Melanocytic Nevi Treatment & Management
- Author: Timothy McCalmont, MD; Chief Editor: Dirk M Elston, MD more...
Medical treatment is typically ineffective and inappropriate for the management of a benign neoplasm such as a melanocytic nevus.
Melanocytic nevi can be surgically removed for cosmetic considerations or because of concern regarding the biological potential of a lesion.
Melanocytic nevi removed for cosmesis are often removed by tangential or shave excision.
Punch excision can be used for relatively small lesions.
Large lesions may require complete excision with sutured closure, even if known to be benign, because lesions exceeding 1 cm in diameter often are not amenable to the shave technique.
A simple conservative excisional biopsy with a sutured closure is usually the most expeditious means to diagnosis if concern exists regarding the possibility of melanoma. If the lesion is found to be benign, then, ordinarily, no further treatment is required.
Providing the pathologist with a complete excisional specimen affords him or her the best opportunity to make an accurate diagnosis because all available criteria (including low-magnification attributes such as size, circumscription, and symmetry) can be applied to the lesion.
If a partial biopsy is obtained, information regarding the size and appearance of the lesion that underwent biopsy should be forwarded to the interpreting pathologist or dermatopathologist.
Interpreting partial biopsy samples of melanoma is not prudent, especially for pathologists with limited experience in the microscopic evaluation of melanocytic neoplasms; not uncommonly, it can lead to a false diagnosis of nevus. If a biopsy specimen represents a partial sample of a larger lesion, the clinician should clearly indicate this to the dermatopathologist or pathologist on the requisition form. If any atypical feature is present, a second opinion from an expert dermatopathologist should be pursued.
Studies have clearly demonstrated that experience is an important factor in the clinical diagnosis of cutaneous pigmented lesions, including both melanocytic nevi and melanoma.
Any generalist or primary care physician should have a low threshold for referral to a dermatologist when questions exist regarding the clinical diagnosis and management of a pigmented lesion. If a dermatologist is not locally available, a generalist with a digital camera can find teledermatology resources readily available via the Internet.
Once a biopsy has been performed on a lesion and a histopathological diagnosis has been made, strong consideration should be given to the possibility of consultation with a board-certified dermatopathologist if the primary diagnosis has been issued by a general pathologist. This is especially true if the diagnosis of melanoma has been forwarded or if the histopathological diagnosis is discordant with the original clinical diagnosis.
Consultation with an experienced physician, typically a dermatologist, is indicated if any concern exists regarding a pigmented lesion.
Diet is not known to be related to the development of melanocytic nevi.
Activity level is unrelated to the development or occurrence of melanocytic nevi.
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