From the Guidelines
The recommended management for an intradermal melanocytic nevus is typically observation without intervention, as these are benign skin lesions with no malignant potential. If removal is desired for cosmetic reasons or if the nevus causes irritation, simple surgical excision is the preferred method, as stated in the guidelines for the management of cutaneous melanoma 1. This can be performed under local anesthesia in an outpatient setting, with the specimen sent for histopathological examination to confirm the diagnosis.
Key Considerations
- Shave excision may be appropriate for raised lesions, while punch excision or elliptical excision may be better for flat lesions.
- Following excision, proper wound care includes keeping the area clean, applying antibiotic ointment like bacitracin for 3-5 days, and protecting the site from sun exposure.
- Patients should be advised that new nevi may develop throughout life, and they should practice regular skin self-examinations to monitor for changes in existing moles.
- The diagnosis and management of melanocytic lesions should be based on a full thickness excisional biopsy with a small side margin, and the histology report should follow the American Joint Committee on Cancer (AJCC) classification, as recommended by the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cutaneous melanoma 1.
Histopathological Examination
The histopathological report must include at least the diagnosis of the melanocytic nature of the lesion and confirmation of its malignancy, as stated in the British Journal of Cancer study 1. However, since intradermal melanocytic nevi are benign, the focus should be on confirming the benign nature of the lesion.
Recent Guidelines
According to the revised U.K. guidelines for the management of cutaneous melanoma 2010, prophylactic excision of naevi, or of small (< 5 cm diameter) congenital naevi in the absence of suspicious features is not recommended 1. This supports the approach of observation without intervention for intradermal melanocytic nevi, unless there are specific concerns or cosmetic reasons for removal. The most recent study from 2021 on the care of congenital melanocytic nevi in newborns and infants also suggests that uncomplicated small and medium lesions can be observed, and indications for surgery may include functional considerations, symptoms, difficulty managing a lesion clinically, or stigma 1.
From the Research
Management of Intradermal Melanocytic Nevus
The management of intradermal melanocytic nevus involves several approaches, including surgical excision and laser treatment.
- Surgical shave excision is a common method for removing benign melanocytic lesions, with a study by 2 showing that it can achieve excellent cosmetic results in a significant proportion of cases.
- However, shave excision may be associated with a higher risk of recurrence, as noted in a study by 3, which compared shave excision with elliptical excision and found that recurrence occurred only after shave excision.
- Elliptical excision with sutured closure may be a more effective method for preventing recurrence, but it may result in larger scars and lower patient satisfaction, as reported by 3.
- Laser treatment is another option for managing intradermal melanocytic nevus, with pigment-specific lasers and pulsed ablative lasers being suitable for treating different subtypes of nevi, as discussed by 4.
- The choice of treatment method depends on various factors, including the size and location of the nevus, as well as the patient's cosmetic concerns and preferences.
Considerations for Treatment
When deciding on a treatment approach for intradermal melanocytic nevus, several factors should be considered, including:
- The risk of recurrence, which may be higher with shave excision, as noted by 3
- The potential for scarring, which may be more significant with elliptical excision, as reported by 3
- The importance of achieving a good cosmetic outcome, which may be a key consideration for patients, as discussed by 2 and 3
- The need for lifelong follow-up to monitor for recurrence and melanoma, as emphasized by 4
Diagnostic Evaluation
Before treating an intradermal melanocytic nevus, a thorough diagnostic evaluation should be performed to rule out malignancy, as discussed by 5 and 6.