The mythical concept and untoward consequences of a diagnosis of dysplastic nevus: an overdue tribute to A. Bernard Ackerman, MD

The so-called dysplastic nevus first entered medical parlance in 1980 [1], originally known as the B-K mole in 1978, only to evolve over the next 34 years into a variety of names including familiar and atypical sporadic mole, melanocytic nevus with persistent lentiginous melanocytic hyperplasia, junctional or compound nevus with architectural atypia/disorder with or without cytological atypia, and Clark’s nevus, to mention but a few [2-6]. It is common knowledge that there is significant discordance and diagnostic uncertainty among consultants in the histopathologic diagnosis of difficult melanocytic neoplasia, i.e., benign or malignant [7]. The fact is there is disagreement among the experts [8,9] as to what constitutes the so-called dysplastic nevus clinically and histopathologically [10]. This is so because there is inadequate and conflicting clinical and histopathologic criteria for a so-called dysplastic nevus. Both a melanoma and a dysplastic nevus have the same clinical features of the notorious ABCD’s (asymmetry, border irregularity, color variability, diameter greater than 6 mm) What was and still is most disturbing and concerning, is the fact that there were reports, studies, theories and beliefs suggesting that the so-called dysplastic nevus is pre-malignant or a precursor of melanoma. Furthermore, it is said that the so-called dysplastic nevus may evolve into a malignant melanoma in either the patient or in family members, or both. Overlapping criteria in melanocytic neoplasia are features that are seen in both benign melanocytic nevi and superficial melanoma, such as seen in some nevi on occasion shortly after birth, persistent (recurrent) nevi, or traumatized nevi. In addition, overlapping criteria may be seen in nevi on special sites such as the palm/sole, genitalia (especially vulva of young women), umbilicus, perianal, scalp, and intertriginous folds. “Although the diagnosis of cutaneous malignant melanoma is usually based on histopathologic criteria may at times be inadequate in differentiating melanoma from certain types of benign nevi.” [11] Collectively, overlapping melanocytic criteria may well be the answer for such confusion between a so-called dysplastic nevus, melanocytic nevus and a superficial melanoma [12]. Unfortunately, when a physician labels a nevus as socalled dysplastic, or used as a hedge when unsure whether the lesion is benign or malignant, and therefore, “premalignant,” there are consequences as this diagnosis evokes considerable The mythical concept and untoward consequences of a diagnosis of dysplastic nevus: an overdue tribute to A. Bernard Ackerman, MD