New insights into nevogenesis: In vivo characterization and follow-up of melanocytic nevi by reflectance confocal microscopy
Accepted 4 April 2009. published online 15 October 2009.
Background
Development of melanocytic nevi is a complex process.
Objective
The aim of the study was to characterize the in vivo confocal microscopy patterns and histopathologic correlates of melanocytic nevi. In addition, for the first time, confocal follow-up of characteristic nevi was performed documenting histologic changes in nevi.
Methods
For the correlation study, 33 melanocytic nevi showing characteristic dermatoscopic patterns were studied by confocal microscopy. For the follow-up study 20 nevi were monitored for 12 to 18 months.
Results
Reticular nevi showed two different confocal patterns, ringed and meshwork, mostly corresponding to lentiginous and nested junctional patterns, respectively. Globular nevi presented large junctional clusters, whereas cobblestone nevi were constituted by dermal dense melanocytic clusters. Homogeneous nevi did not show distinctive confocal and histopathologic findings. Nevi with a rim of globules presented a meshwork pattern with junctional clusters at the periphery. At the confocal follow-up study all lesions showed limited dynamic changes resulting in stable dermatoscopic and confocal patterns, but 3 globular nevi with junctional nests at baseline evolved into reticular-meshwork pattern nevi with peripheral rim of globules–junctional nests.
Limitations
Longer confocal follow-up of more melanocytic nevi is required to confirm this theory and to validate our preliminary findings.
Conclusions
A model explaining the nevus classification and patterns of evolution of nevi observed in the study was proposed.
aDepartment of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
cDepartment of Pathology, University of Modena and Reggio Emilia, Modena, Italy
bMemorial Sloan-Kettering Cancer Center, New York, New York
dDepartment of Dermatology, Second University of Naples, Naples, Italy
eDepartment of Dermatology, Medical University of Graz, Graz, Austria
fDepartment of Dermatology, Melanoma Unit, Hospital Clinic, Institut de Investigacions Biomédiques August Pi-Sunyer (IDIBAPS), and Centro de Investigacion Biomedica En Red (CIBER) Enfermedades Raras, Barcelona, Spain
gDermatology Group, University of Queensland, Brisbane, Australia
Reprint requests: Giovanni Pellacani, MD, Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy.
Supported by the Grant of the Istituto Superiore di Sanità–Italy (project No. 527/B/3A/4), by the Elise Richter Program (project No. V9-B05; NCT00422448) of the Austrian Science Fund, and by the grant from the Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, Spain (project No. 06/0265).
ABSTRACT