Nevus (pl.: nevi) is a nonspecific medical term for a visible, circumscribed, chroniclesion of the skin or mucosa.[1] The term originates from nævus, which is Latin for "birthmark"; however, a nevus can be either congenital (present at birth) 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.
Classification
The term nevus is applied to a number of conditions caused by neoplasias and hyperplasias of melanocytes,[2] as well as a number of pigmentation disorders, both hypermelanotic (containing increased melanin, the pigment responsible for skin color) and hypomelanotic (containing decreased melanin).[3] Suspicious skin moles which are multi-colored or pink may be a finding in skin cancer.[4]
Atypical (dysplastic) nevus: This type of nevus must be diagnosed based on histological features. Clinically, atypical nevi are characterized by variable pigmentation and irregular borders.[5]
These nevi are often categorized based on size, however, the lesions usually grow in proportion to the body over time, so the category may change over an individual's life.[2] This categorization is important because large congenital melanocytic nevi are associated with an increased risk of melanoma, a serious type of skin cancer.[2]
Additional types of nevi do not involve disorders of pigmentation or melanocytes. These additional nevi represent hamartomatous proliferations of the epithelium,[8] connective tissue,[9] and vascular malformations.[10]
Epidermal nevi
These nevi represent excess growth of specific cells types found in the skin, including those that make up oil and sweat glands.[8]
An intramucosal nevus is a nevus within the mucosa as found in for example the mouth and genital areas. In the mouth, they are found most frequently on the hard palate. They are typically light brown and dome-shaped.[12] Intramucosal nevi account for 64% of all reported case of oral nevi.[13]
Diagnosis
Various differential diagnoses of pigmented skin lesions, by relative rates for biopsied lesions, and malignancy potential, including "nevus" at left and top.
Nevi are typically diagnosed clinically with the naked eye or using dermatoscopy. More advanced imaging tests are available for distinguishing melanocytic nevi from melanoma, including computerized dermoscopy and image analysis.[14] The management of nevi depends on the type of nevus and the degree of diagnostic uncertainty. Some nevi are known to be benign, and may simply be monitored over time. Others may warrant more thorough examination and biopsy for histopathological examination (looking at a sample of skin under a microscope to detect unique cellular features). For example, a clinician may want to determine whether a pigmented nevus is a type of melanocytic nevus, dysplastic nevus, or melanoma as some of these skin lesions pose a risk for malignancy. The ABCDE criteria (asymmetry, border irregularity, color variegation, diameter > 6 mm, and evolution) are often used to distinguish nevi from melanomas in adults, while modified criteria (amelanosis, bleeding or bumps, uniform color, small diameter or de novo, and evolution) can be used when evaluating suspicious lesions in children.[15] In addition to histopathological examination, some lesions may also warrant additional tests to aid in diagnosis, including special stains, immunohistochemistry, and electron microscopy.[16] Typically, the nevi that exist since childhood are harmless.
A modern polarized dermatoscope
A dermatoscope
Differential diagnoses
Hypermelanotic nevi must be differentiated from other types of pigmented skin lesions, including:[6][7]
The decision to observe or treat a nevus may depend on a number of factors, including cosmetic concerns, irritative symptoms (e.g., pruritus), ulceration, infection, and concern for potential malignancy.[2]
Syndromes
The term nevus is included in the names of multiple dermatologic syndromes:
^Happle, Rudolf (1995). "What is a nevus? A proposed definition of a common medical term". Dermatology. 191 (1): 1–5. doi:10.1159/000246468. PMID8589475.
^ abcdefgh"Chapter 122. Benign Neoplasias and Hyperplasias of Melanocytes". Fitzpatrick's Dermatology in General Medicine. The McGraw-Hill Companies, Inc. 2012. ISBN978-0-07-166904-7.
^"Chapter 75. Hypomelanoses and Hypermelanoses". Fitzpatrick's Dermatology in General Medicine. The McGraw Hill Companies, Inc. 2012. ISBN978-0-07-166904-7.
^ ab"Chapter 118. Benign Epithelial Tumors, Hamartomas, and Hyperplasias.". Fitzpatrick's Dermatology in General Medicine. The McGraw-Hill Companies, Inc. 2012. ISBN978-0-07-166904-7.
^ ab"Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors.". Fitzpatrick's Dermatology in General Medicine. The McGraw-Hill Companies, Inc. 2012. ISBN978-0-07-166904-7.
^"Chapter 172. Vascular Malformations.". Fitzpatrick's Dermatology in General Medicine. The McGraw Hill Companies, Inc. 2012. ISBN978-0-07-166904-7.
^"Chapter 107. Neonatal, Pediatric, and Adolescent Dermatology". Fitzpatrick's Dermatology in General Medicine. The McGraw-Hill Companies, Inc. 2012. ISBN978-0-07-166904-7.
^"Oral Nevi". MedScape. Retrieved 23 January 2018.
^Buchner, A.; Merrell, P. W.; Carpenter, W. M. (2004). "Relative frequency of solitary melanocytic lesions of the oral mucosa". Journal of Oral Pathology and Medicine. 33 (9): 550–557. doi:10.1111/j.1600-0714.2004.00238.x. ISSN0904-2512. PMID15357676.
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