Melanocytic Nevi Treatment & Management

  • Author: Timothy McCalmont, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 12, 2011
 

Medical Care

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

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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.
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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:
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Diet

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

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Activity

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

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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

Specialty Editor Board

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.

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.

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: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

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, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

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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.
 
 
 
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