wikidoc - User contributions [en]

Melanocytic nevus historical perspective

2019-11-05T01:48:19Z

Qurrat-ul-ain Abid:

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}}: {{Qurrat}}; {{RAK}}

==Overview==

Dysplastic nevus was first discovered by Clark and his colleagues in 1978.
==Historical Perspective==

*Dysplastic nevus was first discovered by Clark and his colleagues in 1978.<ref name="pmid646394">{{cite journal| author=Clark WH, Reimer RR, Greene M, Ainsworth AM, Mastrangelo MJ| title=Origin of familial malignant melanomas from heritable melanocytic lesions. 'The B-K mole syndrome'. | journal=Arch Dermatol | year= 1978 | volume= 114 | issue= 5 | pages= 732-8 | pmid=646394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=646394 }}</ref>
*The name ‘dysplastic nevus’ was proposed since they are benign melanocytic nevi that include cytologic atypia, similar to dysplastic lesions of other organs, such as the cervix.<ref name="pmid7427881">{{cite journal| author=Elder DE, Goldman LI, Goldman SC, Greene MH, Clark WH| title=Dysplastic nevus syndrome: a phenotypic association of sporadic cutaneous melanoma. | journal=Cancer | year= 1980 | volume= 46 | issue= 8 | pages= 1787-94 | pmid=7427881 | doi=10.1002/1097-0142(19801015)46:8<1787::aid-cncr2820460816>3.0.co;2-s | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427881 }}</ref> 
*At one time in the 1950s and 60s, (and, to lesser extent, currently) a mole was known as a “beauty mark” when it appeared in certain spots on a woman’s face. Examples include Marilyn Monroe, model Cindy Crawford and singer Madonna. Madonna's facial mole -- below her right nostril -- has been surgically removed.

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus historical perspective

2019-11-05T01:45:23Z

Qurrat-ul-ain Abid: /* Historical Perspective */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}}: {{RAK}}

==Overview==

Dysplastic nevus was first discovered by Clark and his colleagues in 1978.
==Historical Perspective==

*Dysplastic nevus was first discovered by Clark and his colleagues in 1978.<ref name="pmid646394">{{cite journal| author=Clark WH, Reimer RR, Greene M, Ainsworth AM, Mastrangelo MJ| title=Origin of familial malignant melanomas from heritable melanocytic lesions. 'The B-K mole syndrome'. | journal=Arch Dermatol | year= 1978 | volume= 114 | issue= 5 | pages= 732-8 | pmid=646394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=646394 }}</ref>
*The name ‘dysplastic nevus’ was proposed since they are benign melanocytic nevi that include cytologic atypia, similar to dysplastic lesions of other organs, such as the cervix.<ref name="pmid7427881">{{cite journal| author=Elder DE, Goldman LI, Goldman SC, Greene MH, Clark WH| title=Dysplastic nevus syndrome: a phenotypic association of sporadic cutaneous melanoma. | journal=Cancer | year= 1980 | volume= 46 | issue= 8 | pages= 1787-94 | pmid=7427881 | doi=10.1002/1097-0142(19801015)46:8<1787::aid-cncr2820460816>3.0.co;2-s | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427881 }}</ref> 
*At one time in the 1950s and 60s, (and, to lesser extent, currently) a mole was known as a “beauty mark” when it appeared in certain spots on a woman’s face. Examples include Marilyn Monroe, model Cindy Crawford and singer Madonna. Madonna's facial mole -- below her right nostril -- has been surgically removed.

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus screening

2019-11-03T00:56:38Z

Qurrat-ul-ain Abid: /* Overview */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
Presence of several melanocytic nevi is a strong risk factor for melanoma. Whole body nevus count can help in stratifying the high risk patients prone to developing malignant lesions.

==Screening==
*Presence of several melanocytic nevi is a strong risk factor for melanoma.
*In case of presence of numerous melanocytic nevi, one may perform whole body nevus count to identify at-risk patients.<ref name="pmid10233266">{{cite journal |vauthors=Fariñas-Alvarez C, Ródenas JM, Herranz MT, Delgado-Rodríguez M |title=The naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body |journal=Br. J. Dermatol. |volume=140 |issue=3 |pages=457–62 |date=March 1999 |pmid=10233266 |doi= |url=}}</ref>
* Two methods to count the nevus are used, whole body nevus count or the site-specific count.<ref name="pmid24443914">{{cite journal |vauthors=Echeverría B, Bulliard JL, Guillén C, Nagore E |title=Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients |journal=Br. J. Dermatol. |volume=170 |issue=1 |pages=144–9 |date=January 2014 |pmid=24443914 |doi=10.1111/bjd.12692 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

User:Qurrat-ul-ain Abid

2019-08-31T03:29:51Z

Qurrat-ul-ain Abid:

__NOTOC__

==Qurrat-ul-ain Abid, M.D. ==

*Associate Editor-In-Chief [http://www.wikidoc.org/ WikiDoc.org]
*International Medical Correspondent [https://cardiologynownews.org/ Cardiology Now News]

==Pages Authored==

===Hematology and Oncology project:===

*[[Small intestine cancer]]
*[[B-cell prolymphocytic leukemia]]
*[[T-cell prolymphocytic leukemia]]
*[[Mucinous cystadenocarcinoma]]

===Differential Diagnosis project:===

*[[Mucinous cystadenocarcinoma differential diagnosis]]
*[[Neck masses differential diagnosis]]
*[[Endometrial cancer differential diagnosis]]
*[[Small intestine cancer differential diagnosis]]
*[[B-cell prolymphocytic leukemia differential diagnosis]]
*[[T-cell prolymphocytic leukemia differential diagnosis]]
*[[Colorectal cancer differential diagnosis]]

===Incidence and Prevalence project:===

*[[Small intestine cancer epidemiology and demographics]]
*[[B-cell prolymphocytic leukemia epidemiology and demographics]]
*[[T-cell prolymphocytic leukemia epidemiology and demographics]]
*[[Mucinous cystadenocarcinoma epidemiology and demographics]]

User:Qurrat-ul-ain Abid

2019-08-31T03:28:49Z

Qurrat-ul-ain Abid: /* Qurrat-ul-ain Abid, M.D. */

__NOTOC__

==Qurrat-ul-ain Abid, M.D.==
Email: [mailto:qabid@bidmc.harvard.edu qabid@bidmc.harvard.edu] 

*Associate Editor-In-Chief [http://www.wikidoc.org/ WikiDoc.org]
*International Medical Correspondent [https://cardiologynownews.org/ Cardiology Now News]

==Pages Authored==

===Hematology and Oncology project:===

*[[Small intestine cancer]]
*[[B-cell prolymphocytic leukemia]]
*[[T-cell prolymphocytic leukemia]]
*[[Mucinous cystadenocarcinoma]]

===Differential Diagnosis project:===

*[[Mucinous cystadenocarcinoma differential diagnosis]]
*[[Neck masses differential diagnosis]]
*[[Endometrial cancer differential diagnosis]]
*[[Small intestine cancer differential diagnosis]]
*[[B-cell prolymphocytic leukemia differential diagnosis]]
*[[T-cell prolymphocytic leukemia differential diagnosis]]
*[[Colorectal cancer differential diagnosis]]

===Incidence and Prevalence project:===

*[[Small intestine cancer epidemiology and demographics]]
*[[B-cell prolymphocytic leukemia epidemiology and demographics]]
*[[T-cell prolymphocytic leukemia epidemiology and demographics]]
*[[Mucinous cystadenocarcinoma epidemiology and demographics]]

Melanocytic nevus differential diagnosis

2019-05-23T16:33:33Z

Qurrat-ul-ain Abid: /* Overview */

__NOTOC__
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Melanocytic_nevus]]
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==

Melanocytic nevus must be differentiated from a dysplastic nevus, epidermal nevus, and melanoma.

==Differential diagnosis==

Melanocytic nevus must be differentiated from a dysplastic nevus, melanoma, and epidermal nevus.

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus other imaging findings

2019-05-21T15:15:28Z

Qurrat-ul-ain Abid: /* Overview */

__NOTOC__
{{Melanocytic nevus}}

==Overview==
Melanocytic nevus is diagnosed on visual examination and imaging studies are not used.

==Imaging studies==
CT, MRI, and Ultrasound are not used for the diagnosis of melanocytic nevus. Diagnosis is purely visual.

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus other imaging findings

2019-05-21T15:14:37Z

Qurrat-ul-ain Abid: /* Imaging studies */

__NOTOC__
{{Melanocytic nevus}}

==Overview==

==Imaging studies==
CT, MRI, and Ultrasound are not used for the diagnosis of melanocytic nevus. Diagnosis is purely visual.

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus other imaging findings

2019-05-21T15:13:15Z

Qurrat-ul-ain Abid:

__NOTOC__
{{Melanocytic nevus}}

==Overview==

==Imaging studies==

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus laboratory tests

2019-05-21T15:12:13Z

Qurrat-ul-ain Abid: /* Overview */

__NOTOC__
{{Melanocytic nevus}}

==Overview==
There are no particular laboratory findings in people with a melanocytic nevus.

==Laboratory Findings==
*There are no laboratory findings associated with a congenital or acquired melanocytic nevus.

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus laboratory tests

2019-05-21T15:11:21Z

Qurrat-ul-ain Abid: /* Laboratory Findings */

__NOTOC__
{{Melanocytic nevus}}

==Overview==

==Laboratory Findings==
*There are no laboratory findings associated with a congenital or acquired melanocytic nevus.

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus laboratory tests

2019-05-21T15:10:30Z

Qurrat-ul-ain Abid:

__NOTOC__
{{Melanocytic nevus}}

==Overview==

==Laboratory Findings==

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus physical examination

2019-05-21T15:07:38Z

Qurrat-ul-ain Abid: /* Melanocytic Naevi Intradermal */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.

==Physical Findings==
According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.Untroublesome moles are usually circular or oval and not very large.

===Congenital melanocytic nevi (CMN) clinical features:===

*Congenital melanocytic nevi (CMN) may have different sizes they can be small, medium-sized, single.
*They can be present anywhere in skin.
*Color of CMN varies from black to tan, with irregular borders.
*CMN can also have dark and coarse hair.
*CMN lesions may be grouped by the largest diameter the nevus can obtain until adulthood:<ref name="pmid22982004">{{cite journal |vauthors=Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA |title=New recommendations for the categorization of cutaneous features of congenital melanocytic nevi |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=441–51 |date=March 2013 |pmid=22982004 |doi=10.1016/j.jaad.2012.05.043 |url=}}</ref>
**Small – <1.5 cm.
**Medium-sized – M1 1.5 to 10 cm; M2 10 to 20 cm.
**Large – L1>20 to 30 cm; L2>30 to 40 cm. In a neonate, large CMN are >9 cm on the head or >6 cm on the body.
**Giant – G1>40 to 60 cm; G2>60 cm.

*For larger nevi, "satellite nevi" surrounding it may help in evaluation and monitoring. Large and giant CMN may be classified by the number of satellite lesions present, as follows:
**S – 0
**S1 – <20
**S2 – 20 to 50
**S3 – >50

*Color variation, surface rugosity, dermal or subcutaneous nodules presence, and hypertrichosis may be graded from 0 (none) to 2 (marked).

===Acquired melanocytic nevi (moles) clinical features===
*Nevi are often present in sun-exposed areas.<ref name="pmid9923780">{{cite journal |vauthors=Harrison SL, Buettner PG, MacLennan R |title=Body-site distribution of melanocytic nevi in young Australian children |journal=Arch Dermatol |volume=135 |issue=1 |pages=47–52 |date=January 1999 |pmid=9923780 |doi= |url=}}</ref>
*
*On examination, they have following features:
**Usually ≤6 mm in diameter
**Symmetric with a parallel surface
**Round or oval in shape
**Even pigmentation
**Symmetrical and sharply demarcated border
**Junctional nevi are macular or minimally raised
**Compound nevi are pigmented papules
**Intradermal nevi are skin-colored to tan papules that are dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture

===If malignant===
It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish black spot, often called a [[blue nevus]], is usually benign but often mistaken for melanoma.<ref>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. Melanoma Associated with Blue Nevus and Melanoma Mimicking Cellular Blue Nevus: A Clinicopathologic Study of 10 Cases on the Spectrum of So-called ‘Malignant Blue Nevus’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>

A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.

