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

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

Objective: The objective of this study was to evaluate the clinical/historical/dermatoscopic features of P-VMM in persons with skin of color (SOC).

Method: This cross-sectional study enrolled 200 adults with skin of color 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 similar to each other. No significant difference in trauma was found, nor was there a predilection for weight-bearing areas. Occupations involving manual labor were associated with the presence of P-VMM (P = .019). Dermatoscopically, >90% had a homogeneous pattern, whereas bland ridge, beaded, and fibrillar patterns were rarely seen.

Limitations: Limitations of this study include the lack of histopathology and unbalanced proportions of skin of color subgroups.

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