Continuing medical education
The dysplastic nevus: From historical perspective to management in the modern era: Part I. Historical, histologic, and clinical aspects

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Since its description in the 1970s, the dysplastic nevus has been a source of confusion, and whether it represents a precursor to melanoma remains a controversial subject. Although a Consensus Conference in 1992 recommended that the term “dysplastic nevus” no longer be used, the histologic diagnosis continues to present a therapeutic quandary for dermatologists and other physicians, and there remains significant variation in clinical management. In part I of this continuing medical education review, we will discuss the historical origins of the term, the evidence for its distinct histologic basis, and its clinical significance.

Section snippets

The basis of the controversy

Key points

  1. The term “dysplastic nevus” is confusing and may have unintended meanings

  2. 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

  1. The field can be traced back to three seminal papers published in the late 1970s

  2. 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

  1. Dysplastic nevi exhibit distinct histologic features that are well described

  2. 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

  1. The prevalence of dysplastic nevi is unclear, because most studies did not include histologic confirmation

  2. 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

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  • Cited by (0)

    Dr Grossman is supported by the Department of Dermatology and the Huntsman Cancer Foundation.

    Conflicts of interest: None declared.

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