Medscape is available in 5 Language Editions – Choose your Edition here.


Melanocytic Nevi Treatment & Management

  • Author: Timothy McCalmont, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Dec 16, 2015

Medical Care

Medical treatment is typically ineffective and inappropriate for the management of a benign neoplasm such as a melanocytic nevus.


Surgical Care

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.

Contributor Information and Disclosures

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, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

  1. Natarajan K, Arunachalam P, Sundar D, Srinivas CR. Congenital melanocytic nevi: catch them early!. J Cutan Aesthet Surg. 2013 Jan. 6(1):38-40. [Medline].

  2. Palicka GA, Rhodes AR. Acral melanocytic nevi: prevalence and distribution of gross morphologic features in white and black adults. Arch Dermatol. 2010 Oct. 146(10):1085-94. [Medline].

  3. 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. 1994 Jan. 30(1):40-8. [Medline].

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

  5. 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. 2000 Jun 14. 283(22):2955-60. [Medline].

  6. Zalaudek I, Schmid K, Marghoob AA, et al. Frequency of dermoscopic nevus subtypes by age and body site: a cross-sectional study. Arch Dermatol. 2011 Jun. 147(6):663-70. [Medline].

  7. Menzies SW, Stevenson ML, Altamura D, Byth K. Variables predicting change in benign melanocytic nevi undergoing short-term dermoscopic imaging. Arch Dermatol. 2011 Jun. 147(6):655-9. [Medline].

  8. Patruno C, Scalvenzi M, Megna M, Russo I, Gaudiello F, Balato N. Melanocytic Nevi in Children of Southern Italy: Dermoscopic, Constitutional, and Environmental Factors. Pediatr Dermatol. 2013 May 31. [Medline].

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

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

  11. Longo C, Piana S, Lallas A, Moscarella E, Lombardi M, Raucci M, et al. Routine Clinical-Pathologic Correlation of Pigmented Skin Tumors Can Influence Patient Management. PLoS One. 2015. 10 (9):e0136031. [Medline].

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

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

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

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

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

  17. Carrera C, Puig-Butillè JA, Aguilera P, Ogbah Z, Palou J, Lecha M, et al. Impact of Sunscreens on Preventing UVR-Induced Effects in Nevi: In Vivo Study Comparing Protection Using a Physical Barrier vs Sunscreen. JAMA Dermatol. 2013 May 8. 1-11. [Medline].

  18. Moreno S, Soria X, Martínez M, Martí RM, Casanova JM. Epidemiology of Melanocytic Naevi in Children from Lleida, Catalonia, Spain: Protective Role of Sunscreen in the Development of Acquired Moles. Acta Derm Venereol. 2015 Nov 9. [Medline].

  19. Haenssle HA, Mograby N, Ngassa A, Buhl T, Emmert S, Schön MP, et al. Association of Patient Risk Factors and Frequency of Nevus-Associated Cutaneous Melanomas. JAMA Dermatol. 2015 Nov 4. 1-8. [Medline].

  20. Gellén E, Janka E, Tamás I, B Á, I H, Emri G, et al. Pigmented naevi and sun protection behaviour among primary and secondary school students in an Eastern Hungarian city. Photodermatol Photoimmunol Photomed. 2015 Oct 19. [Medline].

A Clark (dysplastic) nevus with modest variation in pigmentation and irregular borders. Biopsy of the lesion proved no evidence of melanoma.
A compound Clark (dysplastic) nevus with fried egg–like clinical morphology, with a central dark papule flanked by an eccentric more lightly pigmented macular zone.
A conventional (papular) melanocytic nevus occurring within acral skin. Note slight border irregularity, a feature common in association with acral nevi.
A heavily pigmented junctional Spitz nevus, also known as pigmented spindle cell nevus. Note that many Spitz nevi are nonpigmented and may have an angiomalike clinical appearance.
A melanocytic nevus occurring within conjunctival epithelium.
A conventional compound melanocytic nevus. Note the presence of melanocytes with small nuclei in nests along the dermoepidermal junction and the presence of similar melanocytes in nests and syncytia in the subjacent dermis.
This Spitz nevus shows large melanocytes with spindled and epithelioid cytomorphology arrayed along the junctional zone of an acanthotic and hyperkeratotic epithelium.
At higher magnification, this Spitz nevus also demonstrates large, dull-pink globules along the junctional zone. These structures are known as Kamino bodies. Kamino bodies are most commonly observed in association with Spitz nevi but are occasionally observed in melanocytic nevi of other types. Well-formed Kamino bodies are almost never (if ever) found in association with melanoma.
This blue nevus is composed of small dendritic melanocytes. This type of cytomorphology can be seen in so-called common blue nevi and in topographically restricted lesions such as nevus of Ito or nevus of Ota.
This large congenital nevus developed papular areas of pigmentation within it. Microscopic examination proved that the "new" areas represented small nodular collections of benign melanocytes, with no evidence of evolving melanoma.
Histopathologically, a congenital nevus differs from an acquired melanocytic nevus in that melanocytes are often distributed deeply within the reticular dermis, within the adventitial dermis around adnexal elements, and sometimes within the subcutis. This congenital nevus shows a folliculocentric array of melanocytes.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.