home Drugs What is a pigmented nevus and how does it affect health? Complex skin nevus. Treatment tactics for pigmented nevus of the skin

What is a pigmented nevus and how does it affect health? Complex skin nevus. Treatment tactics for pigmented nevus of the skin

This type pigmented nevus characterized by the fact that melanocytes are located in both the epidermis and dermis. Consequently, the formation is a combination of borderline and intradermal nevi. Dermoscopically, this combination most often appears as an area surrounded by a pigment network with globular structures or a homogeneously colored/hypopigmented structureless zone with single comma-shaped vessels and other signs characteristic of intradermal nevi.

Comedon-like structures may be detected. It is believed that mixed nevus is a stage in the gradual evolution of border nevus into intradermal nevus.

When describing pigmented nevi, one cannot ignore the dysplastic nevus (Clark's nevus). This type of nevi, first described by Wallace N. Clark, Jr. in 1978, is often considered as an independent variant of benign melanocytic formations. Taking into account the fact that melanocytic dysplasia can only be confirmed with patho histological examination and is not found in all formations with suspicion of it; the use of the term “dysplastic nevus” is not entirely justified. It is more correct to call these nevi Clark's nevi.

Particular attention to them is due to high risk of their malignant transformation, especially in patients with a family history of melanoma. To a greater extent, the diagnosis of Clark's nevus is clinical, and the presence of such a nevus is indicated in cases of detection of acquired, unevenly colored melanocytic formations with uneven contours, more than 4-5 mm in diameter and tending to grow. At their core, these are borderline or mixed nevi. Often the damage is multiple.

To date, there is no clear description of the dermoscopic features of Clark's nevus. Its presence can be suspected when an alternation of light and dark-colored sections of the pigment network is detected, if it is heterogeneous, if there are homogeneous zones interspersed with dots and globules against the background of the reticular pattern, etc. Often these manifestations are indistinguishable from melanoma, which greatly complicates diagnosis.

In fact, the formation turned out to be an active mixed nevus with symptoms of injury (constant friction with clothing).

Atypical pigment network on the left side of the nevus with a cluster of black dots, abundance various shapes, sizes and colors of globules in the central part and along the right edge. On the left there is a rather large oval zone of hypopigmentation, within which a cluster of light purple globules is visible. A similar picture may indicate the presence of melanocytic dysplasia (Clark's nevus). The formation is subject to dynamic observation or preventive excision.

Dermatoscopic manifestations of this pigmented nevus very diverse: a pigment network is visible on the right edge of the formation, on the left there is a pale brown globular pattern. The structureless zone in the center is unevenly colored; to the left there is a cluster of small dark brown globules. The formation was regarded as a Clark nevus, and taking into account signs of clinical activity ( fast growth) it was excised. The result of pathohistological examination is a mixed pigmented nevus with signs of activity.
One of many similar mixed pigmented nevi on the body of a young patient. The central exophytic part of the mass moves along with the contact plate of the dermatoscope and forms a fold, which is visible in this image as a thin brown line along the left edge at the border between the pigment network and the central zone of hypopigmentation.
Presence of small blue-black globules and the blue and white veil, reminiscent of the structures of regression, in this case is not a cause for concern. The formation is symmetrical in all respects, the structural elements are evenly distributed in it. Diffuse white-blue coloration is caused by pressure from the contact plate of the dermatoscope and is found only within the dermal component of the nevus.
The left of these two nevi is a common papillomatous intradermal nevus (nevus of Unna).

Of greater interest is right-wing education. Its dermoscopic picture is unusual; it seems to be divided into two halves by a vertical line. On the left side in the center there is a globular “cobblestone” pattern surrounded by a pigment network.

On the right are very pale pink globules merging with each other, turning into an almost structureless pink area, which, closer to the edge of the tumor, is replaced by a pseudonetwork. Pinpoint vessels are visible around the entire central zone of hypopigmentation. This education was considered to be Clark's nevus.

Classic example of Clark's nevus- education appeared at the beginning puberty, its dimensions exceed 5 mm, there is uneven coloring and uneven contours. Dermatoscopic manifestations in the area of dark-colored, eccentrically located exophytic areas suggest the presence of melanoma. IN similar cases Excisional biopsy is indicated. The patient refused the operation. According to observation data over 2 years, education remains virtually unchanged.
In the central part of education Brown globules and a single gray-blue structure are visible on a light brown background. The pigment network along the periphery is atypical in some areas; upon careful examination, pigment dots are found closer to the edges of the nevus. In general, the formation is quite symmetrical. In such cases it is necessary dynamic observation. If the resemblance to melanoma increases, an excisional biopsy is performed.
In this nevus, located on the lower leg, the dermoscopic picture is absolutely calm - a classic example of a pigmented nevus mixed type.
This education is mixed nevus with a predominance of the borderline component. A pigment network in a nevus with signs of atypia, but it is not this that is of greater interest, but the dark-colored structure in the lower part of the tumor. This structure appeared in a nevus after a sunburn.

