Dermoscopy of atypical melanocytic lesions in children

When assessing pigmented lesions in children, dermoscopy can often present more questions than answers. In his latest video update, Dr Vincenzo Piccolo explores how to interpret atypical dermoscopic findings in paediatric melanocytic lesions, and why “atypical” doesn’t always mean malignant.

Drawing on real cases and current evidence, Dr Piccolo highlights several important principles:

• Atypical does not always mean dangerous. Many Spitzoid and congenital naevi in children can display irregular, asymmetric, or multi-component patterns on dermoscopy, yet remain benign.

• Context matters. Lesion morphology, patient age, and evolution over time are critical to avoid unnecessary excisions.

• Recognising true warning signs. While rare, paediatric melanoma does occur, often presenting with features such as nodularity, ulceration, or an eccentric area of blue-white colour within a congenital naevus.

• Know the limits of dermoscopy. In certain lesions (for example, congenital nail matrix naevi before age five), dermoscopic atypia may have little diagnostic value.

"Dermoscopic atypia does not equal biological atypia. The goal is to refine specificity to better recognise the small subset of lesions that truly warrant concern."

Watch the full presentation to deepen your understanding of atypical patterns in paediatric pigmented lesions, and to sharpen your diagnostic confidence when managing these challenging cases in practice.

Watch the presentation

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About Dr Vincenzo Piccolo 

Dr Vincenzo Piccolo is a dermatologist in private practice as well as responsible for the Paediatric Dermatology Service, Dermatology Unit, University of Campania, Naples, Italy. At the university, Dr Piccolo teaches the advanced course Management and Treatment of Skin Cancer and is also in the Paediatrics Residency School. He is the author of 92 scientific publications in international journals. 

 

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