48,466
edits
Difference between revisions of "Dysplastic nevus"
Jump to navigation
Jump to search
no edit summary
| (7 intermediate revisions by the same user not shown) | |||
| Line 4: | Line 4: | ||
| Width = | | Width = | ||
| Caption = Dysplastic nevus. [[H&E stain]]. | | Caption = Dysplastic nevus. [[H&E stain]]. | ||
| Micro = "bridges" between sides of rete ridges, draping fibrous tissue/fibrous tissue wraps around the rete ridges ("lamellar fibrosis"), nuclear atypia - see ''grading'' section, +/-junctional component (cells in the epidermis at the DE junction) larger than the intradermal component - ''shoulder phenomenon'' | | Micro = "bridges" between the sides of the rete ridges, draping fibrous tissue/fibrous tissue wraps around the rete ridges ("lamellar fibrosis"), nuclear atypia - see ''grading'' section, +/-junctional component (cells in the epidermis at the DE junction) larger than the intradermal component - ''shoulder phenomenon'' | ||
| Subtypes = junctional, compound | | Subtypes = junctional, compound | ||
| LMDDx = [[melanoma in situ]], [[malignant melanoma]], [[compound melanocytic nevus]], [[atypical lentiginous nevus]] | | LMDDx = [[melanoma in situ]], [[malignant melanoma]], [[compound melanocytic nevus]], [[atypical lentiginous nevus]] | ||
| Line 30: | Line 30: | ||
'''Dysplastic nevus''', abbreviated '''DN''', is a common [[melanocytic lesion]] that is closely associated with [[malignant melanoma]]. | '''Dysplastic nevus''', abbreviated '''DN''', is a common [[melanocytic lesion]] that is closely associated with [[malignant melanoma]]. | ||
It is also known as '''dysplastic melanocytic nevus''', '''Clark nevus''', and '''nevus with architectural disorder'''. | It is also known as '''atypical nevus''', '''dysplastic melanocytic nevus''', '''Clark nevus''', and '''nevus with architectural disorder'''. | ||
In 1992, the term ''nevus with architectural disorder'' was recommended by the American National Institutes of Health (NIH);<ref name=pmid1515516>{{Cite journal | title = Diagnosis and treatment of early melanoma. NIH Consensus Development Conference. January 27-29, 1992. | journal = Consens Statement | volume = 10 | issue = 1 | pages = 1-25 | month = | year = | doi = | PMID = 1515516 }}</ref> however, it is not widely adopted.<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> Also, based on a 2003 survey, it is the preferred term by only 15% of dermatologists.<ref name=pmid14568850>{{Cite journal | last1 = Fung | first1 = MA. | title = Terminology and management of dysplastic nevi: responses from 145 dermatologists. | journal = Arch Dermatol | volume = 139 | issue = 10 | pages = 1374-5 | month = Oct | year = 2003 | doi = 10.1001/archderm.139.10.1374 | PMID = 14568850 }}</ref> | |||
==General== | ==General== | ||
| Line 39: | Line 39: | ||
**Most melanoma cases do not have evidence of a pre-existing (dysplastic) nevus.<ref name=pmid21715047>{{Cite journal | last1 = Longo | first1 = C. | last2 = Rito | first2 = C. | last3 = Beretti | first3 = F. | last4 = Cesinaro | first4 = AM. | last5 = Piñeiro-Maceira | first5 = J. | last6 = Seidenari | first6 = S. | last7 = Pellacani | first7 = G. | title = De novo melanoma and melanoma arising from pre-existing nevus: in vivo morphologic differences as evaluated by confocal microscopy. | journal = J Am Acad Dermatol | volume = 65 | issue = 3 | pages = 604-14 | month = Sep | year = 2011 | doi = 10.1016/j.jaad.2010.10.035 | PMID = 21715047 }}</ref> | **Most melanoma cases do not have evidence of a pre-existing (dysplastic) nevus.