eMedicine Specialties > Dermatology > Benign Neoplasms

Nevi, Melanocytic: Follow-up

Author: Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology
Contributor Information and Disclosures

Updated: Nov 20, 2009

Follow-up

Further Inpatient Care

Inpatient care is not required in the diagnosis or evaluation of patients with melanocytic nevi.

Deterrence/Prevention

Preliminary evidence suggests that childhood ultraviolet radiation exposure is correlated with the number of melanocytic nevi that develop in subsequent years.12 If this is presumed to be true, then measures to limit ultraviolet light exposure (eg, wearing sunscreen, providing sun education) might yield reductions in the incidence of melanocytic nevi and melanoma over time.13

Complications

No known complications are directly related to the presence of melanocytic nevi; however, minor surgical intervention during the biopsy or the removal of such lesions can lead to common complications (eg, infection, hemorrhage).

Prognosis

The prognosis associated with any single melanocytic nevus is favorable because these lesions are benign neoplasms with no potential for malignant behavior, unless evolution of melanoma occurs.

Patients with multiple melanocytic nevi or sizable melanocytic nevi appear to have an increased lifetime risk of melanoma, with the risk increasing in rough proportion to the size and/or number of lesions.

Patient Education

Patients should be educated regarding self-examination of melanocytic nevi. Teach patients to use an ABCDE approach, in which the patient assesses the asymmetry, border irregularity, color, diameter (size), and evolution of any given lesion. Some authorities add an F for "funny looking," suggesting that "ugly duckling" lesions that differ from the patient's other nevi should be evaluated. An explanation of any changes and observations for changes are important. Nevi can change in diameter, outline, and/or color, and they can acquire an itch or begin to bleed. These changes require evaluation by a trained observer to determine the malignant potential of a lesion.

Patient handouts that illustrate these changes and their significance are available from the American Academy of Dermatology. The greater the degree of asymmetry, the greater the irregularity in the border, the greater the variation in color, and the greater the diameter of the lesion, the more cause for concern.

For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article Mole Removal.

Miscellaneous

Medicolegal Pitfalls

Misdiagnosis clinically is the greatest potential pitfall. Melanoma is one of the great clinical imitators and can manifest with great clinical diversity. Failure to have a high index of suspicion and failure to evaluate new or changing lesions that are not unequivocally benign via biopsy, with subsequent interpretation by a competent, certified dermatopathologist, can lead to liability.

Histopathological overdiagnosis refers to the interpretation of a benign lesion as melanoma, which is a tendency of some pathologists. Overdiagnosis can prompt detailed and unwarranted clinical investigation of the patient, can provoke patient anxiety with respect to longevity, and can trigger unnecessary surgery, including reexcision and lymph node sampling. Unnecessary surgery and complications such as chronic lymphedema may result.

Histopathologic underdiagnosis refers to the interpretation of melanoma as a benign lesion. Underdiagnosis can yield considerable delays that may permit metastatic spread before appropriate extirpation is possible.

Clinicians and patients can avoid clinical and histopathological misdiagnosis by adhering closely to standard practices in the evaluation of melanocytic neoplasms and by seeking appropriate consultations with experienced colleagues.

Special Concerns

The prototypical melanoma is readily diagnosable by the ABCDE approach, based on its asymmetry, irregular border, irregular color, large diameter, and evolution. However, these clinical parameters are largely useless in 3 instances, as follows:

  • For amelanotic melanomas, in which pigmentation is largely or entirely absent
  • For desmoplastic melanomas, which sometimes manifest without an associated in situ component and may also lack clinical pigmentation
  • For ulcerated and inflamed melanomas, especially nodular lesions, which may clinically simulate common lesions (eg, basal cell carcinoma, pyogenic granuloma) because of masking by the presence of ulceration and/or inflammation
 


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References
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References

  1. Kelly JW, Rivers JK, MacLennan R, Harrison S, Lewis AE, Tate BJ. Sunlight: a major factor associated with the development of melanocytic nevi in Australian schoolchildren. J Am Acad Dermatol. Jan 1994;30(1):40-8. [Medline].

  2. Harrison SL, MacLennan R, Buettner PG. Sun exposure and the incidence of melanocytic nevi in young Australian children. Cancer Epidemiol Biomarkers Prev. Sep 2008;17(9):2318-24. [Medline].

  3. Gallagher RP, Rivers JK, Lee TK, Bajdik CD, McLean DI, Coldman AJ. Broad-spectrum sunscreen use and the development of new nevi in white children: A randomized controlled trial. JAMA. Jun 14 2000;283(22):2955-60. [Medline].

  4. Khera S, Sarkar R, Jain RK, Saxena AK. Neurocutaneous melanosis: an atypical presentation. J Dermatol. Jul 2005;32(7):602-5. [Medline].

  5. Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion--when and how. J Am Acad Dermatol. Nov 2008;59(5):852-71. [Medline].

  6. Ko CJ, McNiff JM, Glusac EJ. Melanocytic nevi with features of Spitz nevi and Clark's/dysplastic nevi ("Spark's" nevi). J Cutan Pathol. Oct 2009;36(10):1063-8. [Medline].

  7. Ackerman AB, Milde P. Naming acquired melanocytic nevi. Common and dysplastic, normal and atypical, or Unna, Miescher, Spitz, and Clark?. Am J Dermatopathol. Oct 1992;14(5):447-53. [Medline].