==Physical Examination==
===Skin===
<gallery>
Image:Melanocytic_naevi_01.jpeg|Melanocytic Naevi. Image attribution: ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=280 |title=melanocytic naevi - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Congenital Melanocytic Naevi (CMN)===
<gallery>
Image: MN4235.jpg|Congenital melanocytic nevi. Image attribution: ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi congenital - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=281 |title=melanocytic naevi congenital - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Intradermal Melanocytic Nevi===
<gallery>
Image: 4238.jpg|Intradermal melanocytic nevi. Image attribution: ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi intradermal - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=282 |title=melanocytic naevi intradermal - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

== References ==
{{Reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus physical examination

2019-05-21T15:06:08Z

Qurrat-ul-ain Abid: /* Skin */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.

==Physical Findings==
According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.Untroublesome moles are usually circular or oval and not very large.

===Congenital melanocytic nevi (CMN) clinical features:===

*Congenital melanocytic nevi (CMN) may have different sizes they can be small, medium-sized, single.
*They can be present anywhere in skin.
*Color of CMN varies from black to tan, with irregular borders.
*CMN can also have dark and coarse hair.
*CMN lesions may be grouped by the largest diameter the nevus can obtain until adulthood:<ref name="pmid22982004">{{cite journal |vauthors=Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA |title=New recommendations for the categorization of cutaneous features of congenital melanocytic nevi |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=441–51 |date=March 2013 |pmid=22982004 |doi=10.1016/j.jaad.2012.05.043 |url=}}</ref>
**Small – <1.5 cm.
**Medium-sized – M1 1.5 to 10 cm; M2 10 to 20 cm.
**Large – L1>20 to 30 cm; L2>30 to 40 cm. In a neonate, large CMN are >9 cm on the head or >6 cm on the body.
**Giant – G1>40 to 60 cm; G2>60 cm.

*For larger nevi, "satellite nevi" surrounding it may help in evaluation and monitoring. Large and giant CMN may be classified by the number of satellite lesions present, as follows:
**S – 0
**S1 – <20
**S2 – 20 to 50
**S3 – >50

*Color variation, surface rugosity, dermal or subcutaneous nodules presence, and hypertrichosis may be graded from 0 (none) to 2 (marked).

===Acquired melanocytic nevi (moles) clinical features===
*Nevi are often present in sun-exposed areas.<ref name="pmid9923780">{{cite journal |vauthors=Harrison SL, Buettner PG, MacLennan R |title=Body-site distribution of melanocytic nevi in young Australian children |journal=Arch Dermatol |volume=135 |issue=1 |pages=47–52 |date=January 1999 |pmid=9923780 |doi= |url=}}</ref>
*
*On examination, they have following features:
**Usually ≤6 mm in diameter
**Symmetric with a parallel surface
**Round or oval in shape
**Even pigmentation
**Symmetrical and sharply demarcated border
**Junctional nevi are macular or minimally raised
**Compound nevi are pigmented papules
**Intradermal nevi are skin-colored to tan papules that are dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture

===If malignant===
It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish black spot, often called a [[blue nevus]], is usually benign but often mistaken for melanoma.<ref>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. Melanoma Associated with Blue Nevus and Melanoma Mimicking Cellular Blue Nevus: A Clinicopathologic Study of 10 Cases on the Spectrum of So-called ‘Malignant Blue Nevus’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>

A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.

==Physical Examination==
===Skin===
<gallery>
Image:Melanocytic_naevi_01.jpeg|Melanocytic Naevi. Image attribution: ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=280 |title=melanocytic naevi - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Congenital Melanocytic Naevi (CMN)===
<gallery>
Image: MN4235.jpg|Congenital melanocytic nevi. Image attribution: ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi congenital - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=281 |title=melanocytic naevi congenital - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Intradermal===
<gallery>
Image: 4238.jpg|Melanocytic Naevi Intradermal. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

== References ==
{{Reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus physical examination

2019-05-21T15:05:04Z

Qurrat-ul-ain Abid: /* Melanocytic Naevi Congenital */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.

==Physical Findings==
According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.Untroublesome moles are usually circular or oval and not very large.

===Congenital melanocytic nevi (CMN) clinical features:===

*Congenital melanocytic nevi (CMN) may have different sizes they can be small, medium-sized, single.
*They can be present anywhere in skin.
*Color of CMN varies from black to tan, with irregular borders.
*CMN can also have dark and coarse hair.
*CMN lesions may be grouped by the largest diameter the nevus can obtain until adulthood:<ref name="pmid22982004">{{cite journal |vauthors=Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA |title=New recommendations for the categorization of cutaneous features of congenital melanocytic nevi |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=441–51 |date=March 2013 |pmid=22982004 |doi=10.1016/j.jaad.2012.05.043 |url=}}</ref>
**Small – <1.5 cm.
**Medium-sized – M1 1.5 to 10 cm; M2 10 to 20 cm.
**Large – L1>20 to 30 cm; L2>30 to 40 cm. In a neonate, large CMN are >9 cm on the head or >6 cm on the body.
**Giant – G1>40 to 60 cm; G2>60 cm.

*For larger nevi, "satellite nevi" surrounding it may help in evaluation and monitoring. Large and giant CMN may be classified by the number of satellite lesions present, as follows:
**S – 0
**S1 – <20
**S2 – 20 to 50
**S3 – >50

*Color variation, surface rugosity, dermal or subcutaneous nodules presence, and hypertrichosis may be graded from 0 (none) to 2 (marked).

===Acquired melanocytic nevi (moles) clinical features===
*Nevi are often present in sun-exposed areas.<ref name="pmid9923780">{{cite journal |vauthors=Harrison SL, Buettner PG, MacLennan R |title=Body-site distribution of melanocytic nevi in young Australian children |journal=Arch Dermatol |volume=135 |issue=1 |pages=47–52 |date=January 1999 |pmid=9923780 |doi= |url=}}</ref>
*
*On examination, they have following features:
**Usually ≤6 mm in diameter
**Symmetric with a parallel surface
**Round or oval in shape
**Even pigmentation
**Symmetrical and sharply demarcated border
**Junctional nevi are macular or minimally raised
**Compound nevi are pigmented papules
**Intradermal nevi are skin-colored to tan papules that are dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture

===If malignant===
It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish black spot, often called a [[blue nevus]], is usually benign but often mistaken for melanoma.<ref>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. Melanoma Associated with Blue Nevus and Melanoma Mimicking Cellular Blue Nevus: A Clinicopathologic Study of 10 Cases on the Spectrum of So-called ‘Malignant Blue Nevus’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>

A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.

==Physical Examination==
===Skin===
<gallery>
Image:Melanocytic_naevi_01.jpeg|Melanocytic Naevi. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=280 |title=melanocytic naevi - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Congenital Melanocytic Naevi (CMN)===
<gallery>
Image: MN4235.jpg|Congenital melanocytic nevi. Image attribution: ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi congenital - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=281 |title=melanocytic naevi congenital - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Intradermal===
<gallery>
Image: 4238.jpg|Melanocytic Naevi Intradermal. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

== References ==
{{Reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus physical examination

2019-05-21T15:02:24Z

Qurrat-ul-ain Abid: /* Skin */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.

==Physical Findings==
According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.Untroublesome moles are usually circular or oval and not very large.

===Congenital melanocytic nevi (CMN) clinical features:===

*Congenital melanocytic nevi (CMN) may have different sizes they can be small, medium-sized, single.
*They can be present anywhere in skin.
*Color of CMN varies from black to tan, with irregular borders.
*CMN can also have dark and coarse hair.
*CMN lesions may be grouped by the largest diameter the nevus can obtain until adulthood:<ref name="pmid22982004">{{cite journal |vauthors=Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA |title=New recommendations for the categorization of cutaneous features of congenital melanocytic nevi |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=441–51 |date=March 2013 |pmid=22982004 |doi=10.1016/j.jaad.2012.05.043 |url=}}</ref>
**Small – <1.5 cm.
**Medium-sized – M1 1.5 to 10 cm; M2 10 to 20 cm.
**Large – L1>20 to 30 cm; L2>30 to 40 cm. In a neonate, large CMN are >9 cm on the head or >6 cm on the body.
**Giant – G1>40 to 60 cm; G2>60 cm.

*For larger nevi, "satellite nevi" surrounding it may help in evaluation and monitoring. Large and giant CMN may be classified by the number of satellite lesions present, as follows:
**S – 0
**S1 – <20
**S2 – 20 to 50
**S3 – >50

*Color variation, surface rugosity, dermal or subcutaneous nodules presence, and hypertrichosis may be graded from 0 (none) to 2 (marked).

===Acquired melanocytic nevi (moles) clinical features===
*Nevi are often present in sun-exposed areas.<ref name="pmid9923780">{{cite journal |vauthors=Harrison SL, Buettner PG, MacLennan R |title=Body-site distribution of melanocytic nevi in young Australian children |journal=Arch Dermatol |volume=135 |issue=1 |pages=47–52 |date=January 1999 |pmid=9923780 |doi= |url=}}</ref>
*
*On examination, they have following features:
**Usually ≤6 mm in diameter
**Symmetric with a parallel surface
**Round or oval in shape
**Even pigmentation
**Symmetrical and sharply demarcated border
**Junctional nevi are macular or minimally raised
**Compound nevi are pigmented papules
**Intradermal nevi are skin-colored to tan papules that are dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture

===If malignant===
It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish black spot, often called a [[blue nevus]], is usually benign but often mistaken for melanoma.<ref>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. Melanoma Associated with Blue Nevus and Melanoma Mimicking Cellular Blue Nevus: A Clinicopathologic Study of 10 Cases on the Spectrum of So-called ‘Malignant Blue Nevus’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>

A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.

==Physical Examination==
===Skin===
<gallery>
Image:Melanocytic_naevi_01.jpeg|Melanocytic Naevi. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="urlmelanocytic naevi - Pictures">{{cite web |url=http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=280 |title=melanocytic naevi - Pictures |format= |work= |accessdate=}}</ref>{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Congenital===
<gallery>
Image: MN4235.jpg|Melanocytic Naevi Congenital.With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Intradermal===
<gallery>
Image: 4238.jpg|Melanocytic Naevi Intradermal. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

== References ==
{{Reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus staging

2019-05-21T14:58:27Z

Qurrat-ul-ain Abid: /* Overview */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
At present, there is no staging system.

==Staging==
There is no staging system for melanocytic nevus.

==References==

{{Reflist|2}}
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus staging

2019-05-21T14:57:54Z

Qurrat-ul-ain Abid: /* Overview */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
*At present, there is no staging system.

==Staging==
There is no staging system for melanocytic nevus.

==References==

{{Reflist|2}}
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus staging

2019-05-21T14:56:32Z

Qurrat-ul-ain Abid: /* Staging */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==

==Staging==
There is no staging system for melanocytic nevus.

==References==

{{Reflist|2}}
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Template:Mucinous cystadenocarcinoma

2019-05-21T14:24:21Z

Qurrat-ul-ain Abid:

{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"
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'''Mucinous cystadenocarcinoma Microchapters
'''
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[[Mucinous cystadenocarcinoma|Home]]
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[[Mucinous cystadenocarcinoma overview|Overview]]
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[[Mucinous cystadenocarcinoma history and symptoms|History and Symptoms]]
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[[Mucinous cystadenocarcinoma CT scan|CT scan]]
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[[Mucinous cystadenocarcinoma MRI|MRI]]
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[[Mucinous cystadenocarcinoma case study one|Case #1]]
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{{PAGENAME}} On the Web
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=searchanddb=pubmedandterm={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles]
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Melanocytic nevus epidemiology and demographics

2019-05-21T14:10:48Z

Qurrat-ul-ain Abid: /* Epidemiology and demographics */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==

Darker skin shades tend to have fewer moles compared to fair complexion.

