Common Nevus : Clinical

Diagnosis
Andrean Linata
Ospital Ng Maynila Medical Center

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Common Nevus
• Synonim : nevocelllar nevus, common nevus, melanocytic nevus
• Lesions are pigmented or skin-colored macules or papules which tend to be
uniform in appearance and relatively small in size
• They primarily develop during childhood or early adulthood
• Increased numbers of acquired nevi impart an increased risk for melanoma
development

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Risk Factor
• Environmental exposure to UV radiation
• Decreased UV barrier protection
• Male gender
• Fitzpatrick Skin Phototype I-III

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Junctional Nevus

• Macule, or only very slightly raised,

uniform tan, brown, dark brown, or
even black. Round or oval with
smooth, regular borders. Scattered
discrete lesions.
• Never > 1 cm in diameter; if > 1 cm,
the “mole” is a congenital
nevomelanocytic nevus, a DN, or a
melanoma.

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Compound Melanocytic Nevus
• Papules or small nodules. Dark brown,
sometimes even black; dome- shaped,
smooth, or cobblestone-like surface,
regular and sharply defined border,
sometimes papillomatous or
hyperkeratotic.
• Never > 1 cm indiameter; if > 1 cm, the
mole is a congenital nevomelanocytic
nevus, a DN, or a melanoma.
• Consistency either firm or soft. Color may
become mottled as progressive
conversion into dermal MN occurs. May
have hairs.

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Dermal Melanocytic Nevus
• Sharply defined papule or nodule.
Skin-colored, tan, or flecks of brown,
often with telangiectasia. Round,
dome-shaped smooth surface,
diameter < 1 cm. Usually not present
before the second or third decade.
• Older lesions, mostly on the trunk,
may become pedunculated and do
not disappear spontaneously, May be
hairy.

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Summary
Classification Junctional Nevus Compound Nevus Dermal Nevus

Lesion Macules Papules or Papules or

Nodules Nodules
Surface Flat Raised Raised, May be
Pedunculated
Color Brown, black Brown, Black Pink, Skin Colored
Size 1 cm or less 1 cm or less 1 cm or less
Border Well-demarcated Well-demarcated Well-demarcated
Consistency Non-palpable Firm or soft Firm
Depth Dermal-Epidermal Epidermis & Deeper Dermis
Junction Superficial Dermis
Dermoscopy
 Notes
• As for all pigmented lesions, the ABCDE rule applies to rule out
Melanoma. In case of doubt, apply dermoscopy,
• If malignancy cannot be excluded even by this procedure, excise
lesions with a narrow margin.
• The majority of common acquired nevi are less than 6 mm in diameter.
• Very dark brown or black nevi are unusual for people with light skin
tones and should be viewed with suspicion.
• Darkly colored nevi are common in those with dark skin tones. Blue,
gray, red and white areas are not typical for common acquired nevi
and should raise concern for melanoma.

