Individuals with multiple melanocytic nevi oftentimes have melanocytic nevi, usually two, with similar clinical and histopathologic patterns that may be typical or atypical. The melanocytic nevi are known in common parlance as signature nevi [1, 2]. In addition to being aware of these nevi, finding multiple unconventional melanocytic nevi with architectural pattern asymmetric and/or cellular pattern atypical helps to lend credence to the diagnosis of melanocytic nevus rather than melanoma. In order to evaluate the concept of the signature nevus we reviewed the histopathologic patterns of melanocytic nevi from patients having at least two nevi with similar histologic patterns.
Congenital Spitz nevi are true congenital lesions, with histopathologic features of both acquired Spitz nevus and superficial congenital melanocytic nevus.
Appreciation that simulation of a melanoma in situ by the epidermal component of a superficial congenital compound melanocytic nevus in older children and adults is an expected finding and may be similar to congenital nevi biopsied shortly after birth has not been emphasized. Awareness of these simulants may prevent misinterpretation of a benign superficial congenital compound melanocytic nevus as a malignant melanoma.
Since many studies have shown the discordant diagnoses of melanocytic lesions among pathologists despite the existence of an established histologic criteria, we sought to refine the histologic criteria by finding an additional reliable and reproducible objective histopathologic feature, to aid in the diagnosis of melanoma in situ. We performed a retrospective analysis of 100 cases, histologically diagnosed as melanoma in situ and compared to a study control group consisting of junctional benign melanocytic nevi. The epidermis of all the melanocytic lesions were examined for epidermal effacement. Examination of the epidermis in the study group revealed absence of epidermal effacement in only seven (10%) cases, whereas ninety‐three (93%) cases showed absence of rete ridges in some foci, making this an overwhelming majority finding in the cases examined. These results serve as a compelling adjunctive finding that can be used to increase the histologic diagnostic accuracy of melanoma in situ.
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