==Epidemiology and demographics==

===Acquired melanocytic nevi===
*The number of acquired moles among white children depends on the geographical area and sun exposure and its intensity.<ref name="pmid15897379">{{cite journal |vauthors=Valiukeviciene S, Miseviciene I, Gollnick H |title=The prevalence of common acquired melanocytic nevi and the relationship with skin type characteristics and sun exposure among children in Lithuania |journal=Arch Dermatol |volume=141 |issue=5 |pages=579–86 |date=May 2005 |pmid=15897379 |doi=10.1001/archderm.141.5.579 |url=}}</ref>
*According to the American Academy of Dermatology, the majority of moles appear during the first two decades of a person’s life. <ref name="pmid7554507">{{cite journal |vauthors=Gallagher RP, McLean DI |title=The epidemiology of acquired melanocytic nevi. A brief review |journal=Dermatol Clin |volume=13 |issue=3 |pages=595–603 |date=July 1995 |pmid=7554507 |doi= |url=}}</ref>
*Darker skin shades tend to have fewer moles.

===Congenital melanocytic nevi (CMN)===
*The prevalence of congenital melanocytic nevi (CMN) in newborns is between 0.2 and 6% worldwide.<ref name="pmid17377384">{{cite journal |vauthors=Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L |title=Congenital melanocytic nevus: an epidemiologic study in Italy |journal=Dermatology (Basel) |volume=214 |issue=3 |pages=227–30 |date=2007 |pmid=17377384 |doi=10.1159/000099587 |url=}}</ref>

===Melanoma===
*22 in 100,000 people is the age-standardized annual incidence of melanoma worldwide and it has risen more than 10-fold in past ten years.<ref name="pmid8053717">{{cite journal |vauthors=Kang S, Barnhill RL, Mihm MC, Fitzpatrick TB, Sober AJ |title=Melanoma risk in individuals with clinically atypical nevi |journal=Arch Dermatol |volume=130 |issue=8 |pages=999–1001 |date=August 1994 |pmid=8053717 |doi= |url=}}</ref><ref name="pmid29313949">{{cite journal |vauthors=Siegel RL, Miller KD, Jemal A |title=Cancer statistics, 2018 |journal=CA Cancer J Clin |volume=68 |issue=1 |pages=7–30 |date=January 2018 |pmid=29313949 |doi=10.3322/caac.21442 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus screening

2019-05-21T13:46:31Z

Qurrat-ul-ain Abid: /* Screening */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
==Screening==
*Presence of several melanocytic nevi is a strong risk factor for melanoma.
*In case of presence of numerous melanocytic nevi, one may perform whole body naevus count to identify at-risk patients.<ref name="pmid10233266">{{cite journal |vauthors=Fariñas-Alvarez C, Ródenas JM, Herranz MT, Delgado-Rodríguez M |title=The naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body |journal=Br. J. Dermatol. |volume=140 |issue=3 |pages=457–62 |date=March 1999 |pmid=10233266 |doi= |url=}}</ref>
* Two methods to count the nevus are used, whole body nevus count or the site-specific count.<ref name="pmid24443914">{{cite journal |vauthors=Echeverría B, Bulliard JL, Guillén C, Nagore E |title=Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients |journal=Br. J. Dermatol. |volume=170 |issue=1 |pages=144–9 |date=January 2014 |pmid=24443914 |doi=10.1111/bjd.12692 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus epidemiology and demographics

2019-05-21T13:44:24Z

Qurrat-ul-ain Abid: /* Epidemiology and demographics */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==

Darker skin shades tend to have fewer moles compared to fair complexion.

==Epidemiology and demographics==

===Acquired melanocytic nevi===
*The number of acquired moles among white children depends on the geographical area and sun exposure and its intensity.<ref name="pmid15897379">{{cite journal |vauthors=Valiukeviciene S, Miseviciene I, Gollnick H |title=The prevalence of common acquired melanocytic nevi and the relationship with skin type characteristics and sun exposure among children in Lithuania |journal=Arch Dermatol |volume=141 |issue=5 |pages=579–86 |date=May 2005 |pmid=15897379 |doi=10.1001/archderm.141.5.579 |url=}}</ref>
*According to the American Academy of Dermatology, the majority of moles appear during the first two decades of a person’s life. <ref name="pmid7554507">{{cite journal |vauthors=Gallagher RP, McLean DI |title=The epidemiology of acquired melanocytic nevi. A brief review |journal=Dermatol Clin |volume=13 |issue=3 |pages=595–603 |date=July 1995 |pmid=7554507 |doi= |url=}}</ref>
*Darker skin shades tend to have fewer moles.

===Congenital melanocytic nevi (CMN)===
*The prevalence of congenital melanocytic nevi (CMN) in newborns is between 0.2 and 6% worldwide.<ref name="pmid17377384">{{cite journal |vauthors=Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L |title=Congenital melanocytic nevus: an epidemiologic study in Italy |journal=Dermatology (Basel) |volume=214 |issue=3 |pages=227–30 |date=2007 |pmid=17377384 |doi=10.1159/000099587 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus epidemiology and demographics

2019-05-21T13:27:17Z

Qurrat-ul-ain Abid: /* Epidemiology and demographics */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==

Darker skin shades tend to have fewer moles compared to fair complexion.

==Epidemiology and demographics==

Darker skin shades, however, tend to have fewer moles. According to the American Academy of Dermatology, the majority of moles appear during the first two decades of a person’s life while about one in every 100 babies is born with moles. Some folklore about moles includes the notion that picking at a mole can cause it to become [[cancerous]] or grow back larger.<ref name="pmid7554507">{{cite journal |vauthors=Gallagher RP, McLean DI |title=The epidemiology of acquired melanocytic nevi. A brief review |journal=Dermatol Clin |volume=13 |issue=3 |pages=595–603 |date=July 1995 |pmid=7554507 |doi= |url=}}</ref>

===Congenital melanocytic nevi (CMN)===
*The prevalence of congenital melanocytic nevi (CMN) in newborns is between 0.2 and 6% worldwide.<ref name="pmid17377384">{{cite journal |vauthors=Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L |title=Congenital melanocytic nevus: an epidemiologic study in Italy |journal=Dermatology (Basel) |volume=214 |issue=3 |pages=227–30 |date=2007 |pmid=17377384 |doi=10.1159/000099587 |url=}}</ref>
*

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus epidemiology and demographics

2019-05-21T13:26:41Z

Qurrat-ul-ain Abid: /* Epidemiology and demographics */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==

Darker skin shades tend to have fewer moles compared to fair complexion.

==Epidemiology and demographics==

Darker skin shades, however, tend to have fewer moles. According to the American Academy of Dermatology, the majority of moles appear during the first two decades of a person’s life while about one in every 100 babies is born with moles. Some folklore about moles includes the notion that picking at a mole can cause it to become [[cancerous]] or grow back larger.

===Congenital melanocytic nevi (CMN)===
*The prevalence of congenital melanocytic nevi (CMN) in newborns is between 0.2 and 6% worldwide.<ref name="pmid17377384">{{cite journal |vauthors=Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L |title=Congenital melanocytic nevus: an epidemiologic study in Italy |journal=Dermatology (Basel) |volume=214 |issue=3 |pages=227–30 |date=2007 |pmid=17377384 |doi=10.1159/000099587 |url=}}</ref>
*

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus causes

2019-05-21T13:21:39Z

Qurrat-ul-ain Abid: /* Genes */

__NOTOC__
{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==
Scientists suspect that overexposure to [[ultraviolet]] light, including excessive sunlight, may play a role in the formation of acquired moles.<ref>Arne van Schanke, Gemma M.C.A.L. van Venrooij, Marjan J. Jongsma, H. Alexander Banus, Leon H.F. Mullenders, Henk J. van Kranen, and Frank R. de Gruijl. Induction of Nevi and Skin Tumors in Ink4a/ArfXpa Knockout Mice by Neonatal, Intermittent, or Chronic UVB Exposures. Cancer Res 2006; 66 (5), 2608-15.</ref> However, more [[research]] is needed in this area.

==Causes==

===Sunlight===
*Some scientists suspect that overexposure to [[ultraviolet]] light, including excessive sunlight, may play a role in the formation of acquired moles.<ref>Arne van Schanke, Gemma M.C.A.L. van Venrooij, Marjan J. Jongsma, H. Alexander Banus, Leon H.F. Mullenders, Henk J. van Kranen, and Frank R. de Gruijl. Induction of Nevi and Skin Tumors in Ink4a/ArfXpa Knockout Mice by Neonatal, Intermittent, or Chronic UVB Exposures. Cancer Res 2006; 66 (5), 2608-15.</ref> However, more [[research]] is needed in this area.

===Genes===
*[[Genes]] can also have an influence on a person’s moles.
*'''[[Dysplastic nevus|Dysplastic nevi]]''' or atypical mole syndrome is a [[hereditary]] condition which causes the person to have a large number of moles (often 100 or more) with some larger than normal or atypical.
*This often leads to a higher [[risk]] of [[melanoma]], a serious [[skin cancer]].<ref>Burkhart, C.G MPH, MD. Dysplastic nevus declassified; even the NIH recommends elimination of confusing terminology. SKINmed: Dermatology for the Clinician 2(1):12-13, 2003.</ref>
*A slight majority of melanomas do ''not'' form in an existing mole, but rather create a new [[growth]] on the skin. Nevertheless, those with more dysplastic nevi are at a higher risk of this type of melanoma occurrence.<ref>D.J. Pope, T. Sorahan, J.R. Marsden, P.M. Ball, R.P. Grimley, and I.M. Peck. Benign pigmented nevi in children. Arch of Dermatology 2006;142:1599-1604</ref><ref>D.E. Goldgar, L.A. Cannon-Albright, L.J. Meyer, M.W. Pipekorn, J.J. Zone, M.H. Skolnick. Inheritance of Nevus Number and Size in Melanoma and Dysplastic Nevus Syndrome Kindreds. Journal of the National Cancer Institute 1991 83(23):1726-1733</ref> Such persons need to be checked regularly for any changes in their moles and to note any new ones.

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

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Melanocytic nevus causes

2019-05-21T13:19:58Z

Qurrat-ul-ain Abid: /* Sunlight */

__NOTOC__
{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==
Scientists suspect that overexposure to [[ultraviolet]] light, including excessive sunlight, may play a role in the formation of acquired moles.<ref>Arne van Schanke, Gemma M.C.A.L. van Venrooij, Marjan J. Jongsma, H. Alexander Banus, Leon H.F. Mullenders, Henk J. van Kranen, and Frank R. de Gruijl. Induction of Nevi and Skin Tumors in Ink4a/ArfXpa Knockout Mice by Neonatal, Intermittent, or Chronic UVB Exposures. Cancer Res 2006; 66 (5), 2608-15.</ref> However, more [[research]] is needed in this area.

==Causes==

===Sunlight===
*Some scientists suspect that overexposure to [[ultraviolet]] light, including excessive sunlight, may play a role in the formation of acquired moles.<ref>Arne van Schanke, Gemma M.C.A.L. van Venrooij, Marjan J. Jongsma, H. Alexander Banus, Leon H.F. Mullenders, Henk J. van Kranen, and Frank R. de Gruijl. Induction of Nevi and Skin Tumors in Ink4a/ArfXpa Knockout Mice by Neonatal, Intermittent, or Chronic UVB Exposures. Cancer Res 2006; 66 (5), 2608-15.</ref> However, more [[research]] is needed in this area.

===Genes===
[[Genes]] can also have an influence on a person’s moles.

'''[[Dysplastic nevus|Dysplastic nevi]]''' or atypical mole syndrome is a [[hereditary]] condition which causes the person to have a large number of moles (often 100 or more) with some larger than normal or atypical. This often leads to a higher [[risk]] of [[melanoma]], a serious [[skin cancer]].<ref>Burkhart, C.G MPH, MD. Dysplastic nevus declassified; even the NIH recommends elimination of confusing terminology. SKINmed: Dermatology for the Clinician 2(1):12-13, 2003.</ref>
A slight majority of melanomas do ''not'' form in an existing mole, but rather create a new [[growth]] on the skin. Nevertheless, those with more dysplastic nevi are at a higher risk of this type of melanoma occurrence.<ref>D.J. Pope, T. Sorahan, J.R. Marsden, P.M. Ball, R.P. Grimley, and I.M. Peck. Benign pigmented nevi in children. Arch of Dermatology 2006;142:1599-1604</ref><ref>D.E. Goldgar, L.A. Cannon-Albright, L.J. Meyer, M.W. Pipekorn, J.J. Zone, M.H. Skolnick. Inheritance of Nevus Number and Size in Melanoma and Dysplastic Nevus Syndrome Kindreds. Journal of the National Cancer Institute 1991 83(23):1726-1733</ref> Such persons need to be checked regularly for any changes in their moles and to note any new ones.

