The limited specificity of histological examination in the diagnosis of dysplastic nevi

Abstract

Dysplastic nevi were originally described as a distinct entity with specific clinical and histological features of importance as direct precursors of malignant melanoma and as markers of patients at increased risk of developing melanoma in the setting of familial melanoma. Nevi with the clinical and histological features described first as 'B-K moles' and later as 'dysplastic nevi' clearly do exist and do sometimes represent melanoma precursors or melanoma risk markers, but it is now recognized that most dysplastic nevi never progress to melanoma, that the histological features originally described in nevi in familial melanoma patients are poorly correlated with dysplastic nevi as they are defined clinically, and that overlapping or identical histological features are found in a variety of other melanocytic lesions including small (< 5 mm) melanocytic nevi, lentiginous nevi, atypical (dysplastic) lentiginous nevi, lentiginous melanoma, lentigo maligna and nevi in an ever-growing number of 'special sites'. This article will briefly review the evolution of our understanding of the histological range of nevi and the histological differential diagnosis of dysplastic nevi.