Precursor lesions to melanoma

Abstract

T he field of precursor lesions to melanoma is subject to ongoing debate and evolving insights. Regarding congenital melanocytic nevi there is controversy about the management of these lesions. It has become apparent that patients with giant (“bathing trunk-type”) congenital nevi have an increased incidence of malignant melanoma developing in their lesions. Prophylactic excision is generally accepted treatment and these lesions should be removed in early childhood; however, the subject of debate has been enlarged to include all congenital nevi, including those of the “small” type. It is unclear to what extent melanoma develops in smaller congenital nevi and dermatologists disagree on the therapy of smaller lesions. The intensity of the controversy appears to be inversely proportional to the size of the nevus. Regarding dysplastic nevi there is controversy about diagnostic definitions both clinically and histologically. Some even deny the existence of dysplastic nevi! The Familial Atypical Multiple-Mole Melanoma (FAMMM) syndrome also has its contentions with regard to the genetic mechanism: Is a dominant gene localized on chromosome lp involved in all FAMMM families? Furthermore, the complete spectrum of the FAMMM syndrome including the occurrence of systemic cancer(s) and ocular melanoma is still debated. This review focuses on the aforementioned controversies in the field of precursor lesions to melanoma. Early detection of malignant melanoma reduces its morbidity and mortality. The most important method to achieve this is by professional and public education about the signs and symptoms of early melanoma and preven-