From the Guidelines
Complete surgical excision is the recommended management approach for a lentiginous compound nevus with architectural disorder. This approach is based on the principle of removing the entire lesion to prevent potential malignant transformation and to allow for accurate histopathological diagnosis, as suggested by the revised U.K. guidelines for the management of cutaneous melanoma 2010 1. The excision should include a clinical margin of 2 mm of normal skin around the visible lesion, along with a cuff of fat, to ensure complete removal and facilitate possible subsequent wide local excision if needed.
The rationale behind this approach is to avoid diagnostic shave biopsies or partial removal of naevi, which can lead to incorrect diagnosis due to sampling error and make accurate pathological staging impossible, as highlighted in the guidelines 1. Instead, excising the lesion entirely, even without immediate repair, and dressing the wound while awaiting definitive pathology is acceptable in certain circumstances.
Key considerations in the management of lentiginous compound nevi with architectural disorder include:
- Complete surgical excision with a 2 mm margin of normal skin
- Sending the specimen for histopathological examination to confirm the diagnosis and rule out melanoma
- Regular skin examinations every 6-12 months to monitor for new or changing lesions
- Educating patients about sun protection measures to reduce the risk of developing additional atypical nevi or melanoma
By prioritizing complete excision and thorough histopathological evaluation, the management approach for lentiginous compound nevi with architectural disorder aims to minimize the risk of melanoma development and ensure optimal patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Management Approach for Lentiginous Compound Nevus with Architectural Disorder
The management of lentiginous compound nevus with architectural disorder involves careful observation and potentially invasive procedures.
- The use of digital dermoscopy has been shown to be useful for the follow-up of benign melanocytic skin lesions, including congenital nevi 2.
- Severe architectural disorder in small melanocytic lesions can be a potential pitfall in diagnosis, and caution is needed to avoid overdiagnosis of melanoma 3.
- Lentiginous dysplastic nevi in the elderly have been identified as a potential precursor for malignant melanoma, highlighting the importance of close monitoring 4.
Diagnostic Considerations
- The diagnosis of lentiginous compound nevus with architectural disorder requires careful histological examination to distinguish it from other types of nevi, such as speckled lentiginous nevus 5.
- Phacomatosis pigmentokeratotica, a rare syndrome associated with speckled lentiginous nevus, has been reported to involve malignant degeneration of both nevus components, emphasizing the need for long-term follow-up 6.
Key Points
- Digital dermoscopy can be used for follow-up of lentiginous compound nevus with architectural disorder.
- Severe architectural disorder in small melanocytic lesions requires cautious interpretation to avoid overdiagnosis of melanoma.
- Close monitoring is essential for lentiginous dysplastic nevi in the elderly due to their potential to develop into malignant melanoma.