What type of nevus (mole) is typically raised?

Intradermal Nevus is the Type of Nevus That is Raised

Intradermal nevi are the type of melanocytic nevi that typically present as raised lesions on the skin. 1 These nevi have melanocytes confined to the dermis, which creates their characteristic elevated appearance.

Types of Melanocytic Nevi and Their Appearance

Melanocytic nevi can be classified based on their histological location and clinical appearance:

1. Intradermal Nevus

   • Appearance: Raised, dome-shaped or papular
   • Histology: Melanocytes present only in the dermis 1, 2
   • Often flesh-colored or light brown
   • Common locations: Face, neck, and trunk

2. Junctional Nevus

   • Appearance: Flat or macular
   • Histology: Melanocytes present at the dermoepidermal junction 3, 2
   • Usually darker in color (brown to black)

3. Compound Nevus

   • Appearance: Slightly raised with flat component
   • Histology: Melanocytes present both at the junction and in the dermis 4, 2
   • Often has mixed coloration

Clinical Characteristics of Intradermal Nevi

Intradermal nevi have several distinguishing features:

• They are typically dome-shaped or papular
• Often flesh-colored, light brown, or pink
• May develop hypertrichosis (hair growth)
• Surface can become more raised, verrucous, mamillated, or papillated over time 1
• Tend to be more common in adults as junctional nevi evolve into compound and then intradermal nevi with age 2

Clinical Significance and Management

While intradermal nevi are generally benign, they require proper evaluation:

• Visual inspection and palpation are essential components of examination 1, 5
• Dermoscopic evaluation can help distinguish benign features from concerning changes
• Although rare, melanoma can develop in association with intradermal nevi 6
• Any changes in size, color, shape, or symptoms (bleeding, itching, pain) warrant further evaluation

Treatment Considerations

For intradermal nevi that require removal:

• Surgical excision is appropriate when complete histological evaluation is desired 3
• For cosmetic removal of confirmed benign intradermal nevi, pulsed ablative lasers (CO2/Er:YAG) may be suitable due to the dermal location of melanocytes 3
• Shave excision techniques can be used but may result in incomplete removal and possible recurrence 3

Important Caveats

• Even though intradermal nevi have a lower risk of malignant transformation compared to junctional or compound nevi, any suspicious changes should prompt evaluation 6
• Flat melanocytic areas in the vicinity of intradermal nevi should raise suspicion and may warrant excision 6
• Regular monitoring is recommended, especially for nevi in sun-exposed areas or in patients with risk factors for melanoma

Intradermal nevi represent the most common type of raised melanocytic nevi encountered in clinical practice, with their elevation resulting from the dermal location of melanocytes.