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

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Melanocytic nevus screening

2019-05-21T13:09:08Z

Qurrat-ul-ain Abid: /* Screening */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
==Screening==
*Presence of several melanocytic nevi is a strong risk factor for melanoma.
*In case of presence of numerous melanocytic nevi, one may perform whole body naevus count to identify at-risk patients.
* Two methods to count the nevus are used, whole body nevus count or the site-specific count.<ref name="pmid24443914">{{cite journal |vauthors=Echeverría B, Bulliard JL, Guillén C, Nagore E |title=Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients |journal=Br. J. Dermatol. |volume=170 |issue=1 |pages=144–9 |date=January 2014 |pmid=24443914 |doi=10.1111/bjd.12692 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus screening

2019-05-20T17:06:34Z

Qurrat-ul-ain Abid: /* Screening */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
==Screening==
*Presence of several melanocytic nevi is a strong risk factor for melanoma.
*In case of presence of numerous melanocytic naevi, one may perform whole body naevus count to identify at-risk patients.
* Two methods to count the nevus are used, whole body nevus count or the site-specific count.<ref name="pmid24443914">{{cite journal |vauthors=Echeverría B, Bulliard JL, Guillén C, Nagore E |title=Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients |journal=Br. J. Dermatol. |volume=170 |issue=1 |pages=144–9 |date=January 2014 |pmid=24443914 |doi=10.1111/bjd.12692 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus screening

2019-05-20T17:05:21Z

Qurrat-ul-ain Abid: /* Screening */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
==Screening==
*The presence of several melanocytic naevi is a strong risk factor for melanoma.
*In case of presence of numerous melanocytic naevi, one may perform whole body naevus count to identify at-risk patients.
* Two methods to count the nevus are used, whole body nevus count or the site-specific count.<ref name="pmid24443914">{{cite journal |vauthors=Echeverría B, Bulliard JL, Guillén C, Nagore E |title=Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients |journal=Br. J. Dermatol. |volume=170 |issue=1 |pages=144–9 |date=January 2014 |pmid=24443914 |doi=10.1111/bjd.12692 |url=}}</ref>

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
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[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus risk factors

2019-05-20T16:59:35Z

Qurrat-ul-ain Abid: /* Risk Factors */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
Most important risk factor for melanocytic nevus is sunlight however, genetic predisposition is an important factor as well.

==Risk Factors==
*According to the American cancer society risk factors for melanocytic nevi are the following:<ref name="urlRisk Factors for Melanoma Skin Cancer">{{cite web |url=https://www.cancer.org/cancer/melanoma-skin-cancer/causes-risks-prevention/risk-factors.html |title=Risk Factors for Melanoma Skin Cancer |format= |work= |accessdate=}}</ref>
**Exposure to ultraviolet (UV) rays.
**Genetic factors such as Dysplastic nevus syndrome (also known as familial atypical multiple mole melanoma syndrome, or FAMMM.
**Fair skin, freckling, and light hair.
**Family history of melanoma.
**Personal history of melanoma or other skin cancers.
**Having a weakened immune system.
**Olde age
**Male gender
**Xeroderma pigmentosum

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus risk factors

2019-05-20T16:58:21Z

Qurrat-ul-ain Abid: /* Risk Factors */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}

==Overview==
Most important risk factor for melanocytic nevus is sunlight however, genetic predisposition is an important factor as well.

==Risk Factors==
According to the American cancer society risk factors for melanocytic nevi are the following:<ref name="urlRisk Factors for Melanoma Skin Cancer">{{cite web |url=https://www.cancer.org/cancer/melanoma-skin-cancer/causes-risks-prevention/risk-factors.html |title=Risk Factors for Melanoma Skin Cancer |format= |work= |accessdate=}}</ref>
**Exposure to ultraviolet (UV) rays.
**Genetic factors such as Dysplastic nevus syndrome (also known as familial atypical multiple mole melanoma syndrome, or FAMMM.
**Fair skin, freckling, and light hair.
**Family history of melanoma.
**Personal history of melanoma or other skin cancers.
**Having a weakened immune system.
**Olde age
**Male gender
**Xeroderma pigmentosum

==References==

{{Reflist|2}}

[[Category:Needs content]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus natural history

2019-05-20T16:41:32Z

Qurrat-ul-ain Abid: /* Natural history of acquired melanocytic nevi */

__NOTOC__
{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; {{AE}} {{Qurrat}}; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

Vast majority of moles are [[benign]]. Nonetheless, the National (U.S.) Cancer Institute reported 59,940 new cases of [[melanoma]] by June, 2007, with 8,110 deaths.<ref>http://www.nci.nih.gov/cancertopics/types/melanoma</ref>

==Natural history of melanocytic nevi==

===Natural history of congenital melanocytic nevi===
*CMN grows as the child grows, with an approximate increase in size from infancy to adulthood in different regions of the body as follows:<ref name="pmid8629825">{{cite journal |vauthors=Marghoob AA, Schoenbach SP, Kopf AW, Orlow SJ, Nossa R, Bart RS |title=Large congenital melanocytic nevi and the risk for the development of malignant melanoma. A prospective study |journal=Arch Dermatol |volume=132 |issue=2 |pages=170–5 |date=February 1996 |pmid=8629825 |doi= |url=}}</ref><ref name="pmid8543695">{{cite journal |vauthors=Rhodes AR, Albert LS, Weinstock MA |title=Congenital nevomelanocytic nevi: proportionate area expansion during infancy and early childhood |journal=J. Am. Acad. Dermatol. |volume=34 |issue=1 |pages=51–62 |date=January 1996 |pmid=8543695 |doi= |url=}}</ref><ref name="pmid1593350">{{cite journal |vauthors=Ruiz-Maldonado R, Tamayo L, Laterza AM, Durán C |title=Giant pigmented nevi: clinical, histopathologic, and therapeutic considerations |journal=J. Pediatr. |volume=120 |issue=6 |pages=906–11 |date=June 1992 |pmid=1593350 |doi= |url=}}</ref>
**Head – 1.7-fold
**Trunk and upper extremities – 2.8-fold
**Lower extremities – 3.3-fold
*CMN grows more quickly in early infancy.
*In addition to changes in size, CMN may change in appearance.
*Over the course f time CMN may change from flat, evenly pigmented patches to raised moles with a pebbly appearance, verrucous, or cerebriform surface, color may change from tan to darker, lighter, mottled, or uneven pigmentation.

===Natural history of acquired melanocytic nevi===
*Common acquired melanocytic nevi start appearing within the first six months of life.<ref name="pmid8961877">{{cite journal |vauthors=Luther H, Altmeyer P, Garbe C, Ellwanger U, Jahn S, Hoffmann K, Segerling M |title=Increase of melanocytic nevus counts in children during 5 years of follow-up and analysis of associated factors |journal=Arch Dermatol |volume=132 |issue=12 |pages=1473–8 |date=December 1996 |pmid=8961877 |doi= |url=}}</ref><ref name="pmid11874490">{{cite journal |vauthors=Siskind V, Darlington S, Green L, Green A |title=Evolution of melanocytic nevi on the faces and necks of adolescents: a 4 y longitudinal study |journal=J. Invest. Dermatol. |volume=118 |issue=3 |pages=500–4 |date=March 2002 |pmid=11874490 |doi=10.1046/j.0022-202x.2001.01685.x |url=}}</ref>
*They may increase in number in childhood and adolescence, attaining maximum number in the third decade, and then slowly regress with age.<ref name="pmid11874490">{{cite journal |vauthors=Siskind V, Darlington S, Green L, Green A |title=Evolution of melanocytic nevi on the faces and necks of adolescents: a 4 y longitudinal study |journal=J. Invest. Dermatol. |volume=118 |issue=3 |pages=500–4 |date=March 2002 |pmid=11874490 |doi=10.1046/j.0022-202x.2001.01685.x |url=}}</ref><ref name="pmid21562569">{{cite journal |vauthors=Scope A, Dusza SW, Marghoob AA, Satagopan JM, Braga Casagrande Tavoloni J, Psaty EL, Weinstock MA, Oliveria SA, Bishop M, Geller AC, Halpern AC |title=Clinical and dermoscopic stability and volatility of melanocytic nevi in a population-based cohort of children in Framingham school system |journal=J. Invest. Dermatol. |volume=131 |issue=8 |pages=1615–21 |date=August 2011 |pmid=21562569 |pmc=3136658 |doi=10.1038/jid.2011.107 |url=}}</ref>
*Although a change in the appearance of nevus may raise suspicion for melanoma in adults, the ormal natural history of nevi in children and adolescents may include enlargement and elevation of nevi.<ref name="pmid27320410">{{cite journal |vauthors=Scope A, Marchetti MA, Marghoob AA, Dusza SW, Geller AC, Satagopan JM, Weinstock MA, Berwick M, Halpern AC |title=The study of nevi in children: Principles learned and implications for melanoma diagnosis |journal=J. Am. Acad. Dermatol. |volume=75 |issue=4 |pages=813–823 |date=October 2016 |pmid=27320410 |pmc=5030195 |doi=10.1016/j.jaad.2016.03.027 |url=}}</ref>

==Complications==
Experts say that vast majority of moles are [[benign]]. Nonetheless, the National (U.S.) Cancer Institute reported 59,940 new cases of [[melanoma]] by June, 2007, with 8,110 deaths.<ref>http://www.nci.nih.gov/cancertopics/types/melanoma</ref>

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]
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Melanocytic nevus natural history

2019-05-20T16:33:37Z

Qurrat-ul-ain Abid: /* Natural history of Congenital melanocytic nevi */

Melanocytic nevus physical examination

2019-05-20T16:00:50Z

Qurrat-ul-ain Abid: /* Acquired melanocytic nevi (moles) clinical features */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.

==Physical Findings==
According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.Untroublesome moles are usually circular or oval and not very large.

===Congenital melanocytic nevi (CMN) clinical features:===

*Congenital melanocytic nevi (CMN) may have different sizes they can be small, medium-sized, single.
*They can be present anywhere in skin.
*Color of CMN varies from black to tan, with irregular borders.
*CMN can also have dark and coarse hair.
*CMN lesions may be grouped by the largest diameter the nevus can obtain until adulthood:<ref name="pmid22982004">{{cite journal |vauthors=Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA |title=New recommendations for the categorization of cutaneous features of congenital melanocytic nevi |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=441–51 |date=March 2013 |pmid=22982004 |doi=10.1016/j.jaad.2012.05.043 |url=}}</ref>
**Small – <1.5 cm.
**Medium-sized – M1 1.5 to 10 cm; M2 10 to 20 cm.
**Large – L1>20 to 30 cm; L2>30 to 40 cm. In a neonate, large CMN are >9 cm on the head or >6 cm on the body.
**Giant – G1>40 to 60 cm; G2>60 cm.

*For larger nevi, "satellite nevi" surrounding it may help in evaluation and monitoring. Large and giant CMN may be classified by the number of satellite lesions present, as follows:
**S – 0
**S1 – <20
**S2 – 20 to 50
**S3 – >50

*Color variation, surface rugosity, dermal or subcutaneous nodules presence, and hypertrichosis may be graded from 0 (none) to 2 (marked).

