Disease Description (Causes and Symptoms)
- Definition: A melanocytic nevus is a benign skin tumor originating from the melanocyte lineage. It is classified as congenital (approximately 1% of newborns) or acquired. Congenital nevi commonly have hair growing from them.
- Pathophysiology: It develops from the formation of clusters of melanocytes (nevus cells) in the dermis and epidermis, and is classified according to size and depth into epidermal, dermal, and compound nevi, among others.
- Main symptoms: Usually no pain or itching. It appears on the skin as a round black, brown, or skin-colored spot or nodule. The following changes raise suspicion of malignant transformation (melanoma): rapid increase in size, asymmetry, irregular borders, multiple colors, increase in diameter, bleeding, ulceration, inflammation, and so on (ABCDE criteria).
Treatment Methods
- Observation (regular follow-up): If there are no suspicious findings and minimal cosmetic concerns, monitor the progression through photographic records and dermatology follow-up (dermoscopy).
- Surgical removal: If malignancy is suspected or there are symptomatic or cosmetic concerns, an excisional biopsy is the standard. If necessary, a pathological examination is performed after excision (histological confirmation).
- Methods: Complete removal by excision (elliptical excision) followed by suturing, or excision and suturing under local anesthesia. Small lesions may be evaluated for diagnostic purposes using a shave or punch biopsy.
- Congenital giant nevus: Reconstructive surgery such as staged excision, tissue expansion, or skin grafting may be necessary.
- Laser treatment and chemical peeling: These may be used to improve pigmentation for cosmetic purposes, but even if epidermal or superficial pigmentation improves, deeper nevus cells may remain, leading to recurrence, and pathological confirmation may become impossible. For lesions suspected of malignancy, tissue examination is recommended first.
- Medication: There is no specific medical drug therapy.
- Lifestyle management and precautions: Use sun protection, avoid repeated trauma, and consult a specialist immediately if changes occur. Possible complications after surgery include infection, bleeding, and scarring, and recurrence is possible in rare cases.
Checklist Before an Outpatient Visit (Including Example Questions)
Items/records to prepare
- List of medications currently being taken (including anticoagulants)
- Past medical history, surgeries, history of skin cancer, or family history (especially melanoma)
- Photographs of the lesion (comparative photographs taken over time are useful)
- Records of changes in the lesion (size, color, itching, pain, bleeding, etc.) and when they began
- Previous treatments received (laser treatment, cryotherapy, excision, etc.) or biopsy results
Example questions (items to check for yourself during the consultation)
- Has the size or color of this spot changed recently?
- Has there been pain, itching, bleeding, a scab, or ulceration in this spot?
- Is there a family history of skin cancer?
Examples of General Questions to Ask the Doctor
- How likely is it that this lesion is malignant (melanoma)? Is a biopsy necessary?
- Which removal method do you recommend, and why? (Including scarring, recovery, and risk of recurrence)
- How long does it take to receive the pathology results after removal?
- What are the possible side effects of the surgery or procedure, and how long is the recovery period?
Examples of Disease-Specific Questions
- If this spot is removed with a laser, will it become impossible to perform a biopsy? (Ask whether laser treatment is appropriate when malignancy is not suspected.)
- In the case of a congenital (or large) nevus, what do you recommend regarding the risk of cancer development and the timing of removal (during childhood versus adulthood)?
Note: If there are changes in symptoms (size, color, bleeding, ulceration, etc.), it is recommended to visit a dermatologist or plastic surgeon without delay for evaluation (skin examination, dermoscopy, and, if necessary, a biopsy).