Dermal nevus: Difference between revisions

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A suspected dermal nevus generally presents as a [[Dark skin focalities|dark skin focality]].
A suspected dermal (or '''intra'''dermal nevus) generally presents as a [[Dark skin focalities|dark skin focality]].
{{Gross processing of skin excisions}}
{{Gross processing of skin excisions}}
{{Comprehensiveness}}
==Microscopic evaluation==
==Microscopic evaluation==
*Irregularly distributed dermal nests of melanocytes.<ref name=KVAST/>
*Irregularly distributed dermal nests of melanocytes.<ref name=KVAST/>
*Atypia
*Atypia
<gallery mode=packed heights=190>
File:Histopathology of dermal nevus, high magnification.jpg|'''Dermal nevus'''
File:Histopathology of intradermal nevus with multinucleated melanocytes, medium magnification.jpg|A '''dermal nevus''' infrequently shows multinucleated '''giant cells''' as shown.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/skintumormelanocyticdermalnevus.html|title=Skin melanocytic tumor - Dermal nevus|author=Christopher S. Hale, M.D.|website=PathologyOutlines}} Topic Completed: 1 August 2014. Minor changes: 21 September 2020</ref>
</gallery>
===Subtyping===
[[File:Blue nevus (4 of 4) (2797064219).jpg|thumb|center|link=Blue nevus|'''Blue nevus''': Where the pigment is deeper in the skin than in ordinary nevi.]]


===Differential diagnosis===
===Differential diagnosis===
Mainly:
Mainly:
*[[Junctional nevus]]
<gallery mode=packed heights=200>
<gallery mode=packed heights=200>
File:Histopathology of invasive acral lentiginous melanoma.jpg|'''[[Invasive melanoma of the skin]]''', by higher atypia and dysplasia (see table in [[#Grading|the grading section]]).
File:Histopathology of melanocytic nevus 2.jpg|'''[[Junctional nevus]]''' (here seen in H&E stain and Melan A stain), where all nests are continuous with the epidermis.
File:Histopathology of compound nevus.jpg|thumb|'''Compound nevus''', with nevus cells in both dermis and epidermis.
File:Histopathology of invasive acral lentiginous melanoma.jpg|'''[[Invasive melanoma of the skin]]''', has more atypia and dysplasia (see table in [[#Grading|the grading section]]).
</gallery>
</gallery>


===Grading===
===Grading===
It is acceptable to grade a dermal nevus into either low or high grade by the following algorithm:<ref>{{cite journal|last1=Pozo|first1=Lucia|last2=Naase|first2=Mahmoud|last3=Cerio|first3=Rino|last4=Blanes|first4=Alfredo|last5=Diaz-Cano|first5=Salvador J.|title=Critical Analysis of Histologic Criteria for Grading Atypical (Dysplastic) Melanocytic Nevi|journal=American Journal of Clinical Pathology|volume=115|issue=2|year=2001|pages=194–204|issn=0002-9173|doi=10.1309/KXJW-1UJE-BPG6-AXBV}}</ref><ref group="notes" name="regression"/>
{{Moderate-begin}}Grade a dermal nevus into either low or high grade by the following algorithm:{{Moderate-end}}<ref>{{cite journal|last1=Pozo|first1=Lucia|last2=Naase|first2=Mahmoud|last3=Cerio|first3=Rino|last4=Blanes|first4=Alfredo|last5=Diaz-Cano|first5=Salvador J.|title=Critical Analysis of Histologic Criteria for Grading Atypical (Dysplastic) Melanocytic Nevi|journal=American Journal of Clinical Pathology|volume=115|issue=2|year=2001|pages=194–204|issn=0002-9173|doi=10.1309/KXJW-1UJE-BPG6-AXBV}}</ref>
[[File:Algorithm for low grade versus high grade dysplastic nevus.png|center|250px]]
[[File:Algorithm for low grade versus high grade dysplastic nevus.png|center|250px]]


In uncertain cases, more specific grading, and/or differentiation from a non-atypical congenital nevus and suspected [[invasive melanoma of the skin|invasive melanoma]], the following table can be used to determine the most fitting diagnosis:
In uncertain cases,{{Comprehensive-begin}} more specific grading,{{Comprehensive-end}} and/or differentiation from a non-atypical congenital nevus and suspected [[invasive melanoma of the skin|invasive melanoma]], the following table can be used to determine the most fitting diagnosis:


{{Table comparing dermal nevus and suspected invasive melanoma}}
{{Table comparing dermal nevus and suspected invasive melanoma}}
[[File:SOX10 immunohistochemistry of normal skin (edited).jpg|thumb|center|300px|In contrast, normal skin (pictured) has a melanocyte about every 4 cells along the basement membrane.]]
[[File:Histopathology of dermal nevus on the ear with traumatic epidermal atypia.jpg|thumb|center|220px|'''Non-dysplastic''' dermal nevus on the ear with minor epidermal atypia, which on this location does not indicate dysplasia.]]


===Report===
===Report===
*Size
*Diagnosis of dermal nevus.
*Preferably findings included in table.
*{{Moderate-begin}}Most likely grade.{{Moderate-end}}
*Most likely grade if possible.
Example:
{|class=wikitable
| {{Moderate-begin}}Skin, right upper chest, shave biopsy:{{Moderate-end}}<br>Intradermal {{Moderate-begin}}low-grade{{Moderate-end}} nevus.
|}
 
{{Reporting}}
{{Reporting}}
{{Bottom}}
{{Bottom}}
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