Patterns of distribution of giant congenital melanocytic nevi (GCMN): The 6B rule

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Abstract

Background

Garment-related terms have been used to describe the pattern of distribution of giant congenital melanocytic nevi (GCMN).

Objective

We sought to describe patterns of distribution of GCMN and propose a classification scheme.

Methods

Photographic records of patients with GCMN from the Hospital Clinic of Barcelona were analyzed and a classification based on observed GCMN distribution patterns was created. The classification was independently applied by 8 observers to cases found in the literature. The interobserver agreement was assessed.

Results

Among 22 patients we observed 6 repeatable patterns of distribution of GCMN, which we termed the “6B”: bolero (involving the upper aspect of the back, including the neck), back (on the back, without involvement of the buttocks or shoulders), bathing trunk (involving the genital region and buttocks), breast/belly (isolated to the chest or abdomen without involvement of bolero or bathing trunk distributions), body extremity (isolated to extremity), and body (both bolero and bathing trunk involvement). Our literature search found 113 cases of GCMN, which we were able to classify into 1 of the 6B patterns with an overall kappa of 0.89.

Limitations

Some patterns occur infrequently with a dearth of images available for analysis.

Conclusions

The anatomic distribution of GCMN occurs in 6 recognizable and repeatable patterns.

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