Introduction

Globules in pigmented lesions represent clusters of melanocytes or melanin deposits and are generally interpreted as a sign of active growth. While these structures are frequently observed in physiological naevi, they can also manifest in melanomas.

Aim

The objective of this study was to retrospectively analyse the clinical significance of globules as a single factor by correlating their specific dermoscopic characteristics, including distribution, colour and shape, with the final histopathological diagnosis.

Material and methods

We analysed 209 melanocytic lesions with globules from 159 patients examined via dermoscopy between 2017 and 2025. All lesions were surgically excised and underwent histopathological verification. Statistical analysis compared dermoscopic features against the diagnosis using the c2 and Fisher’s exact test, with predictive values quantified using odds ratios.

Results

Histopathological examination of all lesions revealed 192 benign naevi and 17 melanomas. In benign lesions, globules were most common in compound naevi (34.3%), junctional naevi (28.6%), and lentiginous naevi (15.6%). Benign lesions were significantly characterised by overall symmetry (72.9%) and the regularity of the globule shape and size (24.5%), which was absent in all analysed melanomas. On the other hand, malignant lesions were strongly associated with the presence of red globules (11.8% vs. 1.0% in benign cases). Univariate analysis identified red globules as the most significant predictor of malignancy (OR = 12.67; p = 0.0340), while symmetry (OR = 0.26) and globule uniformity (OR = 0.09) were strong protective factors.

Conclusions

The morphology of globules is more diagnostically relevant than their presence alone. Uniformity and symmetry reliably indicate benign naevi, whereas red globules are a strong predictor of melanoma.