Méndez AY, Jurado SF, Peralta PML, Medina BA, Simancas LLT, Alcalá PD

Language: Spanish
References: 27
Page: 5-13
PDF size: 238.61 Kb.

ABSTRACT

Introduction: Dysplastic melanocytic nevus is nevus with atypical clinical findings that is associated with a high risk of malignant transformation; it is a potential precursor of melanoma. The prevalence of dysplastic nevi is difficult to determine; it ranges from 2 to 53%, depending on both the clinical and histological diagnostic criteria used in the different studies that have been conducted. Dermoscopy is a noninvasive diagnostic method that increases the accuracy in the diagnosis of pigmented lesions. Histopathological examination is considered the gold standard for the diagnosis of dysplastic nevi. The atypical clinical features do not correlate properly with the presence of histological dysplasia. Objective: To determine the most frequent clinical features in dysplastic nevus and the most prevalent dermatoscopic signs. Material and methods: It is an observational, comparative, transversal and descriptive study that was conducted in patients with a diagnosis of dysplastic nevi in the service of Dermatooncology at the Pascua Dermatological Center (CDP) between June 2013 to May 2014. Clinical and dermoscopic images of cases of dysplastic nevi confirmed and not confirmed by histopathology were evaluated individually by two dermatooncology experts. Results: Dysplastic nevus diagnosis was performed in 50 cases in 41 patients; the diagnosis of dysplastic nevi lesions was confirmed by histopathology in 22 cases; three were diagnosed as melanoma and, therefore, eliminated from the study. Two groups were formed: the nevus confirmed as dysplastic by histopathology and the non-dysplastic, and the clinical and dermoscopic characteristics of both groups were compared. We found that the presence of two or more colors is most often seen in dysplastic nevi (86.4%). In dermoscopy, the reticular globular pattern is the most common. (7/22). Conclusions: No clinical or dermoscopic statistically significant characteristics were found to guide us to the definitive diagnosis of dysplastic nevi. However, dermoscopy is a useful tool that increases diagnostic accuracy. Limitations: More studies are needed, using a higher number of lesions in patients with more common phototypes in our population.

REFERENCES

1. Becuwe C et al. Naevus pigmentaries. Encycl Méd Chir. Paris, France: Elsevier; 2003. pp. 98, 590.

2. Miller AJ, Mihm MC Jr. Melanoma. N Engl J Med. 2006; 355: 51-65.

3. Bolognia J et al. Dermatología. 2a ed. Madrid: Editorial Mosby; 200. pp. 1709-1733.

4. Fung MA. Terminology and management of dysplastic nevi: responses from 145 dermatologist. Arch Dermatol. 2003; 139: 1374-1375.

5. Clark WH Jr, Reimer RR, Greene MH et al. Origin of familial malignant melanomas from heritable melanocytic lesions: the B-K mole syndrome. Arch Dermatol. 1978; 114 (5): 732-738.

6. Ackerman AB, Magaña-García M. Naming acquired melanocytic nevi. Unna’s, Miescher’s, Spitz’s Clark’s. Am J Dermatopathol. 1990; 12: 193-209.

7. Alcalá PD et al. Nevos melanocíticos y no melanocíticos. Rev Cent Dermatol Pascua. 2010; 19: 49-58.

8. NIH Consensus conference: diagnosis and treatment of early melanoma. JAMA. 1992; 2 51: 1314-1319.

9. Holly EA, Kelly JW, Shpall SN et al. Number of melanocytic nevi as a major risk factor for malignant melanoma. J Am Acad Dermatol. 1987; 17: 459-468.

10. Markovic SN, Erickson LA, Rao RD et al. Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention and diagnosis. Mayo Clin Proc. 2007; 82: 364-380.

11. Burgués CM, Llamas MR. Factores de riesgo y detección temprana del melanoma maligno en pacientes con nevos melanocíticos. Más Dermatol. 2011; 14: 5-13.

12. Naeyaert JM, Brochez L. Dysplastic nevi. N Engl J Med. 2003; 349: 2233-2240.

13. Friedman RJ, Farber MJ, Warycha MA. The “displasic” nevus. Clin Dermatol. 2009; 27: 103-115.

14. Roesch A, Burgdorf W, Stolz W et al. Dermatoscopy of “dysplastic nevi”: a beacon in diagnostic darkness. Eur J Dermatol. 2006; 16: 479-493.

15. Hoffman-Wellenhof R, Blum A, Wolf IH et al. Dermoscopic classification of atypical melanocytic nevi (Clark nevi). Arch Dermatol. 2001; 137: 1575-1580.

16. Hypolito SJ et al. Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma review article. Clinics. 2011; 66: 493-499.

17. Annesi G, Cattaruzza MS, Abeni D et al. Correlation between clinical atypia and histologic displasia in acquired melanocytic nevi. J am Acad Dermatol. 2001; 45: 77-85.

18. Kittler H, Pehamberger H, Wolff K et al. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002; 3: 159-165.

19. Argenziano G, Soyer HP. Dermoscopy of pigmented skin lesions, a valuable tool for early diagnosis of melanoma. Lancet Oncol. 2001; 2: 443-449.

20. Ascierto PA, Palmieri G, Celentano E et al. Sensitivity and specificity of epiluminescence microscopy: evaluation on a sample of 2731 excised cutaneous pigmented lesions. The melanoma cooperative study. Br J Dermatol. 2000; 142: 893-898.

21. Carrera C, Zaballos P, Puig S et al. Correlación histológica en dermatoscopia; lesiones melanocíticas y no melanocíticas. Criterios dermatoscópicos de nevus melanocíticos. Med Cutan IberLat Am. 2004; 32: 47-60.

22. Pehamberger H, Steiner A, Wolff K. In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions. J Am Acad Dermatol. 1987; 17: 571-583.

23. Rezze GG, Sá BCS, Neves RI. Dermatoscopia: o método de análise de padroes. An Bras Dermatol. 2006; 81: 261-268.

24. Rezze GG, León A, Duprat J. Dysplastic nevus (atypicalnevus). An Bras Dermatol. 2010; 85: 863-871.

25. Bronchez L, Verhaeghe E, Grosshans E et al. Inter-observer variation in the histopathological diagnosis of clinically suspicious pigmented skin lesions. J Pathol. 2002; 196: 459-466.

26. De Wit PE, van’t Hof-Grootenboer B, Ruiter DJ 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; 29A: 831-839.

27. Malvehy J et al. Handbook of dermatoscopy. Reino Unido: Editorial Taylor & Francis group; 2006: pp. 21-35.