Introduction
Signature naevi are predominant group of naevi with similar clinical appearance in a patient. Eclipse naevus is a type of signature naevus and it is clinically characterized by a tan center and a brown peripheral rim (1). Although it is mostly seen on the trunk of adults, this type of naevus has also been described on the scalp of children (2). Because eclipse naevi can have some of the ABCDE (asymmetry, border irregularity, color variegation, diameter ≥6 mm, and/or evolution) criteria for melanoma, removal might be recommended, however they are actually benign and they only need observation. In this report a child with eclipse naevi on scalp was described and literature data about eclipse naevi was reviewed.
Case
Fifteen years old boy presented with brown lesions on the scalp which appeared suddenly within one month. The lesions were asymptomatic. The patient had skin phototype III. Melanoma risk factor evaluation was unremarkable except history of intermittent ultraviolet exposure for 3 years. Dermatological examination revealed 8 similar naevi with tan homogenous centers and brown peripheral rims on scalp (Figure 1). Dermatoscopy of the lesions demonstrated central homogenous tan areas that were structureless except focal globules and regular brown pigment networks in the periphery (Figure 2). Excisional biopsy of a lesion was done and histopathological diagnosis was consistent with benign compound melanocytic naevus. With these findings diagnosis of eclipse naevus was made. And as all lesions were similar, eclipse naevus was thought to be signature naevus of the patient. And clinical follow up was recommended for remaining naevi.
Discussion
The term “eclipse naevus” was ?rstly described in 2001 by Schaffer et al. as “a type of melanocytic naevus that is two-tone and has an irregular outline, but is benign” (3). Eclipse naevus is mostly observed in adults in third decades (2). However it has also been described on the scalp of children (2,3,4). In a study evaluating 88 scalp naevi of 39 children, the main clinical patterns included eclipse (n=18), cockade (n=3), solid brown (n=42) and solid pink (n=25) naevi (4). Clinically eclipse naevus is characterized by a tan center and a brown peripheral rim. Peripheral rim can be discontinuous leading to asymmetry, irregular pigmentation and irregular outline (1). Its diameter is frequently greater than 6 mm (5). The most common location is the trunk but other locations such as the arms and legs have also been reported (2). Pink eclipse naevus is a variant of eclipse naevus with a pink central portion that is seen in fair-skinned individuals (1). Etiopathogenesis of eclipse naevi is not known exactly. The effect of immune responses is suggested to play a role (6). Some people with eclipse naevi also have cockade naevi that is characterized by a small central pigmented portion, an intervening nonpigmented zone and a peripheral pigmented ring (1,2,3,2,3,4,5,6). Some authors believe that eclipse and cockade naevi may be two different clinical variants of the same process triggered by sun exposure (5). Histopathological examination of eclipse naevus is consistent with compound naevus with junctional shoulder and intradermal component. The junctional shoulder shows prominent pigmentation and there is decreased junctional pigmentation over the central intradermal component. Sometimes in the central portion prominent ?brosis of the papillary dermis is observed. Dysplastic changes are not observed (2,3). Despite potential worrisome features such as diameter larger than 6 mm, irregular outline, asymmetry and irregular pigmentation, eclipse naevi are benign compound naevi (2,3,3,4,5). Dermatologists frequently have tendency to recommend the excision of melanocytic naevi located on scalp, resulting in formation of permanent scars and localized hair loss. However eclipse naevi actually do not need surgical excision (5). In conclusion, to be aware of this kind of naevi is important to prevent unnecessary concern and surgical procedures. Instead of unnecessary surgical procedures we recommend regular skin examinations in children with eclipse naevi on scalp. Ethics Informed Consent: Informed consent was obtained from the patient. Authorship Contributions Surgical and Medical Practices: Nilay Duman, Gül Erkin Özaygen, Gonca Elçin, Concept: Nilay Duman, Design: Nilay Duman, Data Collection or Processing: Nilay Duman, Gül Erkin Özaygen, Gonca Elçin, Analysis or Interpretation: Nilay Duman, Gül Erkin Özaygen, Gonca Elçin, Literature Search: Nilay Duman, Writing: Nilay Duman, Conflict of Interest: No conflict of interest was declared by the authors, Financial Disclosure: The authors declared that this study has received no financial support, Hakem Degerlendirmesi: Editörler kurulu disinda olan kisiler tarafindan degerlendirilmistir.
