Pointillist nevi

Background. Atypical melanocytic nevi and cutaneous melanoma are often mark ed by variation in color. However, there are examples of "benign" explanati ons for irregularities in pigmentation, such as perifollicular hypopigmenta tion or hyperpigmentation. Objective: The purpose of this study was to correlate the clinical and hist ologic features of 3 unusual melanocytic nevi consisting exclusively of mul tiple, tiny, dark brown to black dots on a skin-colored background, which w e have termed pointillist nevi. Methods: Histologic examination was performed of the single pointillist nev us from each of 3 patients (all women; aged 28, 39, and 47 years). Results: The diameters of the pointillist nevi were 2, 3.5, and 5.5 mm. Ind ividual dots were approximately 0.1-0.25 mm. Each of the 3 nevi showed a di fferent histologic correlate for the dots, either (1) discrete, densely pig mented, junctional melanocytic nests; (2) isolated dermal pigmented melanoc ytic nests; or (3) discrete clusters of melanophages in the papillary dermi s. Conclusion: Pointillist nevi are benign melanocytic nevi with histologic co rrelates similar to those of the "brown globules" observed by dermoscopy in uniformly pigmented nevi. However, the dots seen in pointillist nevi can b e visualized without magnification. The clinical and histologic features of pointillist nevi add to the spectrum of unusual patterns of pigmentation t hat may be encountered in benign melanocytic lesions.