===Acquired melanocytic nevi (moles) clinical features===
*Nevi are often present in sun-exposed areas.<ref name="pmid9923780">{{cite journal |vauthors=Harrison SL, Buettner PG, MacLennan R |title=Body-site distribution of melanocytic nevi in young Australian children |journal=Arch Dermatol |volume=135 |issue=1 |pages=47–52 |date=January 1999 |pmid=9923780 |doi= |url=}}</ref>
*
*On examination, they have following features:
**Usually ≤6 mm in diameter
**Symmetric with a parallel surface
**Round or oval in shape
**Even pigmentation
**Symmetrical and sharply demarcated border
**Junctional nevi are macular or minimally raised
**Compound nevi are pigmented papules
**Intradermal nevi are skin-colored to tan papules that are dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture

===If malignant===
It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish black spot, often called a [[blue nevus]], is usually benign but often mistaken for melanoma.<ref>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. Melanoma Associated with Blue Nevus and Melanoma Mimicking Cellular Blue Nevus: A Clinicopathologic Study of 10 Cases on the Spectrum of So-called ‘Malignant Blue Nevus’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>

A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.

==Physical Examination==
===Skin===
<gallery>
Image:Melanocytic_naevi_01.jpeg|Melanocytic Naevi.With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Congenital===
<gallery>
Image: MN4235.jpg|Melanocytic Naevi Congenital.With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Intradermal===
<gallery>
Image: 4238.jpg|Melanocytic Naevi Intradermal. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

== References ==
{{Reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus physical examination

2019-05-20T16:00:14Z

Qurrat-ul-ain Abid: /* Physical Findings */

__NOTOC__
{{Melanocytic nevus}}
{{CMG}}; {{AE}} {{Qurrat}}; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]

==Overview==

According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.

==Physical Findings==
According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.Untroublesome moles are usually circular or oval and not very large.

===Congenital melanocytic nevi (CMN) clinical features:===

*Congenital melanocytic nevi (CMN) may have different sizes they can be small, medium-sized, single.
*They can be present anywhere in skin.
*Color of CMN varies from black to tan, with irregular borders.
*CMN can also have dark and coarse hair.
*CMN lesions may be grouped by the largest diameter the nevus can obtain until adulthood:<ref name="pmid22982004">{{cite journal |vauthors=Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA |title=New recommendations for the categorization of cutaneous features of congenital melanocytic nevi |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=441–51 |date=March 2013 |pmid=22982004 |doi=10.1016/j.jaad.2012.05.043 |url=}}</ref>
**Small – <1.5 cm.
**Medium-sized – M1 1.5 to 10 cm; M2 10 to 20 cm.
**Large – L1>20 to 30 cm; L2>30 to 40 cm. In a neonate, large CMN are >9 cm on the head or >6 cm on the body.
**Giant – G1>40 to 60 cm; G2>60 cm.

*For larger nevi, "satellite nevi" surrounding it may help in evaluation and monitoring. Large and giant CMN may be classified by the number of satellite lesions present, as follows:
**S – 0
**S1 – <20
**S2 – 20 to 50
**S3 – >50

*Color variation, surface rugosity, dermal or subcutaneous nodules presence, and hypertrichosis may be graded from 0 (none) to 2 (marked).

===Acquired melanocytic nevi (moles) clinical features===
*Nevi are often present in sun-exposed areas.<ref name="pmid9923780">{{cite journal |vauthors=Harrison SL, Buettner PG, MacLennan R |title=Body-site distribution of melanocytic nevi in young Australian children |journal=Arch Dermatol |volume=135 |issue=1 |pages=47–52 |date=January 1999 |pmid=9923780 |doi= |url=}}</ref>
*
*On examination, they have following features:
**usually ≤6 mm in diameter
**Symmetric with a parallel surface
**Round or oval in shape
**Even pigmentation
**Symmetrical and sharply demarcated border
**Junctional nevi are macular or minimally raised
**Compound nevi are pigmented papules
**Intradermal nevi are skin-colored to tan papules that are dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture

===If malignant===
It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish black spot, often called a [[blue nevus]], is usually benign but often mistaken for melanoma.<ref>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. Melanoma Associated with Blue Nevus and Melanoma Mimicking Cellular Blue Nevus: A Clinicopathologic Study of 10 Cases on the Spectrum of So-called ‘Malignant Blue Nevus’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>

A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.

==Physical Examination==
===Skin===
<gallery>
Image:Melanocytic_naevi_01.jpeg|Melanocytic Naevi.With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Congenital===
<gallery>
Image: MN4235.jpg|Melanocytic Naevi Congenital.With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

===Melanocytic Naevi Intradermal===
<gallery>
Image: 4238.jpg|Melanocytic Naevi Intradermal. With permission from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=5Dermatology Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url =http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=279}}
</gallery>

== References ==
{{Reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Melanocytic nevus pathophysiology

2019-05-20T15:51:07Z

Qurrat-ul-ain Abid: /* Neurocutaneous melanosis */

__NOTOC__

Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.

{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

====Gross Pathology====
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

====Proliferative nodules Melanocytic nevus====

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

====Speckled lentiginous nevus (SLN)====
*CMN may appear as a hyperpigmented patch with, superimposed dark or brown macules and papules which is known as lentiginous nevus (SLN) or nevus spilus.
*The "background" tan patch (café-au-lait macule-like) of an SLN is mostly present at birth or appear soon after birth, brown "spots" may appear in the lesions later.
*SLN is of two types:<ref name="pmid19040513">{{cite journal |vauthors=Happle R |title=Speckled lentiginous naevus: which of the two disorders do you mean? |journal=Clin. Exp. Dermatol. |volume=34 |issue=2 |pages=133–5 |date=March 2009 |pmid=19040513 |doi=10.1111/j.1365-2230.2008.02966.x |url=}}</ref><ref name="pmid11176689">{{cite journal |vauthors=Schaffer JV, Orlow SJ, Lazova R, Bolognia JL |title=Speckled lentiginous nevus: within the spectrum of congenital melanocytic nevi |journal=Arch Dermatol |volume=137 |issue=2 |pages=172–8 |date=February 2001 |pmid=11176689 |doi= |url=}}</ref>
**With macular speckles
**With papular and macular speckles

===Acquired melanocytic nevi (moles)===
*Benign growth of a type of melanocyte known as a "nevus cell" is known as melanocytic nevi or mole.
*Although both melanocytes and nevus cells produce the pigment melanin however Nevus cells are different from the Melanocytes due to the following characteristics:
**Nevus cells have a tendency to cluster within the lower epidermis or dermis, while epidermal melanocyte tends to spread out in one group.
**Nevus cells lack dendritic process
*Appearance of moles may vary depending on their location in the skin:
**Junctional nevi: melanocytes are at the dermal-epidermal junction.
**Compound nevi, melanocytes are both at the dermal-epidermal junction and in the dermis.
**Intradermal nevi, the nests of melanocytes are in the dermis.
**Elevated and less pigmented nevi: migration of melanocytes from the dermal-epidermal junction into the dermis.
'''Predisposing factors for the development of acquired melanocytic nevi'''
*Factors influencing to the development of all acquired nevi except blue and Spitz nevi are:<ref name="pmid19001133">{{cite journal |vauthors=Oliveria SA, Satagopan JM, Geller AC, Dusza SW, Weinstock MA, Berwick M, Bishop M, Heneghan MK, Halpern AC |title=Study of Nevi in Children (SONIC): baseline findings and predictors of nevus count |journal=Am. J. Epidemiol. |volume=169 |issue=1 |pages=41–53 |date=January 2009 |pmid=19001133 |pmc=2720704 |doi=10.1093/aje/kwn289 |url=}}</ref><ref name="pmid19770437">{{cite journal |vauthors=Aalborg J, Morelli JG, Mokrohisky ST, Asdigian NL, Byers TE, Dellavalle RP, Box NF, Crane LA |title=Tanning and increased nevus development in very-light-skinned children without red hair |journal=Arch Dermatol |volume=145 |issue=9 |pages=989–96 |date=September 2009 |pmid=19770437 |pmc=2924169 |doi=10.1001/archdermatol.2009.193 |url=}}</ref><ref name="pmid29614272">{{cite journal |vauthors=De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, Rossari S, Papi F, Scarfi F, Janowska A, D'Errico A, Salvati L, Covarelli P, Gandini S |title=Sun-Protection Behavior, Pubertal Development and Menarche: Factors Influencing the Melanocytic Nevi Development-The Results of an Observational Study of 1,512 Children |journal=J. Invest. Dermatol. |volume=138 |issue=10 |pages=2144–2151 |date=October 2018 |pmid=29614272 |doi=10.1016/j.jid.2018.02.046 |url=}}</ref>
**Heredity, with a familial propensity to have many moles.<ref name="pmid25307738">{{cite journal |vauthors=Orlow I, Satagopan JM, Berwick M, Enriquez HL, White KA, Cheung K, Dusza SW, Oliveria SA, Marchetti MA, Scope A, Marghoob AA, Halpern AC |title=Genetic factors associated with naevus count and dermoscopic patterns: preliminary results from the Study of Nevi in Children (SONIC) |journal=Br. J. Dermatol. |volume=172 |issue=4 |pages=1081–9 |date=April 2015 |pmid=25307738 |pmc=4382400 |doi=10.1111/bjd.13467 |url=}}</ref>
**Intense sun exposure during childhood. Other factors that may affect the development of acquired melanocytic nevi in children include lichen sclerosus, immunosuppression, chemotherapy, and endocrine disorders.<ref name="pmid12507670">{{cite journal |vauthors=Dulon M, Weichenthal M, Blettner M, Breitbart M, Hetzer M, Greinert R, Baumgardt-Elms C, Breitbart EW |title=Sun exposure and number of nevi in 5- to 6-year-old European children |journal=J Clin Epidemiol |volume=55 |issue=11 |pages=1075–81 |date=November 2002 |pmid=12507670 |doi= |url=}}</ref><ref name="pmid12548604">{{cite journal |vauthors=Wiecker TS, Luther H, Buettner P, Bauer J, Garbe C |title=Moderate sun exposure and nevus counts in parents are associated with development of melanocytic nevi in childhood: a risk factor study in 1,812 kindergarten children |journal=Cancer |volume=97 |issue=3 |pages=628–38 |date=February 2003 |pmid=12548604 |doi=10.1002/cncr.11114 |url=}}</ref><ref name="pmid18768500">{{cite journal |vauthors=Harrison SL, MacLennan R, Buettner PG |title=Sun exposure and the incidence of melanocytic nevi in young Australian children |journal=Cancer Epidemiol. Biomarkers Prev. |volume=17 |issue=9 |pages=2318–24 |date=September 2008 |pmid=18768500 |doi=10.1158/1055-9965.EPI-07-2801 |url=}}</ref>
**Phenotypic attributes such as skin type, with more nevus in individuals with light skin. Dark skinned people have few nevi. Children with dark hair tend to have more moles compared to people with very fair skin and red hair. <ref name="pmid12548604">{{cite journal |vauthors=Wiecker TS, Luther H, Buettner P, Bauer J, Garbe C |title=Moderate sun exposure and nevus counts in parents are associated with development of melanocytic nevi in childhood: a risk factor study in 1,812 kindergarten children |journal=Cancer |volume=97 |issue=3 |pages=628–38 |date=February 2003 |pmid=12548604 |doi=10.1002/cncr.11114 |url=}}</ref><ref name="pmid29614272">{{cite journal |vauthors=De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, Rossari S, Papi F, Scarfi F, Janowska A, D'Errico A, Salvati L, Covarelli P, Gandini S |title=Sun-Protection Behavior, Pubertal Development and Menarche: Factors Influencing the Melanocytic Nevi Development-The Results of an Observational Study of 1,512 Children |journal=J. Invest. Dermatol. |volume=138 |issue=10 |pages=2144–2151 |date=October 2018 |pmid=29614272 |doi=10.1016/j.jid.2018.02.046 |url=}}</ref><ref name="pmid8961877">{{cite journal |vauthors=Luther H, Altmeyer P, Garbe C, Ellwanger U, Jahn S, Hoffmann K, Segerling M |title=Increase of melanocytic nevus counts in children during 5 years of follow-up and analysis of associated factors |journal=Arch Dermatol |volume=132 |issue=12 |pages=1473–8 |date=December 1996 |pmid=8961877 |doi= |url=}}</ref>

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
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Melanocytic nevus pathophysiology

2019-05-20T15:50:19Z

Qurrat-ul-ain Abid: /* Acquired melanocytic nevi (moles) */

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{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

