G ITAL DERMATOL VENEREOL 2006;141:355-70 Melanocytic skin lesions in children: dermoscopy patterns and management considerations Children may present a large spectrum of melanocytic skin lesions, of those the great majority are benign nevi, while child- hood melanoma is exceptionally rare. However, due to this and other reasons, the diagnosis of childhood melanoma is often delayed. The optimal management of children presenting with melanocytic skin lesions aims therefore at a two-fold goal: first, to reduce surgical excisions of benign melanocytic nevi, and second, to improve the early diagnosis of melanoma. Der- moscopy has been shown to reach this goal, which explains the increasing use of this noninvasive technique for the daily man- agement of patients with pigmented and nonpigmented skin lesions. Supplementary digital dermoscopic follow-up allows the observation of dynamic changes over time, which improves not only the early diagnosis of melanoma, but allows new insights into the natural evolution of melanocytic nevi. In this article, we reviewed the current literature on the dermoscopy patterns of melanocytic skin lesions in childhood and consid- erations on their management as well as on new concepts of nevogenesis and ongoing controversies regarding childhood melanoma. KEY WORDS: Child - Dermoscopy - Melanoma - Melanocytic nevi - Nevogenesis. C hildren may present a large spectrum of me- lanocytic skin lesions (MSL) that differ signifi- cantly in their epidemiology, clinical appearance, bio- logical dynamic and their eventual associated risk for malignant transformation compared to MSL in adults. The great majority of MSL in childhood are benign, such as congenital melanocytic nevi (CMN), Spitz/ Reed nevi (S/RN), halo nevi (HN) and common acquired melanocytic nevi (AMN). By contrast, melanoma is considered exceptionally rare in the age before puberty. However, epidemiologic studies showed that melanoma in children is seldom diag- nosed in the early stages, perhaps due to a reluctance to accept this diagnosis in this age group. While melanoma before the age of 10 years seems very unusual, the risk tends to continuously increase at the age of puberty between 12 to 15 years and older. 1, 2 In this light, an optimized clinical approach to the management of children exhibiting MSL should aim at a two-fold goal: first, to reduce surgical excisions of benign melanocytic nevi, and second, to improve the early diagnosis of melanoma. Dermoscopy, as an addition to the clinical diagno- sis, enriched the diagnostic armamentarium for pig- mented skin lesions (PSL) and its numerous benefits in the diagnosis and management of PSL have been 1 Department of Dermatology Medical University of Graz, Graz, Austria 2 Department of Dermatology Second University of Naples, Naples, Italy 3 Department of Plastic Surgery Second University of Naples, Naples, Italy 4 Pathologic Anatomy Service Gaetano Rummo General Hospital, Benevento, Italy The authors declare no conflict of interest. Address reprint requests to: I. Zalaudek, MD, Department of Derma- tology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria. E-mail.: iris.zalaudek@meduni-graz.at I. ZALAUDEK 1 , A. SGAMBATO 2 , I. MORDENTE 2 , G. ORLANDINO 3 , T. DE LUCA 2 , G. FERRARA 4 , G. ARGENZIANO 2 Vol. 141 - N. 4 GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA 355