Negative pigment network: An additional dermoscopic feature for the diagnosis of melanoma

Maria A. Pizzichetta, Renato Talamini, Ash A. Marghoob, H. Peter Soyer, Giuseppe Argenziano, Riccardo Bono, M. Teresa Corradin, Vincenzo De Giorgi, Marian A. Gonzalez, Isabel Kolm, Andrew W. Kopf, Joseph Malvehy, Niccolò Nami, Margaret Oliviero, Giovanni Pellacani, Susana Puig, Harold Rabinovitz, Pietro Rubegni, Stefania Seidenari, Ignazio StanganelliAndrea Veronesi, Iris Zalaudek, Pierfrancesco Zampieri, Scott W. Menzies

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Background: The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure. Objectives: We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions. Methods: Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN. Results: The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%), melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas. Limitations: Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions. Conclusions: The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.

Original languageEnglish (US)
Pages (from-to)552-559
Number of pages8
JournalJournal of the American Academy of Dermatology
Issue number4
StatePublished - 2013
Externally publishedYes


  • dermoscopy
  • histiocytoma
  • melanocytic nevus
  • melanoma
  • negative pigment network
  • Spitz nevus

ASJC Scopus subject areas

  • Dermatology


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