Upon closer examination, it is clear that it has all the signs of a nevus

One of the melanoma-dangerous formations is a complex nevus. It is something between a borderline and intradermal mole. Non-painful, asymptomatic, small in size. Due to the high risk of degeneration into malignancy requires systematic monitoring by a doctor (once every six months). The exact cause of the appearance is unknown. Removal can be done using laser, liquid nitrogen, radio waves or cutting surgery. Any method should be chosen after consultation with a doctor and the results of a diagnostic analysis. If a complex mole is benign, you don’t have to treat it, but undergo periodic diagnostics. Any visual changes are a signal to check.

One mole can consist of different tissues, vessels, cells.

What it is?

Mixed nevus is a combination of borderline and intradermal nevus. The mole has characteristics of both formations. It is classified as melanoma-hazardous and has a high risk of developing into a tumor. It begins to grow in the upper layer of the skin and goes deeper into the dermis. Non-painful and benign lumps are asymptomatic. The reasons why a mixed mole appears are completely unknown. Factors influencing the appearance are:

A mixed mole can appear at any age and number. With such education, a systematic examination by a doctor is important. The appearance of itching, burning, pain, redness, swelling, increased body temperature are signals for immediate appeal to the doctor. Trauma to a mixed mole can catalyze the process of development into malignancy.

A mixed mole may have uneven color and structure.

What does it look like?

A mixed spot takes the form of a round spot that rises above the surface of the skin. The edges are clear and unblurred. The diameter of a mixed nevus is from 1 mm to 10 mm. It appears in any place on the body, including the surface of hair growth and mucous membranes. The surface of the mole is smooth, but may become rough over time. Hair may grow on the skin. At first they are thin and soft, then they become hard. A nodule of a mixed type with a dense structure. Uneven color, possible asymmetry at the edges. The dermoepidermal mole is brown in color (range from light brown to black). This effect depends on the activity of the melanin pigment. Appearance similar to condyloma. Corneal development on the surface is possible. Often complex nodules are localized on the face.

Diagnostics of education

If a problem or suspicion of danger arises, the doctor you can contact is a dermatologist or surgeon. A therapist can also conduct an initial check by referring you to to the right doctor. The main task of diagnosing mixed birthmark is considered to identify the presence or absence of pathologies and metastases. The table below describes the diagnostic methods used.

If a mixed nevus changes or hurts, it is advisable to examine it for the presence of a malignant formation.

Method	What does it describe?
Visual inspection and palpation	Defining the external picture of structure and form
Oral survey	The symptoms, the patient’s feelings and factors that can influence the occurrence of nevus are clarified
Dermatoscopy	Determines the structure of the mole leaving the tissue intact
Ultrasound examination	Capable of providing information about the depth of location in tissues, pathology changes, period of development
Blood analysis	Tumor markers are used to determine the benignity of the neoplasm and intoxication
Biopsy	It is highly not recommended to carry out this procedure due to tissue injury, which provokes degeneration into a malignant tumor.
Histological analysis	Performed after removal of the nevus. Detects malignant cells

Diagnosis is carried out using laboratory research. Only on the basis of these data is the treatment method determined.

Benign pigment formation Brown, located simultaneously in the epidermal layer of the skin and the dermis. A complex nevus looks like a round papule or wart with a diameter of up to 1 cm, rising above the skin level. Its diagnosis includes examination, dermatoscopy and siascopy, and, if necessary, ultrasound. Histology of a complex pigmented nevus is carried out after its removal. Given the likelihood of nevus transformation into melanoma, patients need to be monitored by a dermatologist. The safest and optimal ways to remove a complex pigmented nevus is radio wave method and surgical excision.

Together with intradermal and borderline pigmented nevus, complex pigmented nevus belongs to the main types melanocytic nevi epidermal origin. It begins its growth in the upper layer of the skin - the epidermis, and then grows into the dermis. Thus, unlike most other moles, a complex pigmented nevus is located simultaneously in both the epidermis and dermis. This fact was the reason for its name - dermoepidermal or complex nevus.

Complex pigmented nevus is benign neoplasm skin. However, according to different authors Transformation to melanoma can occur in 50-80% of cases of complex pigmented nevus. Therefore, in clinical dermatology it is classified as melanoma-hazardous and requires a certain oncological alertness.

