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The journal «ONCOSURGERY» 2013, Vol.5, No 3

Surgical prevention of cutaneous melanoma

Romanova OA, Artemieva NG

Central clinic of Litfond, Moscow, Russia
Contact: Romanova Ol'ga Aleksandrovna, e-mail:

Comparing of clinical features with histological study of excised dysplastic nevi is represented.

Material and methods. Dysplastic nevous (lentiginous melanocytic dysplasia) is a pre-malignant lesion, which may progress to superficial spreading melanoma. In 1982 prof. Golbert ZV from PA Herzen Moscow Cancer Research Institute showed that, lentiginous melanocytic dysplasia of grade 3 was close to melanoma in situ. For prevention of melanoma we offered excision of dysplastic nevi to patients. From 2009 to 2012 in patients with dysplastic nevi 43 pigmented melanocytic lesions in the form of dark pigmented moles from 0.3 cm to 1.2 cm in diameter, elevated above skin surface or elevated less than 0,1 cm. Excision was performed under local anesthesia with 0.4-0.5 cm margins.

Results. According to histological data for all excised melamocytic lesions intradermal nevus was in 6 cases, compound nevus – in 8, lentiginous melanocytic dysplasia – in 28 cases of which 10 was grade 1, 4 – grade 1-2, 6 – grade 2, 1 – grade 2-3, in 7 cases there was no data for grade of evolvement of lentiginous melanocytic dysplasia. Superficial spreading melanoma with 1 level of invasion raised from pre-existing lentiginous melanocytic dysplasia of grade 3 was in 1 case. Compare of clinical features with morphological structure of excised nevi showed that intensity of clinical features (asymmetry, border irregularity, color variety) corresponded with grade of evolvement of lentiginous melanocytic dysplasia. The most relevant features of lentiginous melanocytic dysplasia evolvement were change in size, shape and color of nevus for several months or years and also appearance of dysplastic nevus on normal skin and its following changes in persons older than 17 years.

Conclusion. The indications for excision of dysplastic nevus for prevention of melanoma include features of severe lentiginous melanocytic dysplasia: asymmetry of pigmented mole, border irregularity, color variety, and evolving of nevus for several months or years or appearance of nevus on normal skin and its growth in patient older 17 years. Excision of dysplastic nevus should be performed with 0.4-0.5 cm visible margins. This extent is adequate for total removal of histologically confirmed superficial spreading melanoma with 1-2 level of invasion and width less than 0.1 cm. If patient refuse surgical treatment the nevus should be examined every 6-12 months. The histological study should be performed by morphologist with sufficient experience in studying of melanocytic lesions to determine grade of lentiginous melanocytic dysplasia and its possible progression to melanoma.

KEY WORDS: lentiginous melanocytic dysplasia, dysplastic nevus, superficial spreading melanoma.


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