Background: Acral melanocytic nevi have parallel patterns on dermoscopy; however, it is not understood why pigment distributions exhibit such patterns. Aim: To clarify the reason why melanin distributions in acral melanocytic nevi exhibit a parallel pattern on dermoscopy. Methods: A serial sectioning perpendicular to the skin markings was performed, and each section was stained with modified Fontana-Masson staining to pick out melanin granules. These sections were then reconstructed to three-dimensional images by an image processing software, and these three-dimensional images were analyzed. Results: Melanin columns in the cornified layer were mainly seen in the dermoscopic images of acral melanocytic nevi. In the parallel-furrow pattern melanin columns were arranged vertically, and in the fibrillar pattern they were arranged in a slanting fashion. Conclusion: Melanin columns in the cornified layer, not melanin in the basal layer, mainly contribute to the dermoscopic pattern of acral melanocytic nevi.
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