Difference between revisions of "Intradermal nevus"

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#redirect [[Melanocytic lesions#Intradermal melanocytic nevus]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Intradermal nevus -- intermed mag.jpg
| Width      =
| Caption    = Intradermal nevus. [[H&E stain]].
| Synonyms  = intradermal melanocytic nevus
| Micro      = nests of melanocytes in dermis (only), melanocytes "mature" with depth, usu. no mitoses (occ. superficial), no destruction of surrounding structures, no conspicuous nucleoli, no significant melanocyte enlargement
| Subtypes  =
| LMDDx      = [[malignant melanoma]] (nevoid), [[junctional nevus]], [[compound nevus]], [[dysplastic nevus]], [[skin tag]], [[mastocytosis]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = pigment skin lesion, usu. small, regular border, no irregularity in pigmentation
| Grossing  =
| Site      = [[skin]] - see ''[[melanocytic lesions]]'' and ''[[common nevus]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = very common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = pigmented skin lesions
| Tx        = none required, may be excised for cosmetic reasons
}}
'''Intradermal nevus''' (abbreviated '''IDN'''), also '''intradermal melanocytic nevus''', is a common benign [[melanocytic lesion]].
 
The ''intradermal nevus'' is in the large group '''[[common nevus]]'''. In common language, ''nevus'' is known as a ''mole''.
 
In the oral cavity these are known as ''[[intramucosal melanocytic nevus|intramucosal nevi]]''.
 
==General==
*Benign.
*Common.
*Think ''[[melanoma]]''.
 
Clinical:
*''ABCD'' = asymmetric, borders (irregular), colour (black), diameter (large).
 
==Microscopic==
Features:
*Symmetrical lesion.
*"Matures" with depth.
**Less cellular with depth.
**Less nuclear atypia with depth.
**Smaller cells with depth.
**Smaller nests with depth.
*Rare mitoses (superficial).
**No deep mitoses.
*No destruction of surrounding structures.
*No nucleoli.
*In the dermis only - '''key feature'''.
*+/-Adipocytes - uncommon.<ref name=pmid9810886>{{Cite journal  | last1 = Eng | first1 = W. | last2 = Cohen | first2 = PR. | title = Nevus with fat: clinical characteristics of 100 nevi containing mature adipose cells. | journal = J Am Acad Dermatol | volume = 39 | issue = 5 Pt 1 | pages = 704-11 | month = Nov | year = 1998 | doi =  | PMID = 9810886 }}</ref>
 
DDx:
*[[Malignant melanoma]] (nevoid).
*[[Dysplastic nevus]].
*[[Junctional nevus]].
*[[Compound nevus]].
*[[Skin tag]].
*[[Mastocytosis]].
 
===Images===
<gallery>
Image: Intradermal nevus -- very low mag.jpg | IDN - very low mag.
Image: Intradermal nevus -- low mag.jpg | IDN - low mag.
Image: Intradermal nevus -- intermed mag.jpg | IDN - intermed. mag.
Image: Intradermal nevus -- high mag.jpg | IDN - high mag.
Image: Intradermal nevus -- very high mag.jpg | IDN - very high mag.
</gallery>
 
==Sign out==
<pre>
Skin, Left Alar Crease, Biopsy:
- Benign intradermal nevus.
</pre>
 
===Block letters===
<pre>
SKIN LESION, BACK, PUNCH BIOPSY:
- BENIGN INTRADERMAL NEVUS.
</pre>
 
====Adipocytes present====
<pre>
SKIN LESION, BACK, PUNCH BIOPSY:
- BENIGN INTRADERMAL NEVUS WITH MATURE ADIPOCYTES.
</pre>
 
====Clinically suspicious====
<pre>
SKIN LESION, LEFT UPPER ARM, PUNCH BIOPSY:
- BENIGN INTRADERMAL NEVUS, INCOMPLETELY EXCISED.
 
COMMENT:
HMB-45 marks very rare superficial cells. Ki-67 staining does not show apparent melanocyte
staining. MITF marks the melanocytes and demonstrates maturation of the melanocytes with depth.
</pre>
 
===Micro===
The sections show melanocytes in the dermis separated from the epidermis by a Grenz zone.  The lesion is symmetrical in its architecture and pigment distribution.  Superficially, melanocytes are in nests.  Melanocytes mature with depth. No mitotic activity is appreciated.
 
