Nevoid melanoma

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Nevoid melanoma Skin Tumors-P6231204.jpg
Nevoid melanoma

A nevoid melanoma is a malignant neoplastic lesion of the skin. It is a type of melanoma, the most dangerous form of skin cancer. Nevoid melanomas are clinically significant because they are difficult to distinguish from a benign nevus of the skin, which requires no treatment and is common on most individuals. Nevoid morphologies represent up to 3% of all cases of melanoma.

Contents

Like other forms of melanoma, a nevoid melanoma can become a life-threatening disease through the process of metastasis, after the tumor cells invade through tissue layers and spread to other parts of the body.

Gross appearance

Nevoid melanomas are difficult to identify because of their strong resemblance to benign nevi of the skin. [1] They are either black or brown in general color, but may possess small patches of blue, gray, or other coloration which often cannot be seen without a dermatoscope. They are perfectly or near-perfectly symmetrical. [2] [3] Nevoid melanomas frequently present as isolated papules, nodules, or wart-like in appearance. In most cases, the melanoma will appear with smooth, rounded, regular borders; all of these qualities are seen in harmless skin nevi but not other forms of melanoma, adding to the difficulty of identifying a nevoid melanoma. [2]

Clinical appearance at the time of diagnosis is highly variable. Many melanomas progress from being indistinguishable from benign nevi to much more abnormal presentations, such as sore-like bleeding, shiny papules, atypical moles, and classically-appearing melanomas. Any normal-appearing nevus that rapidly transitions to a new appearance should be considered as a possible melanoma. [4]

Histology

High-powered imaging tools may identify one or more traits that prove a lesion is a malignant melanoma, rather than a benign nevus: [2]

Additionally, dermatoscopy may reveal discoloration, border irregularities, and other patterns typical of other kinds of melanoma, but which are too small or subtle to be seen with the naked eye. [1]

In some cases, it may be difficult to identify these features even with a dermatoscope. This is because some nevoid melanomas preserve normal layers of epidermis above them. Excision and biopsy of the suspected lesion can identify nesting, atypical growth patterns, and other hallmarks of malignant growth. [2] In particular, patterns of confluence among melanocytes, parallel arrays of nested cells (parallel theque pattern), and a lack of connective tissue in the lesion should strongly increase suspicion of a malignant nevoid melanoma. [3]

Treatment

A forearm after removal of a large melanoma. Malignant Melanoma Left Forearm post excision.jpg
A forearm after removal of a large melanoma.

Treatment of a nevoid melanoma typically focuses on surgical removal of the primary lesion. Adjunct chemotherapy, radiotherapy, and other cancer treatments may occur, as with any type of melanoma. One important distinction is that a nevoid melanoma is never considered to be "in-situ" when treating a patient. [2]

Complications

Nevoid melanomas progress at the same rate as other types of melanoma. In many cases, the primary tumor may have a small radius while already penetrating deep into the tissue. When cancer cells reach blood vessels or lymphatic ducts, they may use them to travel to other parts of the body, causing a disseminated cancer that ultimately leads to death. [4]

Epidemiology

Estimates of the prevalence of nevoid melanoma range from less than 1% to as much as 3% of all cases of melanoma. [1] [2]

See also

Related Research Articles

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A melanocytic nevus is usually a noncancerous condition of pigment-producing skin cells. It is a type of melanocytic tumor that contains nevus cells. Some sources equate the term mole with "melanocytic nevus", but there are also sources that equate the term mole with any nevus form.

<span class="mw-page-title-main">Basal-cell carcinoma</span> Most common type of skin cancer

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<span class="mw-page-title-main">Nevus</span> Mole or birthmark; visible, circumscribed, chronic skin lesion

Nevus is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. The term originates from nævus, which is Latin for "birthmark"; however, a nevus can be either congenital or acquired. Common terms, including mole, birthmark, and beauty mark, are used to describe nevi, but these terms do not distinguish specific types of nevi from one another.

