Dysplastic nevus physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

The only way to diagnose dysplastic nevus is to remove tissue and check it for dysplasia.

Physical Examination and Diagnosis

Skin Examination

Features that characterize a nevus as dysplastic linclude:[1][2][3][4][5]

  • Asymmetry (one half of the lesion does not match the other in terms of shape or color).
  • Notched, irregular, or ill-defined borders fading into surrounding skin
  • Variegated color, with areas of pink, tan, brown, or dark brown.
  • Diameter in one dimension >5 mm.
  • Prominent macular component, sometimes with a papular center ("fried egg" or "target" appearance).
  • Mammillated (cobblestone) topography.

Progression to melanoma most often manifests as a new focal area of deep pigmentation or firm elevation.

Signature nevus

  • In individuals with multiple nevi, the predominant group of nevi that share similar clinical and dermoscopic features defines the "signature nevus".

Ugly duckling" sign

  • The identification of nevi that appear different from the signature nevi, called "ugly ducklings" or "outliers", has been suggested as a screening method for the detection of melanoma in patients with many nevi, including those with many atypical nevi

References

  1. Lee H, Kwon K (March 2017). "A mathematical analysis of the ABCD criteria for diagnosing malignant melanoma". Phys Med Biol. 62 (5): 1865–1884. doi:10.1088/1361-6560/aa562f. PMID 28036304.
  2. Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS (April 2015). "Early detection of melanoma: reviewing the ABCDEs". J. Am. Acad. Dermatol. 72 (4): 717–23. doi:10.1016/j.jaad.2015.01.025. PMID 25698455.
  3. Bønnelykke-Behrndtz ML, Schmidt H, Christensen IJ, Damsgaard TE, Møller HJ, Bastholt L, Nørgaard PH, Steiniche T (December 2014). "Prognostic stratification of ulcerated melanoma: not only the extent matters". Am. J. Clin. Pathol. 142 (6): 845–56. doi:10.1309/AJCPW56PHGLFTKZC. PMID 25389339.
  4. Callender GG, McMasters KM (2011). "What does ulceration of a melanoma mean for prognosis?". Adv Surg. 45: 225–36. PMID 21954690.
  5. Tromme I, Sacré L, Hammouch F, Richez P, Degryse JM, Speybroeck N (December 2018). "Melanoma diagnosis: predictive value of macroscopic changes observed by the patient". Melanoma Res. 28 (6): 611–617. doi:10.1097/CMR.0000000000000496. PMID 30192302.

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