Eruptive Acral Nevi Secondary to Treatment With Chemotherapy

A 4-year-old boy undergoing maintenance chemotherapy for acute lymphoblastic leukemia presented with a new eruption of junctional nevi on the dorsum of both feet (Figure). The lesions were brought to the dermatologist’s attention by the patient’s parent during a follow-up for eczematous dermatitis. At the time of presentation, the patient’s chemotherapy regimen followed the Children's Oncology Group protocol AALL0932, comprising mercaptopurine, methotrexate, vincristine, dexamethasone, and trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis jirovecii pneumonia. Differential diagnoses included eruptive nevi and genodermatoses associated with melanocytic nevi, including Noonan syndrome, Carney complex, and familial atypical multiple mole-melanoma syndrome.¹ Physical examination revealed scant melanocytic nevi outside the new eruptions and was otherwise noncontributory. The patient had even skin pigmentation, normal facies, and age-appropriate cognition. Dermoscopy results revealed small, evenly pigmented globules typical of eruptive nevi. Due to the patient’s age and the benign appearance of the nevi using a dermatoscope, histologic examination was not conducted. Given the appearance of the lesions, the patient’s history of immunosuppression, and the lack of findings suggestive of an underlying genetic syndrome, this presentation was considered most in keeping with eruptive nevi.