Evolution of a naevus spilus.

The evolution of a naevus spilus is documented with serial photographs over a 12-year period. The lesion was remarkable for increasing numbers of macules and papules within the background of the café-au-lait macule. Biopsy of a new papule showed lentiginous melanocytic hyperplasia without atypia. We advise photography and periodic follow-up of large, clinically atypical or changing naevi spili. Indications for considering biopsy of naevi spili, irrespective of size, include atypical clinical features or change in one of the hyperpigmented macules or papules, eventuating in an atypical clinical appearance.