Nevus

Nevus
Classification and external resources
Photograph of a nevus on an arm
ICD-10	I78.1
ICD-9	448.1, 216.0-216.9
MeSH	D009506

Nevus (or naevus, plural nevi or naevi, from nævus, Latin for "birthmark") is the medical term for sharply-circumscribed^[1] and chronic lesions of the skin. These lesions are commonly named birthmarks and moles. Nevi are benign by definition. Using the term nevus and nevi loosely, most physicians and dermatologists are actually referring to a variant of nevus called the "melanocytic nevus", which are composed of melanocytes. Histologically, melanocytic nevi are differentiated from lentigines (also a type of benign pigmented macule) by the presence of nests of melanocytes, which lentigines (plural form of lentigo) lack.

Classification

Classification is based on cell line of origin. Melanocytic nevi are derived from melanocytes. Epidermal nevi are derived from keratinocytes or derivatives of keratinocytes. Connective tissue nevi are derived from connective tissue cells like adipocyte and fibroblasts. Vascular nevi are derived from structures of the blood vessels. See birthmark for a more complete discussion

Melanocytic nevus

• Congenital nevus implying a melanocytic nevus present at birth or near birth.
• Acquired melanocytic nevus. Implies a melanocytic nevus acquired later in life, and not at or near birth. Most melanocytic nevi are of the acquired variety.
• Melanocytic nevus (nevomelanocytic nevus, nevocellular nevus): benign proliferation of melanocytes, the skin cells that make the brown pigment melanin. Hence, most nevi are brown to black. They are very common; almost all adults have at least one, usually more. They may be congenital or acquired (usually at puberty).
• Dysplastic nevus usually an acquired melanocytic nevus with abnormal features making it difficult to distinguish from a melanoma. It can be a marker for an individual at risk for developing melanomas.

Epidermal nevus

• Epidermal nevus: congenital, flesh-colored, raised or warty, often linear lesion, usually on the upper half of the body.
• Nevus sebaceus: variant of epidermal nevus on the scalp presenting as a hairless, fleshy or yellowish area.

Connective tissue nevus

• Connective tissue nevus: fleshy, deep nodules. Rare.

Vascular nevus

• Hemangioma (strawberry mark or nevus).
• Nevus flammeus (port-wine stain).
• Spider angioma (nevus araneus).
• Blue Rubber Bleb Nevus Syndrome: dilatation of veins anywhere in the body (both skin and internal organs), usually lethal from internal hemorrhage. It is a very rare genetic disorder.

The term "venous nevus" has recently been proposed.^[2]

Diagnosis of nevi

A dermatoscope.

A modern polarized dermatoscope.

Clinical diagnosis of a melanocytic nevus from other nevi can be made with the naked eye using the ABCD guideline, or using dermatoscopy. The main concern is distinguishing between a benign nevus, a dysplastic nevus, and a melanoma. Other skin tumors can resemble a melanocytic nevus clinically, such as a seborrheic keratosis, pigmented basal cell cancer, hemangiomas, and sebaceous hyperplasia. A skin biopsy is required when clinical diagnosis is inadequate or when malignancy is suspected.

Normal Evolution or Maturation of Melanocytic Nevus

All melanocytic nevi will change with time - both congenital and acquired nevi. The "normal" maturation is evident as elevation of the lesion from a flat macule to a raised papule. The color change occurs as the melanocytes clump and migrate from the surface of the skin (epidermis) down deep into the dermis. The color will change from even brown, to speckled brown, and then losing the color and becomes flesh colored or pink. During the evolution, uneven migration can make the nevi look like melanomas, and dermatoscopy can help in differentiation between the benign and malignant lesions.^[3]

See also

• Becker's nevus
• Dysplastic nevus - a melanocytic nevus with abnormal pigment features which can be difficult to distinguish from a melanoma.
• List of cutaneous conditions

References

External links

• Nevus risk factors, symptoms, treatment, and more information
• Atlas of Pathology Section of a melanocytic nevus
• eMedicine: Mole or Melanoma? Tell-Tale Signs in Benign Nevi and Malignant Melanoma: Slideshow
• Nevus Outreach, Inc.