Furrow or Ridge? Dermoscopy of acral pigmented lesions in pediatrics

Acral nevi are melanocytic lesions located on the palms and soles that represent a frequent reason for pediatric consultation and a common source of family concern due to the difficulty of clinical assessment. Although historically associated with an increased risk of melanoma, melanoma remains extremely rare in childhood. Acral nevi can be classified as congenital or acquired, both usually showing benign evolutionary features. Dermoscopy is a key diagnostic tool, as it enables differentiation between benign patterns and signs suggestive of malignancy through the identification of characteristic acral skin structures such as furrows, ridges, and acrosyringia. In addition, educating families about warning signs using the classic ABCDE rule and its modified pediatric version is essential, as pediatric melanoma often differs from adult melanoma. Knowledge of these criteria may help reduce unnecessary invasive procedures and improve early detection of potentially malignant lesions.