Melanocytic nevus physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2]; Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [3]; Michel C. Samson, M.D., FRCSC, FACS [4]

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:
  • 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.
• 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. Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.

A basic reference chart used for consumers to spot suspicious moles is found in the mnemonic, A-B-C-D. The letters stand for Asymmetry, Border, Color and Diameter. Sometimes, the letter E (for Evolving) 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

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  Melanocytic Naevi. Image attribution: Dermatology Atlas"Dermatology Atlas".

Congenital Melanocytic Naevi (CMN)

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  Congenital melanocytic nevi. Image attribution: Dermatology Atlas"Dermatology Atlas".

Intradermal Melanocytic Nevi

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  Intradermal melanocytic nevi. Image attribution: Dermatology Atlas"Dermatology Atlas".

References

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