Manifestations of complex pigmented nevus

Due to its location in both layers of the skin, a complex pigmented nevus combines the characteristics of an intraepidermal (borderline) and intradermal nevus. The epidermal component of the nevus causes its intense brown, and in some cases almost black, color. The presence of an intradermal component causes the nevus to be slightly elevated above general level skin and therefore may resemble a common wart.

A complex pigmented nevus looks like a papule or dome-shaped node, round shape. Its surface is often smooth, and the growth of bristly hair is noted on it. There are complex nevi with a keratinizing or warty surface. In most cases, the nevus is located on the face or scalp, but can have any location. A complex nevus rarely reaches a significant size, usually its diameter does not exceed 1 cm.

Diagnosis of complex pigmented nevus

Complex pigmented nevus is diagnosed by a dermatologist based on examination data, dermatoscopy and siascopy pigment formation. To determine the extent of nevus growth into the dermis, ultrasound of the skin formation can be used. Suspicion of malignant degeneration of a nevus or melanoma is an indication for an urgent consultation with a dermato-oncologist.

Carrying out a biopsy of a complex nevus is dangerous due to its injury, which can lead to malignant degeneration to melanoma. For this reason, histological examination of nevus tissue is most often carried out after its complete removal. It reveals the characteristic arrangement of nests of nevus cells in both the epidermis and dermis.

Differential diagnosis of a complex pigmented nevus is carried out primarily with melanoma and other types of pigmented nevi: blue nevus, borderline pigmented nevus, Setton's nevus, Dubreuil's melanosis, as well as warts, papillomas, senile keratoma, dermatofibroma.

Treatment of complex pigmented nevus

Complex pigmented nevus requires observation by a dermatologist. Absolute indication Its treatment (removal) requires regular trauma or the appearance of signs of malignancy. Nevus removal may be performed for cosmetic reasons. Methods for removing complex pigmented nevus include: laser removal, radio wave method and surgical excision. Electrocoagulation and cryodestruction are not used due to the risk of traumatizing the formation and incomplete removal, which can stimulate malignant growth.

Removal of moles with a laser is applicable in the case of a complex nevus, if it involves using a laser as a scalpel and allows subsequent histological examination of the removed formation. It is most advisable to use the radio wave method or surgical excision of a complex nevus, since they make it possible to completely remove nevus cells, which has great importance in terms of preventing melanoma.

And we also have

It has been statistically revealed that nevus is registered on the body of every third person of the Caucasian race. The number of these skin tumors in each person can vary from a few to hundreds. In childhood, nevi may be small in size, but over time, under the influence of certain factors (sun, pregnancy), they may increase in size and even become cancerous.

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What is a nevus?

A nevus (nevoid tumor), more simply called, is a collection of nevus cells localized in various skin areas and formed as a result of a developmental defect.

This type of cell arises in utero from the neural crest, from which many organs and tissues are formed. Due to the incomplete transformation of nevoid cells into melanocytes (pigment structures of the skin), they do not penetrate into the deep layers of the skin, but are retained in the dermis (the layer of skin under the epidermis).

Are there malignant nevi?

Along the path of its development, the nevus goes through several stages: first it is intraepithelial, then borderline and intradermal (after 30 years). IN old age its reverse development and replacement is possible connective tissue. So, they distinguish:

Border view:

It appears before the age of 20 and is localized almost everywhere. Visually it is uniformly colored round formation brown in color, up to 1 cm in diameter, with smooth surface and clear outlines.

Mixed:

It is a transitional stage between borderline and intradermal. Characterized by spherical shape, dense structure, dark brown or black, up to 1 cm in diameter.

Intradermal:

Occurs after 45 years in single or multiple formations. It is distinguished by a warty shape (outwardly reminiscent of a raspberry), from 0.2 to 3 cm in diameter, dark brown in color, but may be uncolored.

Congenital:

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How to recognize malignant transformation?

In order to detect an oncological process in a timely manner, you need to pay attention to the area with formation Special attention. Malignancy can be suspected based on the following signs:

the appearance of blurred boundaries;
change in the vascular pattern around the mole;
violation of the integrity of the surface in the form of abrasions or cracks;
rapid growth;
discomfort, burning, itching in the area of the tumor;
surrounding inflammation around the formation;
change in shade;
the appearance of discharge from a mole.

In addition, you should pay attention to nearby lymph nodes, as they can not only become inflamed, but also be affected by metastases. They may become hard, immobile, enlarged, and adherent to adjacent tissues and structures.

