10.5826/dpc.1203a110
text/xml
2160-9381
2007
en
Gerardo Ferrara
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermoscopy
Agminated Nevi Of The Foot With Checkerboard And Blaschkoid Distribution 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-09-01
2022-07-28
2022-09-15
e2022110
Dermatol Pract Concept
Gerardo Ferrara
2022/07/28
10.5826/dpc.1203a110
e2022110
Anatomic Pathology Unit, Hospital of Macerata, Macerata, Italy
2160-9381
dermoscopy
en
e2022110
Torchia D. Melanocytic naevi clustered on normal background skin. Clin Exp Dermatol. 2015;40(3):231-237. DOI: 10.1111/ced.12586. PMID: 25703021.2. Happle R. Loss of heterozygosity in human skin. J Am Acad Dermatol 1999; 41: 143-61. J Am Acad Dermatol. 1999;41(2 Pt 1):143–164. DOI: 10.1016/s0190-9622(99)70042-3. PMID: 10426882.
Agminated Nevi Of The Foot With Checkerboard And Blaschkoid Distribution 
https://dpcj.org/index.php/dpc/article/download/2007/1664
     Agminated Nevi of the Foot with Checkerboard
             and Blaschkoid Distribution
                    Vito Ingordo1, Nicola Licci2, Stefano Caccavale3, Gerardo Ferrara4


1 Outpatients’ Service of Dermatology, District n. 6, Local Health Centre Taranto, Taranto, Italy, Centro Studi GISED, Bergamo, Italy
2 Outpatients’ Service of Dermatology, District n. 1, Local Health Centre Taranto, Taranto, Italy
3 Dermatology Unit, University of Campania “L. Vanvitelli”, Napoli, Italy
4 Anatomic Pathology Unit, Hospital of Macerata, Macerata, Italy



Key words: agminated nevi, acquired melanocytic nevi, congenital melanocytic nevi, acral nevi, dermoscopy
Citation: Ingordo V, Licci N, Caccavale S, Ferrara G. Agminated nevi of the foot with checkerboard and blaschkoid distribution. Dermatol
Pract Concept. 2022;12(3):e2022110. DOI: https://doi.org/10.5826/dpc.1203a110
Accepted: November 8, 2021; Published: July 2022
Copyright: ©2022 Ingordo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/ which permits unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Stefano Caccavale, MD, Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine,
University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy; phone: +39 3336365526; fax: +39 0815468759;
E-mail: stefano85med@libero.it




Introduction                                                             while many other nevi appeared on the lateral, medial and
                                                                         plantar location later on. Dermoscopically, the pigmented
Agminated nevi (AN) are an infrequent group of melano-                   lesions of the lateral margin of the foot (Figure 1A), as well
cytic nevi (MN), whose name derives from the Latin word                  as those located on the fourth and fifth toe and in fourth
agmen, meaning “aggregation.” AN are indeed a clustered                  interdigital space (Figure1B) showed a reticular pattern
group of lesions confined to a localized area of the body.               (­Figure1D) and a transition pattern (reticular plus parallel
Many pigmented lesions have been described in the literature             furrow or lattice-like) (Figure1E). The nevi located on the
as agminated, including Spitz nevi, blue nevi, lentigines, con-          sole (Figure1C) disclosed various dermoscopic patterns:
genital melanocytic nevi (CMN), acquired melanocytic nevi                ­homogeneous, Figure 1F), fibrillary (Figure1G), lattice-like
(AMN). We report a case of a woman with AN of the foot                   pattern (Figure1H), lattice-like pattern with ovoid structure
with a peculiar checkerboard and blaschkoid distribution.                of the furrows (Figure1I).
                                                                              According to the patient medical history and dermoscopic
                                                                         patterns of acral nevi, a diagnosis of uncommon ­coexistence
Case presentation
                                                                         of acral CMN and AMN was done. Unfortunately, the
A 34-years-old woman was seen for multiple MN arranged                   ­patient refused the biopsy and histopathologic examination
in a checkerboard pattern on her right foot. She reported                of some nevi. Anyhow, we decided to plan clinical and der-
that some nevi have been present on the sole since infancy,              moscopic monitoring of our patient every 3–6 months.




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022110                                                                           1
Figure 1. (A) Clinical image of the pigmented lesions of the lateral margin of patient right foot. (B) Close-up picture of agminated nevi located
on the fourth and fifth toe and in fourth interdigital space. (C) Clinical picture of agminated nevi of the right sole. (D and E) Dermoscopy of
agminated nevi on the lateral margin of patient right foot. (F-I) Dermoscopy of agminated nevi of the right sole.




Conclusions                                                                   Besides, we know from the literature that common and
                                                                          dysplastic AMN can be arranged seldom in a checkerboard
According to the dual concept of nevogenesis, small CMN are               pattern, while CMN are commonly arranged along the
present at birth or in the first years of life (so-called tardive         Blaschko lines [1]. Briefly, the checkerboard pattern of acral
small CMN) and are clinically and dermoscopically indistin-               AMN has been explained by an early postzygotic mutational
guishable from early-onset AMN. They are both genetically                 event giving rise to loss of heterozygosity, that is the loss of a
determined, usually share the same dermoscopic features                   normal wild-type allele, and which leads to the expression of
(ie globular pattern) and evolve in nevi with a cobblestone or            a mutant or recessive allele [2].
homogeneous pattern in adult life. These nevi often exhibit                   Although the diagnosis was not confirmed by a biopsy,
overlapping clinical and histopathological features. On the               this is a case with a peculiar arrangement of AN involving
contrary, the “true” AMN develops in adolescence and adult                the acral area.
life and could be influenced by environmental factors, such
as an intermittent sun exposure.
    In our patient, the lesions with a homogeneous                        Reference
brown-grayish or a parallel-furrow pattern combining with
                                                                           1. Torchia D. Melanocytic naevi clustered on normal background
an ovoid shape of the lines, mainly located on the sole along
                                                                              skin. Clin Exp Dermatol. 2015;40(3):231-237. DOI: 10.1111/
Blaschko lines, and appeared in infancy, could be CMN. On                     ced.12586. PMID: 25703021.2. Happle R. Loss of h
                                                                                                                             ­ eterozygosity
the contrary, the lesions with a reticular and checkerboard                   in human skin. J Am Acad Dermatol 1999; 41: 143-61. J Am
pattern, on lateral, medial and interdigital sides of the foot,               Acad Dermatol. 1999;41(2 Pt 1):143–164. DOI: 10.1016/s0190​
appeared in late childhood and adolescence, could be AMN.                     -9622(99)70042-3. PMID: 10426882.




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