eMedicine Specialties > Dermatology > Benign Neoplasms

Nevi, Melanocytic: Treatment & Medication

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

Treatment

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.

Consultations

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.
  • Clinical guideline summaries are as follows:

Diet

Diet is not known to be related to the development of melanocytic nevi.

Activity

Activity level is unrelated to the development or occurrence of melanocytic nevi.

Medication

In current practice, medications have no role in the diagnosis or management of melanocytic nevi.

More on Nevi, Melanocytic

Overview: Nevi, Melanocytic
Differential Diagnoses & Workup: Nevi, Melanocytic
Treatment & Medication: Nevi, Melanocytic
Follow-up: Nevi, Melanocytic
Multimedia: Nevi, Melanocytic
References
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References

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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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