Lentiginous macules and patches of neurofibromatosis (an approach to better terminology)

Background and objectives Freckles (ephelides) are small, light brown macules of sun-exposed areas in fair-skinned subjects. On the other hand, freckle-like pigmentation of the axilla is a highly characteristic feature of neurofibromatosis. To what extent (clinically and pathologically) are the two pigmentary defects similar! And to what extent are cafe-au-lait patches and heckle-like lesions similar pathologically? Subjects and methods Ten cases of neurofibromatosis and 10 cases of freckles were examined clinically. Two biopsies were taken from the former; one obtained from an axillary heckle-like lesion, and the other from a cafe-au-lait patch. One biopsy only was taken from freckles. The biopsies were processed for haematoxylin and eosin, silver stain and transmission electron microscopy. Results Obvious differences were detected between freckles (ephelides) and heckle-like lesions in cases of neurofibromatosis. Cafe-au-lait patches and heckle-like lesions showed the same pathological changes of lentigo simplex, with increased melanin pigment from the basal layer up to the stratum corneum, moderate elongation of the rete ridges and mild inflammatory infiltrate intermingled with melanophages. Electron microscopy revealed an increase in melanocyte number and the presence of giant melanin granules in heckle-like pigmentation as well as cafe-au-lait patches. These ultrastructural freckles (ephelides) showed an increase in activity but not the number of melanocytes. Conclusions The term heckle-like should be changed to lentiginous macules of neurofibromatosis. On the other hand, the cafe-au-lait patches should be considered as lentiginous patches. Freckles should be restricted to sun-exposed areas in fair-skinned persons only.