<span class="mw-page-title-main">Dysplastic nevus</span> Medical condition

A dysplastic nevus or atypical mole is a nevus (mole) whose appearance is different from that of common moles. In 1992, the NIH recommended that the term "dysplastic nevus" be avoided in favor of the term "atypical mole". An atypical mole may also be referred to as an atypical melanocytic nevus, atypical nevus, B-K mole, Clark's nevus, dysplastic melanocytic nevus, or nevus with architectural disorder.

<span class="mw-page-title-main">Dysplastic nevus syndrome</span> Medical condition

Dysplastic nevus syndrome, also known as familial atypical multiple mole–melanoma (FAMMM) syndrome, is an inherited cutaneous condition described in certain families, and characterized by unusual nevi and multiple inherited melanomas. First described in 1820, the condition is inherited in an autosomal dominant pattern, and caused by mutations in the CDKN2A gene. In addition to melanoma, individuals with the condition are at increased risk for pancreatic cancer.

<span class="mw-page-title-main">Lentigo maligna melanoma</span> Medical condition

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<span class="mw-page-title-main">Lentigo maligna</span> Medical condition

Lentigo maligna is where melanocyte cells have become malignant and grow continuously along the stratum basale of the skin, but have not invaded below the epidermis. Lentigo maligna is not the same as lentigo maligna melanoma, as detailed below. It typically progresses very slowly and can remain in a non-invasive form for years.

<span class="mw-page-title-main">Congenital melanocytic nevus</span> Congenital mole caused by genetic mutations

The congenital melanocytic nevus is a type of melanocytic nevus found in infants at birth. This type of birthmark occurs in an estimated 1% of infants worldwide; it is located in the area of the head and neck 15% of the time.

<span class="mw-page-title-main">Dermatoscopy</span> Medical examination of the skin

Dermatoscopy also known as dermoscopy or epiluminescence microscopy, is the examination of skin lesions with a dermatoscope. It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The dermatoscope consists of a magnifier, a light source, a transparent plate and sometimes a liquid medium between the instrument and the skin. The dermatoscope is often handheld, although there are stationary cameras allowing the capture of whole body images in a single shot. When the images or video clips are digitally captured or processed, the instrument can be referred to as a digital epiluminescence dermatoscope. The image is then analyzed automatically and given a score indicating how dangerous it is. This technique is useful to dermatologists and skin cancer practitioners in distinguishing benign from malignant (cancerous) lesions, especially in the diagnosis of melanoma.

<span class="mw-page-title-main">Becker's nevus</span> Medical condition

Becker's nevus is a benign skin disorder predominantly affecting males. The nevus can be present at birth, but more often shows up around puberty. It generally first appears as an irregular pigmentation on the torso or upper arm, and gradually enlarges irregularly, becoming thickened and often hairy (hypertrichosis). The nevus is due to an overgrowth of the epidermis, pigment cells (melanocytes), and hair follicles. This form of nevus was first documented in 1948 by American dermatologist Samuel William Becker (1894–1964).

<span class="mw-page-title-main">Blue nevus</span> Type of melanocytic tumor

A blue nevus is a type of coloured mole, typically a single well-defined blue-black bump.

<span class="mw-page-title-main">Spitz nevus</span> Medical condition

A Spitz nevus is a benign skin lesion. A type of melanocytic nevus, it affects the epidermis and dermis.

<span class="mw-page-title-main">Benign melanocytic nevus</span> Medical condition

A benign melanocytic nevus is a cutaneous condition characterised by well-circumscribed, pigmented, round or ovoid lesions, generally measuring from 2 to 6 mm in diameter. A benign melanocytic nevus may feature hair or pigmentation as well.

<span class="mw-page-title-main">Balloon cell nevus</span> Medical condition

Balloon cell nevus is a benign nevus. It appears like a melanocytic nevus.

<span class="mw-page-title-main">Poroma</span>

Poromas are rare, benign, cutaneous adnexal tumors. Cutaneous adnexal tumors are a group of skin tumors consisting of tissues that have differentiated towards one or more of the four primary adnexal structures found in normal skin: hair follicles, sebaceous sweat glands, apocrine sweat glands, and eccrine sweat glands. Poromas are eccrine or apocrine sweat gland tumors derived from the cells in the terminal portion of these glands' ducts. This part of the sweat gland duct is termed the acrosyringium and had led to grouping poromas in the acrospiroma class of skin tumors. Here, poromas are regarded as distinct sweat gland tumors that differ from other sweat gland tumors by their characteristic clinical presentations, microscopic histopathology, and the genetic mutations that their neoplastic cells have recently been found to carry.