====Gross Pathology====
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

====Proliferative nodules Melanocytic nevus====

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

====Speckled lentiginous nevus (SLN)====
*CMN may appear as a hyperpigmented patch with, superimposed dark or brown macules and papules which is known as lentiginous nevus (SLN) or nevus spilus.
*The "background" tan patch (café-au-lait macule-like) of an SLN is mostly present at birth or appear soon after birth, brown "spots" may appear in the lesions later.
*SLN is of two types:<ref name="pmid19040513">{{cite journal |vauthors=Happle R |title=Speckled lentiginous naevus: which of the two disorders do you mean? |journal=Clin. Exp. Dermatol. |volume=34 |issue=2 |pages=133–5 |date=March 2009 |pmid=19040513 |doi=10.1111/j.1365-2230.2008.02966.x |url=}}</ref><ref name="pmid11176689">{{cite journal |vauthors=Schaffer JV, Orlow SJ, Lazova R, Bolognia JL |title=Speckled lentiginous nevus: within the spectrum of congenital melanocytic nevi |journal=Arch Dermatol |volume=137 |issue=2 |pages=172–8 |date=February 2001 |pmid=11176689 |doi= |url=}}</ref>
**With macular speckles
**With papular and macular speckles

===Acquired melanocytic nevi (moles)===
*Benign growth of a type of melanocyte known as a "nevus cell" is known as melanocytic nevi or mole.
*Although both melanocytes and nevus cells produce the pigment melanin however Nevus cells are different from the Melanocytes due to the following characteristics:
**Nevus cells have a tendency to cluster within the lower epidermis or dermis, while epidermal melanocyte tends to spread out in one group.
**Nevus cells lack dendritic process
*Appearance of moles may vary depending on their location in the skin:
**Junctional nevi: melanocytes are at the dermal-epidermal junction.
**Compound nevi, melanocytes are both at the dermal-epidermal junction and in the dermis.
**Intradermal nevi, the nests of melanocytes are in the dermis.
**Elevated and less pigmented nevi: migration of melanocytes from the dermal-epidermal junction into the dermis.
'''Predisposing factors for the development of acquired melanocytic nevi'''
*Factors influencing to the development of all acquired nevi except blue and Spitz nevi are:<ref name="pmid19001133">{{cite journal |vauthors=Oliveria SA, Satagopan JM, Geller AC, Dusza SW, Weinstock MA, Berwick M, Bishop M, Heneghan MK, Halpern AC |title=Study of Nevi in Children (SONIC): baseline findings and predictors of nevus count |journal=Am. J. Epidemiol. |volume=169 |issue=1 |pages=41–53 |date=January 2009 |pmid=19001133 |pmc=2720704 |doi=10.1093/aje/kwn289 |url=}}</ref><ref name="pmid19770437">{{cite journal |vauthors=Aalborg J, Morelli JG, Mokrohisky ST, Asdigian NL, Byers TE, Dellavalle RP, Box NF, Crane LA |title=Tanning and increased nevus development in very-light-skinned children without red hair |journal=Arch Dermatol |volume=145 |issue=9 |pages=989–96 |date=September 2009 |pmid=19770437 |pmc=2924169 |doi=10.1001/archdermatol.2009.193 |url=}}</ref><ref name="pmid29614272">{{cite journal |vauthors=De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, Rossari S, Papi F, Scarfi F, Janowska A, D'Errico A, Salvati L, Covarelli P, Gandini S |title=Sun-Protection Behavior, Pubertal Development and Menarche: Factors Influencing the Melanocytic Nevi Development-The Results of an Observational Study of 1,512 Children |journal=J. Invest. Dermatol. |volume=138 |issue=10 |pages=2144–2151 |date=October 2018 |pmid=29614272 |doi=10.1016/j.jid.2018.02.046 |url=}}</ref>
**Heredity, with a familial propensity to have many moles.<ref name="pmid25307738">{{cite journal |vauthors=Orlow I, Satagopan JM, Berwick M, Enriquez HL, White KA, Cheung K, Dusza SW, Oliveria SA, Marchetti MA, Scope A, Marghoob AA, Halpern AC |title=Genetic factors associated with naevus count and dermoscopic patterns: preliminary results from the Study of Nevi in Children (SONIC) |journal=Br. J. Dermatol. |volume=172 |issue=4 |pages=1081–9 |date=April 2015 |pmid=25307738 |pmc=4382400 |doi=10.1111/bjd.13467 |url=}}</ref>
**Intense sun exposure during childhood. Other factors that may affect the development of acquired melanocytic nevi in children include lichen sclerosus, immunosuppression, chemotherapy, and endocrine disorders.<ref name="pmid12507670">{{cite journal |vauthors=Dulon M, Weichenthal M, Blettner M, Breitbart M, Hetzer M, Greinert R, Baumgardt-Elms C, Breitbart EW |title=Sun exposure and number of nevi in 5- to 6-year-old European children |journal=J Clin Epidemiol |volume=55 |issue=11 |pages=1075–81 |date=November 2002 |pmid=12507670 |doi= |url=}}</ref><ref name="pmid12548604">{{cite journal |vauthors=Wiecker TS, Luther H, Buettner P, Bauer J, Garbe C |title=Moderate sun exposure and nevus counts in parents are associated with development of melanocytic nevi in childhood: a risk factor study in 1,812 kindergarten children |journal=Cancer |volume=97 |issue=3 |pages=628–38 |date=February 2003 |pmid=12548604 |doi=10.1002/cncr.11114 |url=}}</ref><ref name="pmid18768500">{{cite journal |vauthors=Harrison SL, MacLennan R, Buettner PG |title=Sun exposure and the incidence of melanocytic nevi in young Australian children |journal=Cancer Epidemiol. Biomarkers Prev. |volume=17 |issue=9 |pages=2318–24 |date=September 2008 |pmid=18768500 |doi=10.1158/1055-9965.EPI-07-2801 |url=}}</ref>
**Phenotypic attributes such as skin type, with more nevus in individuals with light skin. Dark skinned people have few nevi. Children with dark hair tend to have more moles compared to people with very fair skin and red hair. <ref name="pmid12548604">{{cite journal |vauthors=Wiecker TS, Luther H, Buettner P, Bauer J, Garbe C |title=Moderate sun exposure and nevus counts in parents are associated with development of melanocytic nevi in childhood: a risk factor study in 1,812 kindergarten children |journal=Cancer |volume=97 |issue=3 |pages=628–38 |date=February 2003 |pmid=12548604 |doi=10.1002/cncr.11114 |url=}}</ref><ref name="pmid29614272">{{cite journal |vauthors=De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, Rossari S, Papi F, Scarfi F, Janowska A, D'Errico A, Salvati L, Covarelli P, Gandini S |title=Sun-Protection Behavior, Pubertal Development and Menarche: Factors Influencing the Melanocytic Nevi Development-The Results of an Observational Study of 1,512 Children |journal=J. Invest. Dermatol. |volume=138 |issue=10 |pages=2144–2151 |date=October 2018 |pmid=29614272 |doi=10.1016/j.jid.2018.02.046 |url=}}</ref><ref name="pmid8961877">{{cite journal |vauthors=Luther H, Altmeyer P, Garbe C, Ellwanger U, Jahn S, Hoffmann K, Segerling M |title=Increase of melanocytic nevus counts in children during 5 years of follow-up and analysis of associated factors |journal=Arch Dermatol |volume=132 |issue=12 |pages=1473–8 |date=December 1996 |pmid=8961877 |doi= |url=}}</ref>

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN, >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
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Melanocytic nevus pathophysiology

2019-05-20T15:09:16Z

Qurrat-ul-ain Abid: /* Acquired melanocytic nevi (moles) */

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{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

====Gross Pathology====
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

====Proliferative nodules Melanocytic nevus====

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

====Speckled lentiginous nevus (SLN)====
*CMN may appear as a hyperpigmented patch with, superimposed dark or brown macules and papules which is known as lentiginous nevus (SLN) or nevus spilus.
*The "background" tan patch (café-au-lait macule-like) of an SLN is mostly present at birth or appear soon after birth, brown "spots" may appear in the lesions later.
*SLN is of two types:<ref name="pmid19040513">{{cite journal |vauthors=Happle R |title=Speckled lentiginous naevus: which of the two disorders do you mean? |journal=Clin. Exp. Dermatol. |volume=34 |issue=2 |pages=133–5 |date=March 2009 |pmid=19040513 |doi=10.1111/j.1365-2230.2008.02966.x |url=}}</ref><ref name="pmid11176689">{{cite journal |vauthors=Schaffer JV, Orlow SJ, Lazova R, Bolognia JL |title=Speckled lentiginous nevus: within the spectrum of congenital melanocytic nevi |journal=Arch Dermatol |volume=137 |issue=2 |pages=172–8 |date=February 2001 |pmid=11176689 |doi= |url=}}</ref>
**With macular speckles
**With papular and macular speckles

===Acquired melanocytic nevi (moles)===
*Benign growth of a type of melanocyte known as a "nevus cell" is known as melanocytic nevi or mole.
*Although both melanocytes and nevus cells produce the pigment melanin however Nevus cells are different from the Melanocytes due to the following characteristics:
**Nevus cells have a tendency to cluster within the lower epidermis or dermis, while epidermal melanocyte tend to spread out in one group.
**Nevus cells lack dendritic process
*Appearance of moles may vary depending on their location in the skin:
**junctional nevi: melanocytes are at the dermal-epidermal junction.
**Compound nevi, melanocytes are both at the dermal-epidermal junction and in the dermis.
**Intradermal nevi, the nests of melanocytes are in the dermis.
**Elevated and less pigmented nevi: migration of melanocytes from the dermal-epidermal junction into the dermis.

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN, >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
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Melanocytic nevus pathophysiology

2019-05-20T14:41:38Z

Qurrat-ul-ain Abid: /* Pathophysiology */

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{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

====Gross Pathology====
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

====Proliferative nodules Melanocytic nevus====

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

====Speckled lentiginous nevus (SLN)====
*CMN may appear as a hyperpigmented patch with, superimposed dark or brown macules and papules which is known as lentiginous nevus (SLN) or nevus spilus.
*The "background" tan patch (café-au-lait macule-like) of an SLN is mostly present at birth or appear soon after birth, brown "spots" may appear in the lesions later.
*SLN is of two types:<ref name="pmid19040513">{{cite journal |vauthors=Happle R |title=Speckled lentiginous naevus: which of the two disorders do you mean? |journal=Clin. Exp. Dermatol. |volume=34 |issue=2 |pages=133–5 |date=March 2009 |pmid=19040513 |doi=10.1111/j.1365-2230.2008.02966.x |url=}}</ref><ref name="pmid11176689">{{cite journal |vauthors=Schaffer JV, Orlow SJ, Lazova R, Bolognia JL |title=Speckled lentiginous nevus: within the spectrum of congenital melanocytic nevi |journal=Arch Dermatol |volume=137 |issue=2 |pages=172–8 |date=February 2001 |pmid=11176689 |doi= |url=}}</ref>
**With macular speckles
**With papular and macular speckles

===Acquired melanocytic nevi (moles)===

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN, >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Needs content]]

{{WikiDoc Help Menu}}
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Melanocytic nevus pathophysiology

2019-05-17T16:49:50Z

Qurrat-ul-ain Abid: /* Pathophysiology */

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{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

===Gross Pathology===
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

===Proliferative nodules Melanocytic nevus===

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

===Speckled lentiginous nevus (SLN)===
*CMN may appear as a hyperpigmented patch with, superimposed dark or brown macules and papules which is known as lentiginous nevus (SLN) or nevus spilus.
*The "background" tan patch (café-au-lait macule-like) of an SLN is mostly present at birth or appear soon after birth, brown "spots" may appear in the lesions later.
*SLN is of two types:<ref name="pmid19040513">{{cite journal |vauthors=Happle R |title=Speckled lentiginous naevus: which of the two disorders do you mean? |journal=Clin. Exp. Dermatol. |volume=34 |issue=2 |pages=133–5 |date=March 2009 |pmid=19040513 |doi=10.1111/j.1365-2230.2008.02966.x |url=}}</ref><ref name="pmid11176689">{{cite journal |vauthors=Schaffer JV, Orlow SJ, Lazova R, Bolognia JL |title=Speckled lentiginous nevus: within the spectrum of congenital melanocytic nevi |journal=Arch Dermatol |volume=137 |issue=2 |pages=172–8 |date=February 2001 |pmid=11176689 |doi= |url=}}</ref>
**With macular speckles
**With papular and macular speckles

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN, >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
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Melanocytic nevus pathophysiology

2019-05-17T16:32:16Z

Qurrat-ul-ain Abid: /* Pathophysiology */

__NOTOC__

Please help WikiDoc by adding more content here. It's easy! Click [[Help:How_to_Edit_a_Page|here]] to learn about editing.

