Dermoscopic features of combined melanocytic nevi Vincenzo de Giorgi 1 , Daniela Massi 2 , Camilla Salvini 1 , Elisa Trez 1 , Francesca Mannone 1 and Paolo Carli 1 1 Department of Dermatology, and 2 Department of Human Pathology and Oncology, University of Florence, Florence, Italy Vincenzo de Giorgi, MD, Department of Dermatology, University of Florence, Via degli Alfani, 37-50121 Firenze, Italy Tel: þ39 055 2758757 Fax: þ39 055 2758757 e-mail: vdegi@tin.it Accepted March 18, 2004 Abstract: In order to investigate the possible role of dermoscopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Two dermatologists expert in dermoscopy retrospectively evaluated all images based on the presence of dermoscopic findings to analyze which epiluminescence microscopy features were more frequently associated with each type of combined nevus. Dermoscopy may provide useful information in the non-invasive diagnosis of combined nevi, allowing a conservative management, but this may be limited to combined nevi including a blue nevus component. Conversely, combined nevi including a Spitz nevus component may be difficult to classify even by dermoscopy, thus requiring careful monitoring or surgical excision. de Giorgi V, Massi D, Salvini C, Trez E, Mannone F, Carli P. Dermoscopic features of combined melanocytic nevi. J Cutan Pathol 2004; 31: 600–604. # Blackwell Munksgaard 2004. Combined nevus has been variously defined in the literature by different authors. 1,2 The term goes back to 1977 when it first appeared in a study by Gartmann and Muller 3 in which the authors coined the expres- sion ‘combined nevus’ through which they meant to indicate a melanocytic lesion showing the histological characteristics of two or more melanocytic nevi such that they could be variously combined: common melanocytic nevus, common blue nevus, cellular blue nevus, and Spitz nevus. The possibility of a combin- ation between acquired and congenital nevi is contro- versial in literature. 4 The combination of different histological patterns can result in a clinical skin lesion showing asymmetry and irregular border and color, possibly mimicking a melanoma, 5 but it may also appear like a blue nevus, a common nevus, or a Spitz nevus, depending upon its dominant histologic com- ponent. Therefore, a combined nevus usually cannot be diagnosed with only clinical examination as such. Epiluminescence microscopy (ELM) or dermo- scopy is an in vivo non-invasive technique for the diagnosis of pigmented skin lesions, which has shown to improve the diagnostic accuracy of pig- mented skin lesions when compared to clinical examin- ation alone. 6,7 In order to investigate the possible role of dermo- scopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Materials and methods In the period 1997–2001, 29 combined nevi were consecutively excised at the Pigmented lesion clinic (PLC) of the University of Florence, Italy. We had dermoscopic images of 15 of combined nevi (51.7%) which represented the study series. Histopathologic diagnoses were made by the same staff of pathologists with great expertise in the field of melanocytic lesions. Before excision, clinical images had been obtained by F50 Nikon camera with objective AF micro Nikkor 60. For dermoscopy, images were taken by means of a special equipment (lens Dermaphot with standard magnification 10, Heine, Optotechnick, Herrsching, Germany, set up on a camera Nikon F50) in order to obtain high-quality dermoscopic (oil immer- sion technique) images according to standardized pro- cedure. 8 Two dermatologists expert in dermoscopy retrospectively evaluated all images based on the pres- ence of dermoscopic findings to analyse which ELM J Cutan Pathol 2004: 31: 600–604 Copyright # Blackwell Munksgaard 2004 Blackwell Munksgaard. Printed in Denmark Journal of Cutaneous Pathology 600