Dermatology: Practical and Conceptual


Research Letter | Dermatol Pract Concept. 2022;12(2):e2022046 1

Dermatology Practical & Conceptual

Introduction

The deep penetrating nevus (DPN) is a benign, acquired, me-

lanocytic lesion that shows intense pigmentation and infil-

tration into the reticular dermis or subcutaneous tissue [1,2]. 

It affects young individuals before the third decade of life, 

primarily in the head and neck region. DPN usually presents 

as an asymptomatic, well-defined, symmetric, solitary, blue, 

brown, or black, papule or nodule. Due to its clinical and 

histopathological similarities, DPN is often confused with 

malignant melanoma, blue nevus, and Spitz nevus. Since der-

moscopic images of DPN are scarce, its features are not well 

established. Here, we present a case of DPN in a patient with 

Fitzpatrick type V skin that showed the rainbow pattern un-

der polarized immersion dermoscopy. 

Case Presentation

A 13-year-old male with Fitzpatrick type V skin presented 

with a 1-year history of an enlarging lesion on the scalp. On 

examination, there was an 8 x 5 x 5 mm, well-defined, black, 

hyperkeratotic nodule with a central erosion (Figure 1A).  

Polarized dermoscopy with ultrasound gel immersion 

showed a pigmented center surrounded by rainbow patterns 

and bluish-white structureless areas (Figure 1B). An exci-

sional biopsy with a 3-mm margin was performed. On histo-

pathology, a benign-appearing, symmetric tumor composed 

of epithelioid and spindle-shaped melanocytes extending to 

the hypodermis was observed (Figure 2), compatible with 

DPN. At the 24-month follow-up there was no recurrence. 

Conclusions

There are less than 5 dermoscopic descriptions of DPN, in-

cluding a globular blue-brown pattern and a polychromatic 

appearance [1,2]. Polarized immersion dermoscopy is a 

suitable technique to evaluate nodular, melanocytic lesions, 

especially when hyperkeratosis, fissures, and ridges are pres-

ent. The rainbow pattern and the clinical appearance of DPN 

in high Fitzpatrick skin types are rare findings among the 

Dermoscopic Rainbow Pattern in Deep 
Penetrating Nevus

Arturo Robles-Tenorio1, Miriam Sarahí Preciado-Aguiar2, Ricardo Quiñones-Venegas2, 
Francisco Javier Salazar-Torres2

1 Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, I. Morones Prieto 3000, Monterrey, México

2 Instituto Dermatológico de Jalisco “Dr. José Barba Rubio”, Federalismo 3102, Zapopan, México

Key words: nevus, dermoscopy, dermis, pigmentation, rainbow

Citation: Robles-Tenorio A, Preciado-Aguiar MS, Quiñones-Venegas R, Salazar-Torres FJ.  Dermoscopic rainbow pattern in deep 
penetrating nevus. Dermatol Pract Concept. 2022;12(2):e2022046. DOI: https://doi.org/10.5826/dpc.1202a46

Accepted: July 27, 2021; Published: April, 2022

Copyright: ©2022 Robles-Tenorio et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Arturo Robles-Tenorio, 1Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey.  
E-mail: arturo.rt@tec.mx



2 Research Letter | Dermatol Pract Concept. 2022;12(2):e2022046

Figure 2. Histopathology of deep penetrating nevus. A symmetric 

tumor composed of spindle-shaped melanocytes extending to the 

deep dermis was observed (H&E x 40).

available images from the literature. Increasing awareness of 

this condition in skin of color, as well as selecting an ade-

quate dermoscopy technique can help to refine the character-

ization of DPN in underrepresented populations. 

References

1. Strazzula L, Senna MM, Yasuda M, Belazarian L. The deep pen-

etrating nevus. J Am Acad Dermatol. 2014;71(6):1234-1240. 

DOI: 10.1016/j.jaad.2014.07.026. PMID: 25175710.2

2. Cosgarea I, Griewank KG, Ungureanu L, Tamayo A, Siepmann T. 

Deep Penetrating Nevus and Borderline-Deep Penetrating Nevus: 

A Literature Review. Front Oncol. 2020;10:837. DOI: 10.3389/

fonc.2020.00837. PMID: 32509588. PMCID: PMC7251176..

Figure 1. Deep penetrating nevus. (A) Clinical appearance. (B) Polarized immersion dermoscopy revealed a pigmented 

center, rainbow patterns (red ovals), and bluish-white structureless areas.