknowledge Dr Laurel R. Schwartz, a previous contributor to this topic.

Disclosures

LRS declares that she has no competing interests.

Peer reviewers

Craig G. Burkhart, MD

Clinical Professor

Department of Medicine

Medical College of Ohio

Toledo

OH

Disclosures

CGB declares that he has no competing interests.

Mark Hurt, MD

Dermatologist

Cutaneous Pathology

WCP Laboratories

Missouri

MO

Disclosures

MH declares that he has no competing interests.

Veronique Bataille, MBBS

Consultant Dermatologist

West Herts NHS Trust and King's College London

London

UK

Disclosures

VB declares that she has no competing interests.

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