{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

===Gross Pathology===
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

===Proliferative nodules Melanocytic nevus===

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

===Speckled lentiginous nevus (SLN)===
*Speckled lentiginous nevus (SLN) or nevus spilus is a hyperpigmented, macular, patch-type, tan or light brown patch with superimposed darker brown macules and papules (picture 14A-B). The "background" tan patch (café-au-lait macule-like) of an SLN is usually noted at birth or soon after, with brown "spots" appearing within the lesion over time.

The superimposed, pigmented macules and papules can range from lentigines to junctional, compound, and intradermal nevi to Spitz nevi and blue nevi. There are two distinct subtypes of SLN: those with only macular speckles and those with papular as well as macular speckles [55].

Several lines of evidence suggest that SLN, which have a prevalence of approximately 2 percent, represent a subtype of CMN [56]. Some SLN have patterns of distribution reflecting embryonic development (eg, block-like with a sharp demarcation at the midline or following the lines of Blaschko).

The risk of developing melanoma in SLN is thought to be similar to classic CMN of the same size range. SLN should therefore be followed clinically with periodic examinations and biopsy of suspicious areas. (See 'Management' above and "Risk factors for the development of melanoma", section on 'Congenital nevi'.)

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN, >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
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Sandbox:Qurrat

2019-05-17T16:22:25Z

Qurrat-ul-ain Abid:

__NOTOC__

{{CMG}}; {{AE}}{{Qurrat}}

==Managemnet of Congenital melanocytic Nevi==

https://www.uptodate.com/contents/congenital-melanocytic-nevi?search=melanocytic%20nevus%20pathophysiology&sectionRank=1&usage_type=default&anchor=H2&source=machineLearning&selectedTitle=1~44&display_rank=1#H2

MANAGEMENT

Small/medium CMN — Small and medium-sized CMN are managed on an individual basis depending on factors that affect ease of monitoring (eg, color, thickness/topography, and location), clinical history, parents' anxiety, and cosmetic concerns [4]. As an example, a multinodular black CMN on the scalp that is partially obscured by dense hair growth would be difficult to follow clinically, whereas a thin light brown lesion on the face would be relatively simple to observe. However, the latter might be removed for cosmetic reasons, and the former may spontaneously lighten during childhood.

Periodic evaluation of small- and medium-sized CMN is most important after puberty, since the risk of melanoma arising within these lesions during childhood is extremely low. Baseline photographs can be helpful, and dermoscopy represents a useful tool for assessing changes. (See "Dermoscopic evaluation of skin lesions".)

Patients and parents should be instructed to perform skin self-examinations and to bring focal changes in color, border, or topography (eg, a red or black papule, nodule, or crust) to the clinician's attention. (See "Screening and early detection of melanoma in adults and adolescents", section on 'Patient self-examination'.)

Large CMN — Early surgical removal is often desired for large CMN because of their cosmetic and psychosocial sequelae and concern for possible malignant transformation. Complete excision is difficult to achieve; however, resection of bulky and cumbersome portions of large CMN can be beneficial for some patients. Elimination of every nevus cell may be impossible because of the large area of skin affected, the anatomic site (eg, distal extremity, periocular area, genitalia), and involvement of deeper structures (eg, fat, fascia, muscle). Even theoretically complete surgical excision cannot completely eliminate future risk of melanoma, as some melanomas in these patients may develop in the CNS or retroperitoneum. In many cases, close clinical observation with no surgical removal of the lesion is a reasonable choice.

Factors that affect the decision to perform surgery as well as to determine the timing of surgery include the size and location of the large CMN, the technical difficulty of the procedure(s) required, and anesthesia options. When possible, complete removal of large CMN usually necessitates staged excision with the use of tissue expanders and, occasionally, skin grafting [45].

When surgical excision is not feasible, cosmetic benefit may potentially be obtained from procedures such as curettage, dermabrasion, and ablative laser therapy (eg, carbon dioxide or erbium:yttrium aluminum garnet lasers, sometimes combined with pigment-directed lasers). During the neonatal period, there is a lower risk of excessive scarring following such interventions, and nevus cells are more accessible because they are concentrated in the upper dermis [46,47]. Curettage can be performed during the first two weeks of life, taking advantage of a cleavage plane between the upper and mid-dermis exclusive to neonatal skin. However, nevus cells remain in the dermis after all of these procedures, as evidenced by frequent repigmentation as well as several reports of the subsequent development of melanoma in treated areas [48-52]. This underscores the need for lifelong clinical observation.

Regardless of the treatments employed, patients with large CMN (or scars after their excision) should be followed with periodic skin and general physical examinations. Palpation of the nevus and/or scars is essential for detection of focal induration. Histologic evaluation is indicated for firm nodules or indurated areas. Even theoretically complete removal of a large CMN does not eliminate the risk of melanoma, since melanoma of the CNS and other visceral primary sites (eg, the retroperitoneum) may still occur [53].

Proliferative nodules that develop within large CMN during infancy can have histologic features of melanoma yet behave in a benign manner. Techniques such as comparative genomic hybridization can help to distinguish proliferative nodules (usually having no chromosomal aberrations or only numeric changes) from melanoma (typically demonstrating gains/losses of chromosomal fragments) [40]. Mass spectroscopy imaging proteomic analysis may also help differentiate proliferative nodules from melanoma [29]. (See 'Proliferative nodules' above.)

Surveillance for neurocutaneous melanosis — Patients with a large CMN plus multiple (especially >20) satellite nevi or with multiple medium-sized CMN are at risk for NCM and should be followed with serial head circumference measurements, neurologic examinations, and developmental assessments [3,37,39]. This monitoring includes evaluation for signs and symptoms of increased intracranial pressure, mass lesions, and spinal cord compression [3,39].

Gadolinium-enhanced magnetic resonance imaging (MRI) of brain and spine should be performed in any high-risk patient exhibiting neurologic symptoms, and we suggest that asymptomatic high-risk patients also be screened for NCM with gadolinium-enhanced MRI of the brain and spine, ideally during the first six months of life before myelination, which may obscure evidence of melanosis [42]. For very young infants, it may be possible to obtain initial high-quality MRI images without general anesthesia using "feed and wrap" techniques that allow a swaddled infant to sleep during the imaging procedure [54].

Given the poor prognosis, aggressive surgical procedures for CMN removal should be postponed in patients with symptomatic NCM. NCM in an asymptomatic patient does not necessarily preclude skin surgery.

{|
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! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 1
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! colspan="1" rowspan="1" |Physical exam 2
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!Lab 1
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|}

==Table for Differential Diagnosis of Small Intestine Cancer==
'''ABBREVIATIONS''':

'''N/A''': Not available, '''NL''': Normal,<nowiki/><nowiki/>
==References==
{{Reflist|2}}

Melanocytic nevus medical therapy

2019-05-17T16:22:05Z

Qurrat-ul-ain Abid:

{{Melanocytic nevus}}
{{CMG}}

==Overview==

==Managemnet of Congenital Melanocytic Nevi(CMN)==

==References==
{{reflist|2}}

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Melanocytic nevus pathophysiology

2019-05-17T16:18:07Z

Qurrat-ul-ain Abid: /* Neurocutaneous melanosis */

__NOTOC__

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{{Melanocytic nevus}}
'''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org];{{AE}} {{Qurrat}} [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
==Overview==

Melanocytic nevus is a benign growth on the skin (usually tan, brown, or flesh-colored) that contains a cluster of melanocytes and surrounding supportive tissue.

==Pathophysiology==

===Congenital melanocytic nevi (CMN)===

*When melanocytic nevi are present at birth or within the first few months of life they are known as Congenital melanocytic nevi (CMN).
*Congenital melanocytic nevi (CMN) are hamartomas lesions.
*Small melanocytic nevi that appear during early childhood between three months and two years of age, resemble true CMN clinicaly and histologicaly and are known as "tardive CMN," "early-onset nevi," and "congenital nevus-like nevi.<ref name="pmid12130901">{{cite journal |vauthors=Makkar HS, Frieden IJ |title=Congenital melanocytic nevi: an update for the pediatrician |journal=Curr. Opin. Pediatr. |volume=14 |issue=4 |pages=397–403 |date=August 2002 |pmid=12130901 |doi= |url=}}</ref>
*During embryogenesis clonal proliferations of benign melanocytes may give rise to melanocytic nevi.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref><ref name="pmid20541682">{{cite journal |vauthors=Price HN, Schaffer JV |title=Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies |journal=Clin. Dermatol. |volume=28 |issue=3 |pages=293–302 |date=2010 |pmid=20541682 |doi=10.1016/j.clindermatol.2010.04.004 |url=}}</ref>
*BRAF V600E mutations have a very high corelation with small congenital melanocytic nevi (CMN), acquired melanocytic nevi and cutaneous melanomas.<ref name="pmid16691193">{{cite journal |vauthors=Ichii-Nakato N, Takata M, Takayanagi S, Takashima S, Lin J, Murata H, Fujimoto A, Hatta N, Saida T |title=High frequency of BRAFV600E mutation in acquired nevi and small congenital nevi, but low frequency of mutation in medium-sized congenital nevi |journal=J. Invest. Dermatol. |volume=126 |issue=9 |pages=2111–8 |date=September 2006 |pmid=16691193 |doi=10.1038/sj.jid.5700366 |url=}}</ref><ref name="pmid18032947">{{cite journal |vauthors=Wu J, Rosenbaum E, Begum S, Westra WH |title=Distribution of BRAF T1799A(V600E) mutations across various types of benign nevi: implications for melanocytic tumorigenesis |journal=Am J Dermatopathol |volume=29 |issue=6 |pages=534–7 |date=December 2007 |pmid=18032947 |doi=10.1097/DAD.0b013e3181584950 |url=}}</ref>
*While giant congenital melanocytic nevi (CMN) have somatic gain-of-function mutations in NRAS.<ref name="pmid18633438">{{cite journal |vauthors=Dessars B, De Raeve LE, Morandini R, Lefort A, El Housni H, Ghanem GE, Van den Eynde BJ, Ma W, Roseeuw D, Vassart G, Libert F, Heimann P |title=Genotypic and gene expression studies in congenital melanocytic nevi: insight into initial steps of melanotumorigenesis |journal=J. Invest. Dermatol. |volume=129 |issue=1 |pages=139–47 |date=January 2009 |pmid=18633438 |doi=10.1038/jid.2008.203 |url=}}</ref><ref name="pmid24129063">{{cite journal |vauthors=Charbel C, Fontaine RH, Malouf GG, Picard A, Kadlub N, El-Murr N, How-Kit A, Su X, Coulomb-L'Hermine A, Tost J, Mourah S, Aractingi S, Guégan S |title=NRAS mutation is the sole recurrent somatic mutation in large congenital melanocytic nevi |journal=J. Invest. Dermatol. |volume=134 |issue=4 |pages=1067–1074 |date=April 2014 |pmid=24129063 |doi=10.1038/jid.2013.429 |url=}}</ref>
*Compared to acquired melanocytic nevi, CMN penetrate into deeper layers of dermis.<ref name="pmid4756859">{{cite journal |vauthors=Mark GJ, Mihm MC, Liteplo MG, Reed RJ, Clark WH |title=Congenital melanocytic nevi of the small and garment type. Clinical, histologic, and ultrastructural studies |journal=Hum. Pathol. |volume=4 |issue=3 |pages=395–418 |date=September 1973 |pmid=4756859 |doi= |url=}}</ref>
*Melanocytes in CMN follow pathyway of nerves and vessels and grow along adenxal structures (eg, hair follicles, sebaceous glands, eccrine ducts) and settle between collagen bundles in a single arrangement.<ref name="pmid6715623">{{cite journal |vauthors= |title=Precursors to malignant melanoma. National Institutes of Health Consensus Development Conference Statement, Oct. 24-26, 1983 |journal=J. Am. Acad. Dermatol. |volume=10 |issue=4 |pages=683–8 |date=April 1984 |pmid=6715623 |doi= |url=}}</ref><ref name="pmid22771898">{{cite journal |vauthors=Kokta V, Hung T, Al Dhaybi R, Lugassy C, Barnhill RL |title=High prevalence of angiotropism in congenital melanocytic nevi: an analysis of 53 cases |journal=Am J Dermatopathol |volume=35 |issue=2 |pages=180–3 |date=April 2013 |pmid=22771898 |doi=10.1097/DAD.0b013e318260908c |url=}}</ref>

