Related to this topic: Leaflets | Patient+ | UK Guidelines | Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Black and Brown Skin Lesions
Black and brown skin lesions can be considered as melanocytic neoplasms. The important task is to exclude malignant melanoma that is increasing in incidence and is potentially fatal.1
The commonest pigmented lesions include:
Common naevi
Most adults will have approximately 30 moles which they have been acquiring from infancy. New common moles rarely develop after age 40 years and any that do are suspicious.
Typical features of common naevi are:
- Symmetrical in area
- Even brown colouring (light or dark)
- Sharp margin
- <5 mm in diameter
- Profile varying from flat to pedunculated
Any one with >50 moles is at greatly increased risk of malignant melanoma, that may or may not arise from an existing mole. These patients need careful skin monitoring including baseline skin photography. Any lesion that starts to change colour, bleed, itch, be painful or increase in size needs excisional biopsy.
Atypical moles
Also known as dysplastic naevi, these are found in approx.1 in 12 Caucasians and do not usually become evident until puberty. These are easily mistaken for malignant melanoma because of their:
- Lack of symmetry
- Lack of sharp margin
- Size >6 mm
- Variation in colour within the lesion

Unlike common moles they continue to appear throughout life and occur in areas not often exposed to the sun e.g. buttocks. They are a strong, independent risk factor for malignant melanoma (MM) especially when they are present in numbers (12% risk over 10 years). Patients should be very careful with sunlight and undergo regular skin surveillance. Excision of dysplastic naevi is not performed routinely.
Congenital naevi
These are found in approx. 1% of newborns and characteristically have:
- Variegated brown colour
- Sharp edge
- Rough surface
- Hair growing out of them
They are classified according to size:
- <1.5 cm - small
- 1.5 to 20 cm - medium
- >20 cm - large
Very large ones are known as giant naevi. Patients with large congenital naevi have a risk of up to 10% of developing MM often by age 10 years. These appear either within the lesion or as CNS melanoma.2 Treatment is either excision or close monitoring. Laser treatment is also now available. 3
Malignant melanoma
Characterised by 'ABCDE' rule:
- Asymmetrical shape
- Irregular border
- Variegated colour
- Diameter changing
- Enlargement
However, not all these feature may be present and if MM cannot be excluded then excision biopsy is required.4

Blue naevus
Despite its name, this lesion is usually a shade of blue-black. It is also called the Tièche-Jadassohn naevus.5 These occur in children and adolescents as solid papules or nodule of 10 mm in diameter with a round or oval, irregular shape. Mostly found on the back of the hand or top of foot, also on head, lower back and buttocks. Newly occurring lesion may need excision biopsy to exclude nodular MM. 6

Spitz naevus
This is a dark brown, smooth, firm papule or nodule that rarely occurs after age 40 years. These grow rapidly on the head and neck. Require careful excision with 5mm border to avoid recurrence.7
Document references
- Cutaneous Melanoma, SIGN (2003)
- Au S; CNS melanoma; emedicine September 2006
- Dave R, Mahaffey PJ; Combined early treatment of congenital melanocytic naevus with carbon dioxide and NdYag lasers. Br J Plast Surg. 2004 Dec;57(8):720-4. [abstract]
- Cancer Research UK; Overview of Malignant Melanoma; Updated January 2007
- Whonamedit.com, Tieche-Jadassohn naevus.; Historical and biographical information on the lesion's eponymous discoverers.
- Colour Atlas and Synopsis of Clinical Dermatology. Fitzpatrick TB et al. McGraw-Hill 2001.
- Strungs I; Common and uncommon variants of melanocytic naevi. Pathology. 2004 Oct;36(5):396-403. [abstract]
Internet and further reading
- Univ. Iowa; Dept. of Dermatology - College of Medicine, Dermatology Differential Diagnosis by Morphology, Differential by colour (blue).
- Roth R, Acker S; Blue Nevi; eMedicine (2007)
DocID: 1867
Document Version: 21
DocRef: bgp997
Last Updated: 8 May 2007
Review Date: 7 May 2009
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineInformation leaflets related to this topic (^ top of page)
Cancer of the Skin - MelanomaMedical reference articles in PatientPlus related to this topic (^ top of page)
Blue Naevus
Junctional Naevus
Malignant Melanoma (all sites)UK guidelines related to this topic (^ top of page)
Guidelines on Malignant Melanoma Of SkinOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Medical equipment products related to this topic (^ top of page)

Books related to this topic (^ top of page)

Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
