Frațilă Simona, Țica Ovidiu, Rațiu Ioana Adela, Ardelean Alexandra
Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania.
Clinic of Dermatology, Emergency County Clinical Hospital of Bihor, 37 Republicii Street, 410167 Oradea, Romania.
J Clin Med. 2025 Sep 9;14(18):6366. doi: 10.3390/jcm14186366.
Speckled lentiginous nevus (SLN), also known as nevus spilus (NS), is a variant of congenital melanocytic nevus. Although historically considered to have low malignant potential, recent studies have reported melanoma arising within SLN. This study presents a systematic review of multiple melanomas occurring in association with SLN and includes a representative clinical case. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was performed from 1957 to 2025 using the terms "melanoma" and "nevus spilus" or "speckled lentiginous nevus." Filters were applied for original reports, case series, and case reports. Studies were selected based on predefined criteria, with data independently extracted by two reviewers. A case of a 66-year-old male with three melanomas (two within and one outside SLN) over nine years is also presented. Because the evidence base consisted almost exclusively of case reports and small series, meta-analysis and formal risk-of-bias assessment were not feasible; findings were therefore synthesized qualitatively. We first describe an illustrative case of a 66-year-old male who developed three melanomas (two within and one outside SLN) over a nine-year period, underscoring the challenges of diagnosis and long-term monitoring. In the systematic review, we identified 41 eligible publications describing 51 patients, and in our illustrative case, we identified a total of 52 with melanoma on SLN; 9/52 (17.3%) developed multiple melanomas (24 total), and in our illustrative case, we identified a total of 52. Most were male (seven of nine), with the first melanoma diagnosed at a mean age of 52.4 years. The majority (21/24) occurred within SLNs ≥5 cm and were of the superficial spreading type (16/17 where specified). Of 24 tumors, 19 (79.2%) were synchronous, and among the 16 invasive melanomas, the mean Breslow thickness was 1.17 mm (median 0.95 mm, IQR 0.56-1.40 mm). Large or segmental SLNs may carry a clinically relevant risk for developing multiple melanomas. Regular full-body skin examinations and dermoscopic monitoring are recommended for early detection and management. As the synthesis is based mainly on case reports and small series, these conclusions are necessarily descriptive and exploratory, providing a qualitative mapping of the available evidence rather than definitive risk estimates.
斑疹样雀斑痣（SLN），也称为雀斑样痣（NS），是先天性黑素细胞痣的一种变体。尽管历史上认为其恶性潜能较低，但最近的研究报告了SLN内发生的黑色素瘤。本研究对与SLN相关的多发性黑色素瘤进行了系统综述，并包括一个具有代表性的临床病例。我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了系统综述。使用“黑色素瘤”和“雀斑样痣”或“斑疹样雀斑痣”等术语，对1957年至2025年期间的PubMed、Scopus、科学网和谷歌学术进行了全面检索。对原始报告、病例系列和病例报告应用了筛选条件。根据预先确定的标准选择研究，由两名评审员独立提取数据。还介绍了一例66岁男性在9年内发生3例黑色素瘤（2例在SLN内，1例在SLN外）的病例。由于证据基础几乎完全由病例报告和小系列组成，因此无法进行Meta分析和正式的偏倚风险评估；因此对研究结果进行了定性综合分析。我们首先描述了一例66岁男性的典型病例，该患者在9年期间发生了3例黑色素瘤（2例在SLN内，1例在SLN外），强调了诊断和长期监测的挑战。在系统综述中，我们确定了41篇符合条件的出版物，描述了51例患者，在我们的典型病例中，我们总共确定了52例SLN上有黑色素瘤；9/52（17.3%）发生了多发性黑色素瘤（共24例），在我们的典型病例中，我们总共确定了52例。大多数为男性（9例中的7例），首例黑色素瘤诊断时的平均年龄为52.4岁。大多数（21/24）发生在直径≥5 cm的SLN内，且为浅表扩散型（在有明确说明的病例中为16/17）。在24个肿瘤中，19个（79.2%）为同时性，在16例浸润性黑色素瘤中，平均Breslow厚度为1.17 mm（中位数0.95 mm，四分位间距0.56 - 1.40 mm）。大型或节段性SLN可能具有发生多发性黑色素瘤的临床相关风险。建议定期进行全身皮肤检查和皮肤镜监测，以便早期发现和处理。由于综合分析主要基于病例报告和小系列，这些结论必然是描述性和探索性的，提供了现有证据的定性图谱，而不是确定性的风险估计。
