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Difference between revisions of "Acral nevus"
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*Palms ''or'' soles. | *Palms ''or'' soles. | ||
*May be confused with [[malignant melanoma]].<ref name=pmid19318796>{{Cite journal | last1 = Massi | first1 = G. | last2 = Vellone | first2 = VG. | last3 = Pagliarello | first3 = C. | last4 = Fabrizi | first4 = G. | title = Plantar melanoma that mimics melanocytic nevi: a report of 4 cases with lymph node metastases and with review of positive and negative controls. | journal = Am J Dermatopathol | volume = 31 | issue = 2 | pages = 117-31 | month = Apr | year = 2009 | doi = 10.1097/DAD.0b013e318194c904 | PMID = 19318796 }}</ref> | *May be confused with [[malignant melanoma]].<ref name=pmid19318796>{{Cite journal | last1 = Massi | first1 = G. | last2 = Vellone | first2 = VG. | last3 = Pagliarello | first3 = C. | last4 = Fabrizi | first4 = G. | title = Plantar melanoma that mimics melanocytic nevi: a report of 4 cases with lymph node metastases and with review of positive and negative controls. | journal = Am J Dermatopathol | volume = 31 | issue = 2 | pages = 117-31 | month = Apr | year = 2009 | doi = 10.1097/DAD.0b013e318194c904 | PMID = 19318796 }}</ref> | ||
**>45 years old with a "compound nevus"... consider melanoma.<ref name=pmid19318796/> | |||
Note: | Note: | ||
*''Volar'' refers to the palmar aspect ''or'' plantar aspect.<ref>URL: [http://www.medterms.com/script/main/art.asp?articlekey=9907 http://www.medterms.com/script/main/art.asp?articlekey=9907]. Accessed on: 14 January 2013.</ref> | *''Volar'' refers to the palmar aspect ''or'' plantar aspect.<ref>URL: [http://www.medterms.com/script/main/art.asp?articlekey=9907 http://www.medterms.com/script/main/art.asp?articlekey=9907]. Accessed on: 14 January 2013.</ref> | ||
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*Pigmented lesion - usually small. | *Pigmented lesion - usually small. | ||
Grossing note: | |||
*Should be bisected perpendicular to the dermatoglyphs (ridges).<ref name=pmid22703907/> | *Should be bisected perpendicular to the dermatoglyphs (ridges).<ref name=pmid22703907/> | ||
**Lesions sectioned parallel to the ridges (on microscopy) may appear to have confluent junctional nests (leading to the diagnosis of melanoma). | **Lesions sectioned parallel to the ridges (on microscopy) may appear to have confluent junctional nests (leading to the diagnosis of melanoma). | ||
===Image=== | |||
*[http://www.dermoscopy.org/consensus/2a_12.asp Acral nevus with parallel furrow-pattern (dermoscopy.org)] | |||
==Microscopic== | ==Microscopic== | ||
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*Nests in the ridges raise the suspicion of melanoma. | *Nests in the ridges raise the suspicion of melanoma. | ||
**Memory device "ridges are risky, furrows are fine".<ref name=pmid22703907>{{Cite journal | last1 = Elston | first1 = D. | title = Practical advice regarding problematic pigmented lesions. | journal = J Am Acad Dermatol | volume = 67 | issue = 1 | pages = 148-55 | month = Jul | year = 2012 | doi = 10.1016/j.jaad.2012.04.006 | PMID = 22703907 }}</ref> | **Memory device "ridges are risky, furrows are fine".<ref name=pmid22703907>{{Cite journal | last1 = Elston | first1 = D. | title = Practical advice regarding problematic pigmented lesions. | journal = J Am Acad Dermatol | volume = 67 | issue = 1 | pages = 148-55 | month = Jul | year = 2012 | doi = 10.1016/j.jaad.2012.04.006 | PMID = 22703907 }}</ref> | ||
*Large (diameter) lesions (>10 mm) should prompt consideration of melanoma.<ref name=pmid19318796/> | |||
*Depth >1 mm should prompt consideration of melanoma.<ref name=pmid19318796/> | |||
DDx: | DDx: | ||
*Acral lentiginous [[melanoma]]. | *Acral lentiginous [[melanoma]]. | ||
==Sign out== | |||
<pre> | |||
Lesion, Sole of Left Foot, Excision: | |||
- Benign acral compound nevus. | |||
</pre> | |||
===Alternate=== | |||
<pre> | |||
Skin Lesion, Plantar Aspect Left Foot, Excision: | |||
- Benign compound nevus, completely excised. | |||
</pre> | |||
===Micro=== | |||
The sections show melanocytes predominantly in the superficial dermis. Rare melanocytic nests are seen at the dermal-epidermal junction. There is no pagetoid spread of melanocytes in the epidermis at the edge of the lesion. The lesion is symmetrical in its architecture. Superficially, melanocytes are in nests and pigment is present. The melanocytes mature with depth. No mitotic activity is appreciated. The lesion is clear of the margin (clearance ~ 3 mm). | |||
==See also== | ==See also== | ||