Kang S, Masayuki A, Bruckner AL, Enk AH, Margolis D, McMichael AJ, et al. Fitzpatrick’s Dermatology 9 th ed. New York : McGrawHill, 2019.p. 1951-7.
Other Types of Nevus
Other Types of Nevus
• Blue Nevus
• Pigmented Spindle Cell Nevus
• Spitz Nevus
• Nodal Nevi
• Lentigo Simplex
• Solar Lentigo
• Dysplastic Melanocytic Nevi
Blue Nevus
• A group of lesions composed of deeply pigmented spindle or epithelioid
melanocytes in the dermis; includes common blue, cellular blue, combined blue,
and atypical cellular blue lesions
• Lesions appear as blue, blue-gray, or blue-black papules, nodules, or plaques.
• Lesions are generally acquired but may be congenital.
• Cellular blue nevi may have an elevated risk for development of melanoma.
• Related lesions include nevus of Ota/Ito, Mongolian spot, dermal dendritic
hamartoma.
• Initiating mutations in GNAQ or GNA11 are present in most blue nevi.
• Most blue nevi are blue, blue-gray, or
blue-black smooth surfaced papules
or nodules.
• Common blue nevi are deeply
pigmented small lesions, usually less
than 1 cm in diameter. Cellular blue
nevi have a similar color but are often
larger plaques or nodules greater than
1 cm.
 Pigmented Spindle Cell Nevus
• Synonym: Reed nevus
• Acquired, benign melanocytic tumor composed of heavily pigmented spindle-shaped
melanocytes in nests confined primarily to the epidermis
• Lesions are jet black often with “starburst” appearance on dermoscopy.
• They may develop quickly and then stabilize.
• Malignant degeneration is thought to be rare.
Pigmented Spindle Cell Nevus
• PSCN classically presents as a sharply
circumscribed darkly pigmented
papule, usually less than 7 mm in
diameter.
• They are jet-black but may have
shades of blue, gray, or brown (Fig.
115-12).
 Spitz Nevus
• Spitz nevi represent a spectrum of unique, usually acquired lesions, exhibiting
epithelioid and often spindle-shaped melanocytic cells with abundant eosinophilic
cytoplasm, large nuclei, and often prominent nucleoli.
• They often develop in the epidermis and dermis or may be purely intradermal and
even desmoplastic. Atypical variants exist.
• Clinically, they often present as red, domeshaped papules. Some have varying
degrees of pigmentation.
• Spitz nevi are thought to develop quickly and then stabilize. Their clinical
presentation and histopathology can cause diagnostic confusion for melanoma.
• Synonyms: spindle and epithelioid cell nevus
Spitz Nevus
• The most common variety of Spitz
nevus is solitary, asymptomatic, pink
or red, hairless, firm, and dome
shape. Some Spitz nevi may resemble
a keloid or pyogenic granuloma when
eroded.
• The surface is commonly smooth, and
the borders may fade into surrounding
skin. Verrucous, scaly, stippled, and
crusted lesions may occur.
 Nodal Nevi
• Benign melanocytic neoplasia present in a lymph node. Nevomelanocytes are
characteristically located in the capsule. They are generally asymptomatic and
found incidentally as a result of lymph node removal.
• Cells may be deposited passively into the node from a cutaneous melanocytic
lesion. It is also possible that abnormal migration pathways result in the
nevomelanocytes taking up residence in lymph nodes during embryonic
development.
• The presence of melanocytic cells in nodal tissue may create difficulties for
pathologists evaluating sentinel node biopsies in patients with cutaneous
melanoma.
Nodal Nevi
• Melanocytic neoplasia in the form of
melanoma or melanocytic nevi may
be present at the cutaneous site
corresponding to the draining lymph
node basin.
• Lymph nodes harboring benign nodal
nevi commonly seen in patients
undergoing lymphadenectomy for
melanoma but are also seen in
lymphadenectomy specimens for
breast carcinoma and other causes
 Lentigo Simplex
• Clinically, lesions are hyperpigmented macules, occurring alone, in focal clusters
(agminated), or have a generalized distribution. They occur on the skin, conjunctivae
and mucous membranes.
• They commonly develop in early childhood. Multiple lentigines may be associated
with somatic abnormalities. Synonyms: simple lentigo, melanotic macule,
lentiginosis. Other names for agminated lentigines include unilateral lentigines,
partial unilateral lentiginosis, lentiginous mosaicism, and segmental lentiginosis.
Lentigo Simplex
• Lentigo simplex are usually sharply
circumscribed macules, measuring 1 to 5
mm in size, with uniform light brown to
black pigmentation.
• LEOPARD syndrome : hundreds of
lentigines during childhood, on the
genitalia, conjunctiva, oral cavity, palms,
and soles.
• Peutz-Jeghers syndrome : Buccal mucosa,
lips, perioral skin, and ventral surfaces of
the hands and feet.
• Centrofacial lentiginosis, lentigines :
distributed in a horizontal band across the
face.
Solar Lentigo
• Solar lentigines are hyperpigmented macules that occur on photodamaged skin,
singly or as multiple lesions.
• They predominantly develop in older individuals. Children with xeroderma
pigmentosum develop solar lentigines during the first year of life because of
increased susceptibility to UV radiation.
• Histology shows elongation of rete ridges with budlike processes,
hyperpigmentation, normal or slightly increased melanocytes, and dermal
solarelastosis.
• Solar lentigines  exposed to natural
sunlight or artificial sources of UV
radiation.
• They have well-defined, irregular
borders, < 1 mm to several
centimeters
• light to dark brown in color.
• PUVA lentigines  sun-protected
sites, including the buttocks and
genitalia
• An ephelis (freckle) is a small,
uniformly pigmented macule 
central face.
 Dysplastic Melanocytic Nevi
• Commonly occur in Caucasians; prevalence varies by population
• Flat or raised with smooth or “pebbly” surface, irregular shape, indistinct borders,
variable pigmentation, and measure at least 5 mm in diameter
• Identify population at risk for melanoma Most frequent on sun-exposed areas,
especially intermittently exposed, including the upper back
• Associated with large numbers of common acquired nevi
• May persist or involute; subset undergoes malignant transformation to melanoma
Histologic features include lentiginous melanocytic hyperplasia with architectural
and cytologic atypia and stromal response
• Clinically, dysplastic nevi is irregular
indistinct border, tan and brown
color, with some lesions showing
pink-red coloration measure at least
5 mm in diameter.
• Dysplastic nevi are often slightly
raised and have a “pebbly” or
smooth texture.
• They predominate on intermediate
sun-exposed skin sites, such as the
trunk and especially the upper back.
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