'''Dermoscopic features of Congenital melanocytic nevi (CMN)'''
*CMN and acquired melanocytic nevi appear as pigment network, aggregated globules, or diffuse homogeneous brown pigmentation on dermoscopy.<ref name="pmid23252411">{{cite journal |vauthors=Haliasos EC, Kerner M, Jaimes N, Zalaudek I, Malvehy J, Hofmann-Wellenhof R, Braun RP, Marghoob AA |title=Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions |journal=Pediatr Dermatol |volume=30 |issue=3 |pages=281–93 |date=2013 |pmid=23252411 |doi=10.1111/pde.12041 |url=}}</ref>
*Dermoscopic patterns that are commonly seen in CMN are:<ref name="pmid17709659">{{cite journal |vauthors=Changchien L, Dusza SW, Agero AL, Korzenko AJ, Braun RP, Sachs D, Usman MH, Halpern AC, Marghoob AA |title=Age- and site-specific variation in the dermoscopic patterns of congenital melanocytic nevi: an aid to accurate classification and assessment of melanocytic nevi |journal=Arch Dermatol |volume=143 |issue=8 |pages=1007–14 |date=August 2007 |pmid=17709659 |doi=10.1001/archderm.143.8.1007 |url=}}</ref>
**Reticular
**Globular/cobblestoning
**Homogenous
**Or a mixture of these (ie, multicomponent)
*CMN may exhibit exaggerated attributes on dermoscopy compared to acquired melanocytic nevi, they may show:<ref name="pmid16792752">{{cite journal |vauthors=Seidenari S, Pellacani G, Martella A, Giusti F, Argenziano G, Buccini P, Carli P, Catricalà C, De Giorgi V, Ferrari A, Ingordo V, Manganoni AM, Peris K, Piccolo D, Pizzichetta MA |title=Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study |journal=Br. J. Dermatol. |volume=155 |issue=1 |pages=56–61 |date=July 2006 |pmid=16792752 |doi=10.1111/j.1365-2133.2006.07182.x |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref><ref name="pmid16707885">{{cite journal |vauthors=Ingordo V, Iannazzone SS, Cusano F, Naldi L |title=Dermoscopic features of congenital melanocytic nevus and Becker nevus in an adult male population: an analysis with a 10-fold magnification |journal=Dermatology (Basel) |volume=212 |issue=4 |pages=354–60 |date=2006 |pmid=16707885 |doi=10.1159/000092286 |url=}}</ref>
**Perifollicular hypopigmentation
**Marked follicular structures
**Skin hyperpigmentation
**Hypertrichosis
**Pigment changes surrounding follicles such as hypopigmentation

===Gross Pathology===
[[Image:Mole (body part).jpg|thumb|200px|left|Melanocytic naevus]]
 

===Proliferative nodules Melanocytic nevus===

*Benign melanocytic proliferations may occasionally appear within large or giant CMN.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analyses of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref>
*They may be congenital or develop in infancy or childhood.
*They may grow rapidly with clinical characteristics of firmness or ulceration, in that case, a biopsy should be performed to eliminate melanoma.
*Large, atypical melanocytes and mitoses may be present on microscopy that make it difficult to differentiate from Melanoma.
*In case of difficulty in differentiating benign melanocytic proliferation from Melanoma on microscopy, an evaluation of an experienced doctor may be helpful. Other modalities of evaluation are comparative genomic hybridization or mass spectroscopy imaging proteomic analysis.<ref name="pmid21436676">{{cite journal |vauthors=Phadke PA, Rakheja D, Le LP, Selim MA, Kapur P, Davis A, Mihm MC, Hoang MP |title=Proliferative nodules arising within congenital melanocytic nevi: a histologic, immunohistochemical, and molecular analysis of 43 cases |journal=Am. J. Surg. Pathol. |volume=35 |issue=5 |pages=656–69 |date=May 2011 |pmid=21436676 |doi=10.1097/PAS.0b013e31821375ea |url=}}</ref><ref name="pmid28248717">{{cite journal |vauthors=Lazova R, Yang Z, El Habr C, Lim Y, Choate KA, Seeley EH, Caprioli RM, Yangqun L |title=Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma |journal=Am J Dermatopathol |volume=39 |issue=9 |pages=689–695 |date=September 2017 |pmid=28248717 |pmc=5647999 |doi=10.1097/DAD.0000000000000849 |url=}}</ref>

==Complications of Melanocytic nevi==

===Melanoma===

*Melanoma may arise as a complication within congenital melanocytic nevi(CMN), the lifetime risk is lower than 1%.<ref name="pmid15692463">{{cite journal |vauthors=Tannous ZS, Mihm MC, Sober AJ, Duncan LM |title=Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical management |journal=J. Am. Acad. Dermatol. |volume=52 |issue=2 |pages=197–203 |date=February 2005 |pmid=15692463 |doi=10.1016/j.jaad.2004.07.020 |url=}}</ref>
*Melanoma arises at the dermal-epidermal junction, in giant CMN they may arise in the deeper layers.
*In large or giant CMN, there is 2 to 5 percent lifetime risk of developing either cutaneous or extracutaneous melanoma.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Half of the Melanoma may arise within the first five years of life.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref><ref name="pmid18811688">{{cite journal |vauthors=Kinsler VA, Birley J, Atherton DJ |title=Great Ormond Street Hospital for Children Registry for congenital melanocytic naevi: prospective study 1988-2007. Part 1-epidemiology, phenotype and outcomes |journal=Br. J. Dermatol. |volume=160 |issue=1 |pages=143–50 |date=January 2009 |pmid=18811688 |doi=10.1111/j.1365-2133.2008.08849.x |url=}}</ref>
*Early identification and assessment may be difficult in giant CMN, becuase of there subepidermal location in cutaneous melanomas.
*Palpation of the lesion during physical exam may help in detecting deeper nodules.
*Primary melanoma may arise in the central nervous system (CNS) or retroperitoneum.
*Posterior axial giant CMN have the greateset risk of developing Melanomas, nevi of head and extrimities are less likely to develop melanomas.

===Neurocutaneous melanosis===

*Rarely in CMN neurocutaneous melanosis(NCM) may arise, it is the growth of melanocytes in CNS and skin.
*Neurocutaneous melanosis (NCM) includes leptomeningeal melanosis and CNS melanosis.<ref name="pmid11252085">{{cite journal |vauthors=Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ |title=Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children |journal=Plast. Reconstr. Surg. |volume=107 |issue=4 |pages=933–41 |date=April 2001 |pmid=11252085 |doi= |url=}}</ref>
*NCM is diagnosed on MRI as it may stay asymptomatic or produce minimal symptoms.<ref name="pmid15253185">{{cite journal |vauthors=Watt AJ, Kotsis SV, Chung KC |title=Risk of melanoma arising in large congenital melanocytic nevi: a systematic review |journal=Plast. Reconstr. Surg. |volume=113 |issue=7 |pages=1968–74 |date=June 2004 |pmid=15253185 |doi= |url=}}</ref>
*Symptomatic NCM has a poor prognosis with high mortality rate.<ref name="pmid23182059">{{cite journal |vauthors=Vourc'h-Jourdain M, Martin L, Barbarot S |title=Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review |journal=J. Am. Acad. Dermatol. |volume=68 |issue=3 |pages=493–8.e1–14 |date=March 2013 |pmid=23182059 |doi=10.1016/j.jaad.2012.09.039 |url=}}</ref>
*Risk factors for NCM are:<ref name="pmid8859278">{{cite journal |vauthors=DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS |title=Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis |journal=J. Am. Acad. Dermatol. |volume=35 |issue=4 |pages=529–38 |date=October 1996 |pmid=8859278 |doi= |url=}}</ref><ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref><ref name="pmid19766348">{{cite journal |vauthors=Lovett A, Maari C, Decarie JC, Marcoux D, McCuaig C, Hatami A, Savard P, Powell J |title=Large congenital melanocytic nevi and neurocutaneous melanocytosis: one pediatric center's experience |journal=J. Am. Acad. Dermatol. |volume=61 |issue=5 |pages=766–74 |date=November 2009 |pmid=19766348 |doi=10.1016/j.jaad.2008.11.022 |url=}}</ref>
**A large CMN, >40 cm and in a posterior axial location
**Multiple satellite nevi
**Greater than two medium-sized CMN

*According to a study CMN with >20 satellites had a fivefold increased risk for NCM compared with those with ≤20 satellites.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*NCM may cooccur with the structural abnormalities of CNS such as Dandy-Walker malformation/posterior fossa cysts, defects of the vertebrae or skull, and intraspinal lipomas.<ref name="pmid14967788">{{cite journal |vauthors=Marghoob AA, Dusza S, Oliveria S, Halpern AC |title=Number of satellite nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi |journal=Arch Dermatol |volume=140 |issue=2 |pages=171–5 |date=February 2004 |pmid=14967788 |doi=10.1001/archderm.140.2.171 |url=}}</ref>
*MRI with gadolinium contrast can pick NCM.<ref name="pmid18671780">{{cite journal |vauthors=Kinsler VA, Chong WK, Aylett SE, Atherton DJ |title=Complications of congenital melanocytic naevi in children: analysis of 16 years' experience and clinical practice |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=907–14 |date=September 2008 |pmid=18671780 |doi=10.1111/j.1365-2133.2008.08775.x |url=}}</ref>
*Symptomatic NCM may present with hydrocephalus, seizures that may be consequence of intracranial hemorrhage, impaired cerebrospinal fluid circulation, spinal cord compression, or malignant transformation of the melanocytes.<ref name="pmid14576958">{{cite journal |vauthors=Di Rocco F, Sabatino G, Koutzoglou M, Battaglia D, Caldarelli M, Tamburrini G |title=Neurocutaneous melanosis |journal=Childs Nerv Syst |volume=20 |issue=1 |pages=23–8 |date=January 2004 |pmid=14576958 |doi=10.1007/s00381-003-0835-9 |url=}}</ref>
*If symptomatic NCM have poor prognosis even with abscence of malignant changes.<ref name="pmid11737677">{{cite journal |vauthors=Schaffer JV, McNiff JM, Bolognia JL |title=Cerebral mass due to neurocutaneous melanosis: eight years later |journal=Pediatr Dermatol |volume=18 |issue=5 |pages=369–77 |date=2001 |pmid=11737677 |doi= |url=}}</ref>

==References==
{{reflist|2}}

[[Category:Dermatology]]
[[Category:Plastic surgery]]
[[Category:Needs content]]

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[[Category:Up-To-Date]]
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Melanocytic nevus pathophysiology

2019-05-17T16:06:37Z

Qurrat-ul-ain Abid: /* Neurocutaneous melanosis */

Melanocytic nevus pathophysiology

2019-05-17T15:48:21Z

Qurrat-ul-ain Abid: /* Complications of Melanocytic nevi */

Melanocytic nevus pathophysiology

2019-05-17T15:45:47Z

Qurrat-ul-ain Abid: /* Melanoma */

Melanocytic nevus pathophysiology

2019-05-16T16:47:58Z

Qurrat-ul-ain Abid: /* Proliferative nodules Melanocytic nevus */

Melanocytic nevus pathophysiology

2019-05-16T16:41:34Z

Qurrat-ul-ain Abid: