A Cross-Sectional Study of Physiologic Volar Melanotic Macules: Demographic, Historical, Clinical and Dermatoscopic Features of a Common yet Neglected Pigmentary Variant in Individuals with Skin of Color.

Abstract

Background: Physiologic volar melanotic macules (P-VMM) are understudied. Trauma has been a suggested predisposing factor. Little has been published over the last several decades.

Objective: To evaluate clinical/historical/dermatoscopic features of P-VMM in Skin-of-Color (SOC) persons.

Method: This cross-sectional study enrolled 200 SOC adults from Jamaica and Massachusetts. In those with P-VMM, clinical and dermatoscopic images were taken with size, color, localization, distribution, and dermatoscopic patterns recorded. Questionnaires recorded demographic, occupational and trauma history in both groups.

Results: For those with P-VMM, most (91.8%, n=89) were Black followed by mixed-race (5.2%, n=5), Indian Asian (2.1%, n=2), and Hispanic (1%, n=1). The F:M ratio was 2.5:1. Both palms/soles were involved in 67%. Light-to-dark brown, round/oval macules/patches were common and were similar to each other. No significant difference in trauma was found, nor predilection for weight-bearing areas. Occupations involving manual labor were associated with the presence of P-VMM (p=0.019). Dermatoscopically, >90% had a homogenous pattern, while bland ridge, beaded, and fibrillar patterns were rarely seen.

Limitations: Lack of histopathology and unbalanced proportions of SOC subgroups.

Conclusion: P-VMM is common in Black adults. It lacks association with major trauma or predilection for weight-bearing sites. Dermoscopy primarily reveals a homogenous pattern.