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OVERVIEW

image SUMMARY

  • Dysplastic nevi are a subtype of acquired melanocytic nevi that share morphologic features observed in superficial spreading melanoma; they often have a diameter of at least 5 mm, variegation in pigmentation, and irregular borders.

  • Although dysplastic nevi are not obligate precursor lesions to melanoma, their presence is a phenotypic risk marker that identifies individuals at heightened risk for developing melanoma.

  • Regular follow-up of these lesions can be augmented by a variety of technologies that can help differentiate dysplastic nevi from melanoma and ultimately help identify early melanoma while at the same time avoiding unnecessary biopsies.

image DON’T FORGET

  • The majority of melanomas in patients with dysplastic nevi arise de novo in normal non–nevus-associated skin.

image CLINICAL PEARLS

  • Objective follow-up to help detect new and changing lesions in patients with dysplastic nevi can be augmented with baseline total body photography and digital dermoscopy images.

  • Dysplastic nevi displaying features concerning for melanoma should be biopsied.

image PATIENT EDUCATION POINTS

  • Given the increased risk of melanoma in patients with dysplastic nevus syndrome or the atypical mole syndrome, patients and their care team should be educated about the importance of periodic skin cancer surveillance examinations. Patients should be encouraged to examine their own skin on a monthly basis and to inform their primary care provider of any changes or symptomatic lesions.

INTRODUCTION

The dysplastic nevus (DN), first described in 1978,1 continues to fuel much clinical, histopathologic, and molecular research. Despite four decades of study, clinicians and pathologists still debate the validity of the existence of this entity. Early efforts to quell the debate around the concept of “dysplasia” led to the proposal that the term atypical be used instead.2 Unfortunately, this did not alleviate the controversy and may, in fact, have led to even more confusion, with some clinicians using the term atypical for nevi displaying at least some of the clinical “ABCD” morphologic features associated with superficial spreading melanoma (asymmetry, border irregularity, color variegation, and diameter of at least 6 mm) and some pathologists using the term dysplastic to describe nevi displaying variable degrees of cellular atypia with or without architectural disorder. Although today the terms atypical nevus and dysplastic nevus are often used interchangeably, the term dysplastic nevus, which had become entrenched in the dermatology lexicon, continues to be favored by most. Even among those clinicians who believe that DN is a unique melanocytic nevus subtype, clear and unambiguous clinical and histologic criteria defining and differentiating this entity from other nevus subtypes in a consistent and reproducible manner are lacking. Much of the controversy regarding DN stems from both diagnostic and biologic uncertainty. Although this uncertainty persists, it is generally agreed that individuals with multiple acquired nevi displaying increased variability in their morphologies and at least one nevus greater than 5 mm in diameter define a population of individuals with ...

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