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In patients with very low GH output, the stronger stimulation from GHRP-2 may be needed to produce a meaningful GH pulse

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Present at birth or clinically apparent in early childhood May be large (giant nevi) Silhouette Symmetric Sharp peripheral borders Junctional component Similar to common nevi but may be broader Possible associated papillomatous epidermal hyperplasia Possible pagetoid melanocytes Stromal component Evidence of maturation Frequently involves reticular dermis, may extend into subcutis Patterns of dermal involvement: diffuse, interstitial, or perivascular Adnexal involvement is common Nerve involvement may be seen Schwannian differentiation may be prominent Cellular or proliferative nodules may be present Heterologous elements may be present in large nevi Cellular or proliferative nodules may develop in congenital nevi, especially giant congenital nevi

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