Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

1048 Nevi and Pigmented Lesions

■Nevi have a lifespan – may disappear as pt ages

■Nevi are common.

Signs and Symptoms

■Junctional nevus=flat lesion, characterized by pigmentation w/

sharp margin; usually symmetrical & small

■Intradermal nevus=elevated, sharply demarcated lesion, usually

nonpigmented

■Compound nevus=combination of features of junctional & intra-

dermal nevi; elevated, sharply marginated pigmented mole

■Atypical mole=has one or more characteristics of melanoma (see

below)

➣Clinically suspicious lesions, suggestive of melanoma:

Morphology (A, B, C, Ds):

Asymmetry

Border irregularity

Color – variation w/in lesion

Diameter >6 mm

Pruritus or other sx

Recent accelerated growth pattern

Changes in “mole” such as growth, bleeding, irritation

tests

Laboratory

■Excisional biopsy of suspicious lesions for dermatopathology exam-

ination

■Histologic evaluation of margins

Clinical

■Dermoscopy (epiluminesence microscopy): reserved for experts in

this technique

■Photography of all areas w/ nevi can be used to evaluate presence of

new lesions or changes to existing lesions.

differential diagnosis

■Melanoma

■Atypical nevus

■Seborrheic keratosis – sharply marginated

■Lentigo (freckle)

■Dermatofibroma (biopsy)

■Thrombosed hemangioma (biopsy)

■Pigmented basal cell carcinoma (biopsy)