Dermatology - Dysplastic Melanocytic Nevus
Dysplastic nevi (DN) are distinct acquired pigmented lesions characterized by the abnormal growth of melanocytes, which can potentially develop into superficial spreading melanoma. They can appear spontaneously or as a component of a compound melanocytic nevus. These nevi are clinically different from common acquired nevi, since they are larger, have more varied colors, asymmetrical outlines, and uneven borders. They also have distinct histologic findings. Lesions typically develop in later infancy compared to common acquired nevomelanocytic nevi (NMN), which initially manifest in late childhood, shortly before puberty. Additional lesions persistently emerge over an extended period of time. While common moles typically exhibit a similar stage of growth in a certain area of the body, such as being junctional, compound, or dermal, dysplastic nevi (DN) tend to deviate from this pattern. For instance, DN may have a combination of large and small, flat and raised, tan, and extremely dark lesions. The diagnosis is established through the clinical identification of characteristic and unique skin lesions, which are then further validated using dermoscopy. Once a diagnosis of DN is confirmed in a family member, it is advisable to also assess siblings, children, and parents for the condition. The differential diagnosis include congenital nevomelanocytic nevi, common acquired nevomelanocytic nevi (moles), superficial spreading malignant melanoma, melanoma in situ, lentigo maligna, Spitz nevus, and pigmented basal cell carcinoma. Dysplastic nevus (DN) should be surgically removed with precise margins. The use of laser or other physical destruction methods should be avoided since they do not allow for histopathologic verification of diagnosis. It is crucial to closely monitor patients with DN in the context of familial melanoma, and it is essential to conduct regular photographic follow-up. It is important to educate patients about the distinct characteristics of DN, malignant melanoma, and typical acquired NMN as digital dermoscopy is the most dependable method. Advise patients to abstain from sunbathing or using tanning salons and to apply sunscreens while being exposed to the outdoors.
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