The dysplastic nevus: from historical perspective to management in the modern era: part I. Historical, histologic, and clinical aspects

Abstract

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.

Figure 1

Clinical features of atypical nevi. Indistinct borders are evident in lesions (A), (B), and (C). Variable pigmentation is seen in these lesions as well as lesions (D), (E), and (F). Irregular borders are present in many of these lesions.

Figure 2

Histologic features of dysplastic nevi. (A) Architectural disorder demonstrated by lateral asymmetry and “shouldering” (original magnification x40). (B) Lentiginous melanocytic hyperplasia with bridging of rete ridges (original magnification x200) and (C) cellular atypia (original magnification x200). (D) Patchy lymphocytic host response (original magnification x100). (E) Prominent eosinophilic fibroplasias (original magnification x200). (F) Variable and “random” cytologic atypia and mitotic junctional activity (original magnification x600).