  8. Ackerman AB, Magana-Garcia M. Naming acquired melanocytic nevi. Unna's, Miescher's, Spitz's Clark's. Am J Dermatopathol. Apr 1990;12(2):193-209. [Medline].

  9. [Guideline] The Cancer Council Australia, Australian Cancer Network, Sydney and New Zealand Guidelines Group. Congenital melanocytic naevi. Clinical practice guidelines for the management of melanoma in Australia and New Zealand. National Guideline Clearinghouse. 2008.

  10. [Guideline] Finnish Medical Society Duodecim. Skin cancer. In: EBM Guidelines. Evidence-Based Medicine. National Guideline Clearinghouse. May 2005.

  11. [Guideline] Scottish Intercollegiate Guidelines Network. Cutaneous melanoma. National Guideline Clearinghouse. Jul 2003.

  12. Harth Y, Friedman-Birnbaum R, Linn S. Influence of cumulative sun exposure on the prevalence of common acquired nevi. J Am Acad Dermatol. Jul 1992;27(1):21-4. [Medline].

  13. Richtig E, Jung E, Asback K, Trapp M, Hofmann-Wellenhof R. Knowledge and perception of melanocytic nevi and sunburn in young children. Pediatr Dermatol. Sep-Oct 2009;26(5):519-23. [Medline].

  14. Barnhill RL, Argenyi ZB, From L, et al. Atypical Spitz nevi/tumors: lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome. Hum Pathol. May 1999;30(5):513-20. [Medline].

  15. Casso EM, Grin-Jorgensen CM, Grant-Kels JM. Spitz nevi. J Am Acad Dermatol. Dec 1992;27(6 Pt 1):901-13. [Medline].

  16. Cesinaro AM, Foroni M, Sighinolfi P, Migaldi M, Trentini GP. Spitz nevus is relatively frequent in adults: a clinico-pathologic study of 247 cases related to patient's age. Am J Dermatopathol. Dec 2005;27(6):469-75. [Medline].

  17. DeDavid M, Orlow SJ, Provost N, et al. A study of large congenital melanocytic nevi and associated malignant melanomas: review of cases in the New York University Registry and the world literature. J Am Acad Dermatol. Mar 1997;36(3 Pt 1):409-16. [Medline].

  18. Ferrara G, Argenziano G, Soyer HP, et al. The spectrum of Spitz nevi: a clinicopathologic study of 83 cases. Arch Dermatol. Nov 2005;141(11):1381-7. [Medline].

  19. Florell SR, Meyer LJ, Boucher KM, et al. Nevus distribution in a Utah melanoma kindred with a temperature-sensitive CDKN2A mutation. J Invest Dermatol. Dec 2005;125(6):1310-2. [Medline].

  20. Gallagher RP, McLean DI. The epidemiology of acquired melanocytic nevi. A brief review. Dermatol Clin. Jul 1995;13(3):595-603. [Medline].

  21. Harrison SL, Buettner PG, MacLennan R. Body-site distribution of melanocytic nevi in young Australian children. Arch Dermatol. Jan 1999;135(1):47-52. [Medline].

  22. James MR, Roth RB, Shi MM, et al. BRAF polymorphisms and risk of melanocytic neoplasia. J Invest Dermatol. Dec 2005;125(6):1252-8. [Medline].

  23. Kincannon J, Boutzale C. The physiology of pigmented nevi. Pediatrics. Oct 1999;104(4 Pt 2):1042-5. [Medline].

  24. Lazova R, McNiff JM, Glusac EJ. Under the microscope. Surgeons, pathologists, and melanocytic nevi. Clin Plast Surg. Jul 2000;27(3):323-9, vii. [Medline].

  25. Mooi WJ. Cutaneous melanocytic naevus versus melanoma: pitfalls, surprises, dilemmas. Eur J Surg Oncol. Dec 1999;25(6):622-7. [Medline].

  26. Murali R, McCarthy SW, Scolyer RA. Blue nevi and related lesions: a review highlighting atypical and newly described variants, distinguishing features and diagnostic pitfalls. Adv Anat Pathol. Nov 2009;16(6):365-82. [Medline].

  27. Sagebiel RW. Pigmented lesion pathology: the specimen and its report. A personal and probably biased approach. Pathology (Phila). 1994;2(2):281-98. [Medline].

  28. Shea CR, Prieto VG. Recent developments in the pathology of melanocytic neoplasia. Dermatol Clin. Jul 1999;17(3):615-30, ix. [Medline].

  29. Zaal LH, Mooi WJ, Klip H, van der Horst CM. Risk of malignant transformation of congenital melanocytic nevi: a retrospective nationwide study from The Netherlands. Plast Reconstr Surg. Dec 2005;116(7):1902-9. [Medline].

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Further Reading

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Keywords

nevi, nevus, melanocytic nevi, nevocellular nevus, melanocytic nevus, Spitz nevus, atypical nevus, mole, dysplastic nevus, nevus spilus, congenital nevus, blue nevus, Spitz nevus, Spitz's nevi, Spitz's nevus, Clark nevus, Unna nevus, Miescher nevus, Clark nevi, Unna nevi, Miescher nevi, Clark's nevus, Unna's nevus, Miescher's nevus, Clark's nevi, Unna's nevi, Miescher's nevi, atypical mole, dysplastic nevi, dysplastic nevus

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Contributor Information and Disclosures

Author

Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology
Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Apsara Consulting fee Independent contractor

Medical Editor

James J Nordlund, MD, Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine
James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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