The lesion is completely excised in the plane of section.
 
====IDN with congenital features====
The sections show melanocytes in the dermis separated from the epidermis by a Grenz
zone. The lesion is symmetrical in its architecture. Superficially, melanocytes are in
nests. Melanocytes mature with depth and track along adnexal structures.  No mitotic
activity is appreciated. The lesion is incompletely excised in the plane of section.
 
==See also==
*[[Melanocytic lesions]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Melanocytic lesions]]

Latest revision as of 17:38, 26 August 2016

Intradermal nevus
Diagnosis in short

Intradermal nevus. H&E stain.
Synonyms intradermal melanocytic nevus
LM nests of melanocytes in dermis (only), melanocytes "mature" with depth, usu. no mitoses (occ. superficial), no destruction of surrounding structures, no conspicuous nucleoli, no significant melanocyte enlargement
LM DDx malignant melanoma (nevoid), junctional nevus, compound nevus, dysplastic nevus, skin tag, mastocytosis
Gross pigment skin lesion, usu. small, regular border, no irregularity in pigmentation
Site skin - see melanocytic lesions and common nevus
Prevalence very common
Prognosis benign
Clin. DDx pigmented skin lesions
Treatment none required, may be excised for cosmetic reasons

Intradermal nevus (abbreviated IDN), also intradermal melanocytic nevus, is a common benign melanocytic lesion.

The intradermal nevus is in the large group common nevus. In common language, nevus is known as a mole.

In the oral cavity these are known as intramucosal nevi.

General

Clinical:

  • ABCD = asymmetric, borders (irregular), colour (black), diameter (large).

Microscopic

Features:

  • Symmetrical lesion.
  • "Matures" with depth.
    • Less cellular with depth.
    • Less nuclear atypia with depth.
    • Smaller cells with depth.
    • Smaller nests with depth.
  • Rare mitoses (superficial).
    • No deep mitoses.
  • No destruction of surrounding structures.
  • No nucleoli.
  • In the dermis only - key feature.
  • +/-Adipocytes - uncommon.[1]

DDx:

Images

  • IDN - very low mag.

  • IDN - low mag.

  • IDN - intermed. mag.

  • IDN - high mag.

  • IDN - very high mag.

Sign out

Skin, Left Alar Crease, Biopsy:
- Benign intradermal nevus.

Block letters

SKIN LESION, BACK, PUNCH BIOPSY: 
- BENIGN INTRADERMAL NEVUS.

Adipocytes present

SKIN LESION, BACK, PUNCH BIOPSY: 
- BENIGN INTRADERMAL NEVUS WITH MATURE ADIPOCYTES.

Clinically suspicious

SKIN LESION, LEFT UPPER ARM, PUNCH BIOPSY:
- BENIGN INTRADERMAL NEVUS, INCOMPLETELY EXCISED.

COMMENT:
HMB-45 marks very rare superficial cells. Ki-67 staining does not show apparent melanocyte
staining. MITF marks the melanocytes and demonstrates maturation of the melanocytes with depth.

Micro

The sections show melanocytes in the dermis separated from the epidermis by a Grenz zone. The lesion is symmetrical in its architecture and pigment distribution. Superficially, melanocytes are in nests. Melanocytes mature with depth. No mitotic activity is appreciated.

The lesion is completely excised in the plane of section.

IDN with congenital features

The sections show melanocytes in the dermis separated from the epidermis by a Grenz zone. The lesion is symmetrical in its architecture. Superficially, melanocytes are in nests. Melanocytes mature with depth and track along adnexal structures. No mitotic activity is appreciated. The lesion is incompletely excised in the plane of section.

See also

References

  1. ↑ Eng, W.; Cohen, PR. (Nov 1998). "Nevus with fat: clinical characteristics of 100 nevi containing mature adipose cells.". J Am Acad Dermatol 39 (5 Pt 1): 704-11. PMID 9810886.
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