Congenital Nevi Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 17, 2012
 

Laboratory Studies

Biopsy confirms a benign or malignant nature in suggestive lesions.

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Imaging Studies

In cases associated with a high index of suspicion for the presence of neurocutaneous melanosis, magnetic resonance imaging of the central nervous system is a useful diagnostic tool. The presence of a large congenital melanocytic nevus in an infant should prompt magnetic resonance imaging testing before age 4 months if it is in a posterior midline location or is associated with multiple satellite nevi.[14]

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Other Tests

A review of dermoscopy patterns in congenital nevi found that most nevi demonstrate a reticular, globular, or reticuloglobular pattern. The findings varied with age and the anatomic location of the nevus, with the globular pattern found more often in younger children and the reticular pattern found in patients aged 12 years or older.[23] The clinical trial, The Role of Dermoscopy in the Classification of Melanocytic Nevi, is currently recruiting.

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Histologic Findings

Because of the increased risk of melanoma associated with congenital nevi, attempts have been made to distinguish congenital nevi from acquired nevi on the basis of histology. Distinguishing histologic features include (1) involvement by nevus cells of deep dermal appendages and neurovascular structures (including hair follicles, sebaceous glands, arrector pili muscles, and within walls of blood vessels), (2) extension of nevus cells to deep dermis and subcutaneous fat, (3) infiltration of nevus cells between collagen bundles, and (4) a nevus cell–poor subepidermal zone.[24, 25, 26] Note the images below.

The photomicrograph shows a symmetrical broad prolThe photomicrograph shows a symmetrical broad proliferation of melanocytes in the papillary and reticular dermis with maturation with progressive descent; splaying between collagen bundles; and permeation of muscles of hair erection, blood vessels, and adnexa (hematoxylin and eosin stain, 20X magnification). Higher-power view of the previous image (hematoxylHigher-power view of the previous image (hematoxylin and eosin stain, 40X magnification).

In contrast to congenital nevi, acquired nevi are usually composed of nevus cells that are limited to the papillary and upper reticular dermis and do not involve the appendages.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher J Steen, MD  Dermatologist, Private Practice

Christopher J Steen, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi

Disclosure: Nothing to disclose.

Jerry Rothenberg, MD  Clinical Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; President, Director, New Jersey Dermatopathology Laboratory, Inc

Disclosure: Nothing to disclose.

Isabelle Thomas, MD  Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange

Isabelle Thomas, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

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.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

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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The photomicrograph shows a symmetrical broad proliferation of melanocytes in the papillary and reticular dermis with maturation with progressive descent; splaying between collagen bundles; and permeation of muscles of hair erection, blood vessels, and adnexa (hematoxylin and eosin stain, 20X magnification).
Higher-power view of the previous image (hematoxylin and eosin stain, 40X magnification).
 
 
 
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