<ref name=pmid21715047>{{Cite journal | last1 = Longo | first1 = C. | last2 = Rito | first2 = C. | last3 = Beretti | first3 = F. | last4 = Cesinaro | first4 = AM. | last5 = Piñeiro-Maceira | first5 = J. | last6 = Seidenari | first6 = S. | last7 = Pellacani | first7 = G. | title = De novo melanoma and melanoma arising from pre-existing nevus: in vivo morphologic differences as evaluated by confocal microscopy. | journal = J Am Acad Dermatol | volume = 65 | issue = 3 | pages = 604-14 | month = Sep | year = 2011 | doi = 10.1016/j.jaad.2010.10.035 | PMID = 21715047 }}</ref> | ||
*Large numbers of these nevi (10-100) are seen in ''dysplastic nevus syndrome''.<ref name=omim155600>{{OMIM|155600}}</ref> | *Large numbers of these nevi (10-100) are seen in ''dysplastic nevus syndrome''.<ref name=omim155600>{{OMIM|155600}}</ref> | ||
**Individuals with this syndrome have an increased risk of melanoma and approximately one third of their melanomas arise from a '' | **Individuals with this syndrome have an increased risk of melanoma and approximately one third of their melanomas arise from a ''dysplastic nevus''. The other two thirds arise ''de novo''. | ||
Clinical:<ref name=pmid22220461>{{Cite journal | last1 = Dediol | first1 = I. | last2 = Bulat | first2 = V. | last3 = Zivković | first3 = MV. | last4 = Marković | first4 = BM. | last5 = Situm | first5 = M. | title = Dysplastic nevus--risk factor or disguise for melanoma. | journal = Coll Antropol | volume = 35 Suppl 2 | issue = | pages = 311-3 | month = Sep | year = 2011 | doi = | PMID = 22220461 }}</ref> | Clinical:<ref name=pmid22220461>{{Cite journal | last1 = Dediol | first1 = I. | last2 = Bulat | first2 = V. | last3 = Zivković | first3 = MV. | last4 = Marković | first4 = BM. | last5 = Situm | first5 = M. | title = Dysplastic nevus--risk factor or disguise for melanoma. | journal = Coll Antropol | volume = 35 Suppl 2 | issue = | pages = 311-3 | month = Sep | year = 2011 | doi = | PMID = 22220461 }}</ref> | ||
| Line 62: | Line 62: | ||
**Joining of three or more adjacent rete ridges = suspicious for melanoma.<ref name=pmid15509670/> | **Joining of three or more adjacent rete ridges = suspicious for melanoma.<ref name=pmid15509670/> | ||
*Draping fibrous tissue - "lamellar fibrosis" - collagen deep to epidermis. | *Draping fibrous tissue - "lamellar fibrosis" - collagen deep to epidermis. | ||
* | *Nuclear atypia - often moderate (small nucleoli visible with 20x objective) - see ''grading'' section. | ||
*+/-Junctional component (cells in the epidermis at the DE junction) larger than the intradermal component - ''shoulder phenomenon''. | *+/-Junctional component (cells in the epidermis at the DE junction) larger than the intradermal component - ''shoulder phenomenon''. | ||
| Line 105: | Line 105: | ||
**A two-tier grading system also exists (''low-grade'' (leave it alone) / ''high-grade'' (cut it out)). | **A two-tier grading system also exists (''low-grade'' (leave it alone) / ''high-grade'' (cut it out)). | ||
**Some pathologists do not grade dysplastic nevi. | **Some pathologists do not grade dysplastic nevi. | ||
*Normal melanocytes have a nucleus that is ~70% the size of a resting basal keratocyte nucleus. | |||
==Sign out== | ==Sign out== | ||
| Line 129: | Line 130: | ||
- DYSPLASTIC JUNCTIONAL MELANOCYTIC NEVUS WITH MILD NUCLEAR ATYPIA. | - DYSPLASTIC JUNCTIONAL MELANOCYTIC NEVUS WITH MILD NUCLEAR ATYPIA. | ||
- NEAREST MARGIN (LATERAL MARGIN) 1 MM. | - NEAREST MARGIN (LATERAL MARGIN) 1 MM. | ||
</pre> | |||
A comment for lesions with mild cytologic atypia: | |||
<pre> | |||
COMMENT: | |||
Excision of any clinically apparent residual components of the lesion | |||
is suggested. | |||
</pre> | </pre> | ||