Malignant degeneration of nevus into melanoma

When localizing the formation on open areas for aesthetic reasons, atraumatic material is used for sutures, which will ensure complete healing postoperative wound without visible defect.

According to the standards of oncological surgery for melanoma with the aim of excision of all cancer cells 5 mm of healthy tissue should be captured in the removed conglomerate. In addition, if the lymph nodes are affected, the issue of their removal is considered.

As for the fight against non-dangerous moles on the face and neck, you can use cauterizing solutions, laser or electrocoagulation.

Regardless of the type of formation and the risk of its malignancy, it is advisable to follow preventive tips:

avoid burning sun rays, solarium;
promptly remove suspicious moles if they are located in traumatic areas;
review regularly nevus for changes in color or shape.

A complex pigmented nevus is a benign formation in the form of pigment spot brown in color, which is located simultaneously in two layers of the skin - epidermal and dermal. Externally, a nevus resembles a small wart (no more than a centimeter in diameter) or a papule rising above the skin. The nevus begins its growth in the upper layers of the skin, and then gradually grows into the dermis. Although this type nevus is benign education skin, according to some data it can transform into melanoma (in 50-80% of cases).

Symptoms of complex pigmented nevus

A complex pigmented nevus is distinguished by a warty or smooth surface, on which the growth of bristly hair is often present. The nevus is located in two layers skin, therefore combines the characteristics of intraepidermal and intradermal. The epidermal component causes its brown color, and the presence of an intradermal component contributes to its raised appearance above the skin level. A complex nevus will rarely reach a large size.

Diagnosis of complex pigmented nevus

A dermatologist can diagnose a nevus based on a preliminary examination. Timely diagnosis of nevus is the key to quick and successful treatment. In order to determine the depth and extent of nevus growth into the dermis, the doctor may prescribe an ultrasound of the skin formation. During the examination, the doctor interviews the patient, finding out exactly when the formation occurred, whether its appearance, size, shape and color have changed, as well as the reasons for the changes themselves. It turns out whether there were attempts at treatment and what exactly the previous treatment was? If melanoma is suspected, immediate consultation with an oncologist is necessary. Carrying out a biopsy of a nevus is very dangerous; injury to the nevus can develop into a malignant formation. It is for this reason that histological examination is carried out after its removal.

Today there is new method diagnosing nevi - epiluminescent microscopy. This method diagnosis is carried out using a special optical device with artificial lighting. The study takes place directly on the surface of the skin. Apply a couple of drops to the nevus vegetable oil in order to create the effect of epiluminescence, then the device is placed on the neoplasm. This research method will not damage the nevus and is therefore the most accurate in determining the structure of the neoplasm. This study called dermatoscopy.

Way computer diagnostics are also widely used in such studies. Thanks to a digital video camera, the image of the pigment formation is recorded and stored in the computer memory. There is a special computer program, which processes the received information and compares it with the database, ultimately producing an accurate conclusion.

Treatment of complex pigmented nevus

This disease requires mandatory observation by a dermatologist. Treatment of pigmented nevus is a strictly individual procedure. The treatment method is selected by the doctor for each specific case. Before consulting a doctor, do not use ointments. There is no point in delaying treatment or going to the doctor, as there is a high probability that the spot will increase in size every year. The indication for its removal is permanent injury or the appearance characteristic features malignancy. Removal may also be done for cosmetic reasons. There are several ways to remove a nevus:

using a laser;
radio wave method;
surgical excision;
electrocoagulation;
cryodestruction.

Cryodestruction and electrocoegulation are used very rarely due to the fact that during the removal process the nevus may not be completely eliminated, and also because of the risk of traumatizing it, which can later develop into malignant growth.

Removing a nevus with a laser does not make it possible to study the nevus in a histological examination after elimination. It is most advisable to use the radio wave method or surgical excision for removal, since they guarantee complete removal nevus cells, which is of great importance for preventing the development of melanoma.

The surgical method is most suitable when the nevus is deep in the skin. The disadvantage of this method of elimination is the postoperative scar, since the nevus is removed along with the adjacent skin. According to oncological requirements, the diameter of the removed surface should be 3-5 cm.

If a nevus is detected, you should immediately consult a doctor for advice. Under no circumstances should you excise a nevus yourself, since injury to it leads to the development malignant tumor. According to statistics, in men melanoma more often develops on the back, and in women on lower limbs. To prevent the appearance of melanoma, you need to stay under the sun as little as possible, avoid solariums, and also carefully monitor existing moles. The first time their shape or size changes, you should immediately consult a doctor. There are many known cases that ended fatal due to self-medication and the reluctance of patients to seek medical help in a timely manner.