Chapter 8: Lumps and Bumps
Flat Pigmented Lesions
Ephelides
Ephelides are more commonly known as freckles and are a marker of UV exposure. They are small 1-3mm light brown macules and occur only on sun-exposed skin in light skinned patients. During times of the year with low UV exposure such as winter ephelides tend to become lighter in colour.
Café-au-lait Macules
Café-au-lait macules (CALM) are named for their light brown colour resembling coffee with milk. They are round to oval light brown patches that vary from ~1.5cm up to 15cm in diameter. CALM are a common finding occurring in up to 1/3 of normal children. An isolated CALM is therefore a benign finding and no further workup or treatment is necessary. The finding of 5 or more CALM can be associated with a syndrome, such as neurofibromatosis, and suggests the need for further evaluation. Referral to opthalmology for evaluation of Lisch nodules is recommended in these cases. Referral to pediatrics, genetics and neurology should be considered for patients with confirmed NF1.
Lentigines
Lentigines are small, sharply circumscribed macules or patches that can vary from tan, dark brown in colour. They usually begin to appear in childhood and increase in number into adulthood. They can occur anywhere on the skin or mucus membranes. Lentigines can in the mouth or on the lips, termed oral and labial melanotic macules respectively. Lentigines are generally darker than both ephelides and CALM. Lentigines are generally benign but can be associated with several syndromes including:
LEOPARD syndrome: (multiple lentigines, EKG abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retardation of growth, and sensorineural deafness)
Carney complex: (multiple lentigines, blue nevi, and endocrine abnormalities and tumors)
Peutz-Jeghers syndrome: (localized mucocutaneous lentigines and intestinal polyps)
