Dysplastic nevus natural history, complications and prognosis

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Dysplastic nevus Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

If left untreated, dysplastic nevus progression occurs horizontally (radial growth plate) and vertically (vertical growth plate) and is then followed by dermal invasion and distant metastasis. Dysplastic nevus is an aggressive tumor characterized by early metastasis. Common sites of metastasis include bones, brain, kidneys, lungs, liver and skin (secondary distant site). Complications of dysplastic nevus are usually related to the site of metastasis. The 5-year relative survival of patients with dysplastic nevus is approximately 93%. Features associated with worse prognosis are tumor thickness (Breslow thickness), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, location of lesion, presence of satellite lesions, and the presence of regional or distant metastasis.

Natural History

Complications

Complications of Dysplastic nevus are usually due to distant metastasis. Common sites of metastasis are shown below:

Prognosis

Determinants of Prognosis

Micro-metastasis vs. Macro-metastasis

5-Year Survival

  • When stratified by age, the 5-year relative survival of patients with melanoma was 92.7% and 88.2% for patients <65 and ≥ 65 years of age respectively.[3]
  • When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.[4]
Stage 5-year relative survival (%), 2004-2010
All stages 91.3%
Localized 98.1%
Regional 62.6%
Distant 16.1%
Unstaged 78.4%
  • Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[3]

5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER


References

  1. Brant JM (November 2013). "Breathlessness with pulmonary metastases: a multimodal approach". J Adv Pract Oncol. 4 (6): 415–22. PMC 4093448. PMID 25032021.
  2. Homsi J, Kashani-Sabet M, Messina J, Daud A (2005). "Cutaneous melanoma: prognostic factors". Cancer Control. 12 (4): 223–9. PMID 16258493.Full text (PDF)
  3. 3.0 3.1 3.2 3.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  4. Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J (2001). "Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma". J Clin Oncol. 19 (16): 3635–48. PMID 11504745.Full text

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