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Patient Case: Dysplastic Naevi

Patient Case: Dysplastic Naevi

Discussion

A 32-year-old woman presents to a dermatology clinic for evaluation of multiple moles on her back and shoulders. She reports that some of them have grown larger over the past few years and appear irregular in shape. She denies itching, bleeding, or pain but is concerned because her father was diagnosed with melanoma.

On examination, numerous pigmented lesions are observed, varying in size from 5 to 12 mm. Several have irregular borders, asymmetrical shapes, and mixed shades of brown and pink. A dermoscopic evaluation shows atypical pigment networks without ulceration. The rest of her skin examination is unremarkable.

Given her family history of melanoma and the presence of multiple atypical moles, a biopsy of the most irregular lesion is performed. Histopathology confirms a dysplastic naevus with mild architectural atypia but no evidence of malignancy. The patient is counseled on regular skin surveillance, sun protection, and the importance of monitoring her moles for changes.

Questions
  1. Which of the following clinical features is most characteristic of dysplastic naevi?
    a) Symmetrical shape with uniform color
    b) Asymmetrical shape with irregular borders
    c) Raised, dome-shaped lesion with smooth borders
    d) Pearly, translucent papule with telangiectasia
  2. What is the primary concern with dysplastic naevi?
    a) They always progress to melanoma
    b) They are highly contagious
    c) They have a higher risk of transformation into melanoma
    d) They are always benign and require no monitoring
  3. Which of the following is the best management approach for a patient with multiple dysplastic naevi and a family history of melanoma?
    a) Immediate excision of all moles
    b) Regular skin examinations and sun protection
    c) Use of antifungal creams for treatment
    d) Ignoring the lesions unless they become painful
  4. Which biopsy finding is most consistent with a diagnosis of dysplastic naevus?
    a) Atypical melanocytes with invasion into the dermis
    b) Regularly arranged melanocytes without atypia
    c) Mild architectural atypia without evidence of malignancy
    d) Presence of atypical lymphocytes and ulceration
Reveal answers

Answers

  1. (b) Asymmetrical shape with irregular borders
    • Dysplastic naevi often have irregular borders, asymmetry, and varied pigmentation, distinguishing them from common benign moles.
  2. (c) They have a higher risk of transformation into melanoma
    • While dysplastic naevi do not always progress to melanoma, they are considered markers of increased melanoma risk, especially in patients with a family history.
  3. (b) Regular skin examinations and sun protection
    • Management includes routine dermatologic monitoring, sun protection, and patient education on recognizing suspicious changes. Excision is considered only for lesions showing malignant features.
  4. (c) Mild architectural atypia without evidence of malignancy
    • Dysplastic naevi show some architectural atypia but lack the full malignant characteristics of melanoma, differentiating them histologically.