Porocarcinoma (PCA) is a rare form of skin cancer that develops in eccrine sweat glands, i.e. the body's widely distributed major type of sweat glands, as opposed to the apocrine sweat glands which are located primarily in the armpits and perineal area. This cancer typically develops in individuals as a single cutaneous tumor in the intraepidermal spiral part of these sweat glands' ducts at or near to where they open on the skin's surface. PCA tumors are classified as one form of the cutaneous adnexal tumors; in a study of 2,205 cases, PCA was the most common (11.8%) form of these tumors.

Oral pigmentation is asymptomatic and does not usually cause any alteration to the texture or thickness of the affected area. The colour can be uniform or speckled and can appear solitary or as multiple lesions. Depending on the site, depth, and quantity of pigment, the appearance can vary considerably.

Animal-type melanoma is a rare subtype of melanoma that is characterized by heavily pigmented dermal epithelioid and spindled melanocytes. Animal-type melanoma is also known to be called equine-type melanoma, pigment synthesizing melanoma, and pigmented epithelioid melanocytoma (PEM). While melanoma is known as the most aggressive skin cancer, the mortality for PEM is lower than in other melanoma types. Animal-type melanoma earned its name due to the resemblance of melanocytic tumors in grey horses.

<span class="mw-page-title-main">Choroidal nevus</span> Medical condition

Choroidal nevus is a type of eye neoplasm that is classified under choroidal tumors as a type of benign (non-cancerous) melanocytic tumor. A choroidal nevus can be described as an unambiguous pigmented blue or green-gray choroidal lesion, found at the front of the eye, around the iris, or the rear end of the eye.

References

  1. 1 2 3 Martín-Alcalde, Javier; Gamo-Villegas, Reyes; Floristán-Muruzábal, María Uxua; Pampín-Franco, Ana; Pinedo-Moraleda, Fernando; López-Estebaranz, José Luis (May 2021). "Nevoid melanoma: Dermoscopic and in vivo reflectance confocal microscopic aspects in 4 cases". JAAD Case Reports. 11: 132–136. doi:10.1016/j.jdcr.2021.03.044. ISSN   2352-5126. PMC   8099597 . PMID   33997213.
  2. 1 2 3 4 5 6 Diwan, A. Hafeez; Lazar, Alexander J. (June 2011). "Nevoid Melanoma". Clinics in Laboratory Medicine. 31 (2): 243–253. doi:10.1016/j.cll.2011.03.002. PMID   21549238.
  3. 1 2 Idriss, Munir H.; Rizwan, Lubna; Sferuzza, Anthony; Wasserman, Elen; Kazlouskaya, Viktoryia; Elston, Dirk M. (November 2015). "Nevoid melanoma: A study of 43 cases with emphasis on growth pattern". Journal of the American Academy of Dermatology. 73 (5): 836–842. doi:10.1016/j.jaad.2015.07.003. ISSN   0190-9622. PMID   26299955.
  4. 1 2 Zembowicz, Artur; McCusker, Margaret; Chiarelli, Concetta; Dei Tos, Angelo P.; Granter, Scott R.; Calonje, Eduardo; McKee, Phillip H. (June 2001). "Morphological Analysis of Nevoid Melanoma". The American Journal of Dermatopathology. 23 (3): 167–175. doi:10.1097/00000372-200106000-00001. ISSN   0193-1091. PMID   11391094. S2CID   8302599.
  5. Mesbah Ardakani, Nima; Singh, Shalinder; Thomas, Carla; Van Vliet, Chris; Harvey, Nathan Tobias; Calonje, Jaime Eduardo; Wood, Benjamin Andrew (2020-07-07). "Mitotically Active Nevus and Nevoid Melanoma: A Clinicopathological and Molecular Study". The American Journal of Dermatopathology. 43 (3): 182–190. doi:10.1097/dad.0000000000001721. ISSN   0193-1091. PMID   32649342. S2CID   220483813.