Continuing medical educationThe dysplastic nevus: From historical perspective to management in the modern era: Part I. Historical, histologic, and clinical aspects
Section snippets
The basis of the controversy
Key points The term “dysplastic nevus” is confusing and may have unintended meanings In our opinion, the terms “dysplastic nevus” and “atypical nevus” should not be interchangeable
Since the advent of the term in the late 1970s, “dysplastic nevi” (DN) have been a source of both confusion and controversy. The heart of the matter is whether (and to what extent) DN represent premalignant lesions that will progress to melanoma.1 There are those who view DN as a discreet entity of clinical significance,2, 3, 4
Origin of the concept
Key points The field can be traced back to three seminal papers published in the late 1970s Atypical nevi in melanoma-prone families were described, and given different “syndrome” names
Cawley17 is credited with the first description of familial melanoma based on cases of cutaneous melanoma in a father and two of his three children. There were subsequent reports of melanoma-prone families in the 1960s and early 1970s.18, 19 However, the concept of the DN and its association with melanoma came from clinical
Basic histopathology
Key points Dysplastic nevi exhibit distinct histologic features that are well described Melanocyte cytology and distribution, along with dermal characteristics, distinguish dysplastic nevi from common nevi
Although some melanocytic neoplasms may be difficult if not impossible to classify under conventional light microscopy, there is abundant literature describing the histologic nature of DN. In their original description of DN, Clark et al6 enumerated four main features: (1) atypical melanocytic
How common are dysplastic nevi?
Key points The prevalence of dysplastic nevi is unclear, because most studies did not include histologic confirmation Dysplastic nevi may be less common than common nevi in the general population, but more common than common nevi in “high-risk” patients
The prevalence of DN in the general population is unknown, because most epidemiologic studies have been based on clinical examination without histologic confirmation of dysplasia. A study by Steijlen et al66 based on autopsy cases estimated the prevalence of
References (123)
- et al.
How common is the atypical mole syndrome phenotype in apparently sporadic melanoma?
J Am Acad Dermatol
(1993) - et al.
In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions
J Am Acad Dermatol
(1987) - et al.
Sensitivity, specificity, and diagnostic accuracy of three dermoscopic algorithmic methods in the diagnosis of doubtful melanocytic lesions: the importance of light brown structureless areas in differentiating atypical melanocytic nevi from thin melanomas
J Am Acad Dermatol
(2007) - et al.
Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme
Hum Pathol
(1991) - et al.
Validity of the histopathological criteria used for diagnosing dysplastic naevi. An interobserver study by the pathology subgroup of the EORTC Malignant Melanoma Cooperative Group
Eur J Cancer
(1993) - et al.
Correlating architectural disorder and cytologic atypia in Clark (dysplastic) melanocytic nevi
Hum Pathol
(1999) - et al.
Positive reactivity of dysplastic melanocytes with a monoclonal antibody against melanoma melanosomes, MoAb HMSA-2
J Invest Dermatol
(1988) - et al.
Management of dysplastic nevi: a survey of fellows of the American Academy of Dermatology
J Am Acad Dermatol
(2002) - et al.
Histologic atypia in clinically benign nevi. A prospective study
J Am Acad Dermatol
(1990) - et al.
A multiobserver, population-based analysis of histologic dysplasia in melanocytic nevi
J Am Acad Dermatol
(1994)
Grading of atypia in nevi: correlation with melanoma risk
Mod Pathol
Histopathologic characteristics of dysplastic nevi. Limited association of conventional histologic criteria with melanoma risk group
J Am Acad Dermatol
Clinical diagnosis of dysplastic melanocytic nevi. A clinicopathologic correlation
J Am Acad Dermatol
Interobserver concordance in discriminating clinical atypia of melanocytic nevi, and correlations with histologic atypia
J Am Acad Dermatol
Correlation between clinical atypia and histologic dysplasia in acquired melanocytic nevi
J Am Acad Dermatol
The dysplastic melanocytic nevus: a prevalent lesion that correlates poorly with clinical phenotype
J Am Acad Dermatol
Dysplastic nevi on the scalp of prepubertal children from melanoma-prone families
J Pediatr
Natural history of dysplastic nevi
J Am Acad Dermatol
Acral eruptive nevi after chemotherapy in children with acute lymphoblastic leukemia [in Spanish]
An Pediatr (Barc)
Widespread eruptive dermal and atypical melanocytic nevi in association with chronic myelocytic leukemia: case report and review of the literature
J Am Acad Dermatol
Prevalence of common “acquired” nevocytic nevi and dysplastic nevi is not related to ultraviolet exposure
J Am Acad Dermatol
The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer
J Invest Dermatol
Influence of UVB therapy on dermoscopic features of acquired melanocytic nevi
J Am Acad Dermatol
Comet assay demonstrates a higher ultraviolet B sensitivity to DNA damage in dysplastic nevus cells than in common melanocytic nevus cells and foreskin melanocytes
J Invest Dermatol
The dysplastic nevus controversy: it is not about the nevus per se but one's belief in the multistep tumorigenesis theory
Am J Dermatopathol
The dysplastic nevus syndrome: our definition
Am J Dermatopathol
Dysplastic melanocytic nevi: a reproducible histologic definition emphasizing cellular morphology
Mod Pathol
Dysplastic naevi—an alternative view
Histopathology
What naevus is dysplastic, a syndrome and the commonest precursor of malignant melanoma? A riddle and an answer
Histopathology
Origin of familial malignant melanomas from heritable melanocytic lesions. ‘The B-K mole syndrome’
Arch Dermatol
Precursor lesions in familial melanoma
Semin Oncol
Precursor lesions in familial melanoma. A new genetic preneoplastic syndrome
JAMA
Diagnosis and treatment of early melanoma
JAMA
National Institutes of Health Consensus Development Conference Statement on Diagnosis and Treatment of Early Melanoma, January 27-29, 1992
Am J Dermatopathol
What is early melanoma?
Am J Dermatopathol
A critique of an N.I.H. Consensus Development Conference about “early” melanoma
Am J Dermatopathol
What to call the LEJC-BFV nevus?
J Cutan Pathol
War and peace in the realm of dysplastic nevi
J Cutan Pathol
The melanocytic nevus described by Clark et al. What is its nature? What should it be named? An answer from history and from logic
J Cutan Pathol
Variability in nomenclature used for nevi with architectural disorder and cytologic atypia (microscopically dysplastic nevi) by dermatologists and dermatopathologists
J Cutan Pathol
Genetic aspects of malignant melanoma
AMA Arch Derm Syphilol
Family studies of malignant melanoma and associated cancer
Surg Gynecol Obstet
Clinical characteristics of the genetic variety of cutaneous melanoma in man
Cancer
Familial atypical multiple mole-melanoma syndrome
J Med Genet
Dysplastic nevus syndrome: a phenotypic association of sporadic cutaneous melanoma
Cancer
Dysplastic nevi. Occurrence in first- and second-degree relatives of patients with ‘sporadic’ dysplastic nevus syndrome
Arch Dermatol
The genetics of malignant melanoma: lessons from mouse and man
Nat Rev Cancer
Genotype-phenotype relationships in U.S. melanoma-prone families with CDKN2A and CDK4 mutations
J Natl Cancer Inst
Genotype/phenotype and penetrance studies in melanoma families with germline CDKN2A mutations
J Invest Dermatol
A natural history of melanomas and dysplastic nevi: an atlas of lesions in melanoma-prone families
Cancer
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Dr Grossman is supported by the Department of Dermatology and the Huntsman Cancer Foundation.
Conflicts of interest: None declared.