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Dysplastischer melanozytärer Nävus

Dysplastic melanocytic nevus

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Zusammenfassung

Der dysplastische melanozytäre Nävus ist nach wie vor klinisch und histologisch eine umstrittene Entität. Das Auftreten dysplastischer Nävi wird insbesondere beim Nachweis eines dysplastischen Nävussyndroms mit einem erhöhten Risiko für ein malignes Melanom assoziiert. Folgende histologische Kriterien sollten zumindest erfüllt sein: Form- und größenvariante, teilweise horizontal gelegene und konfluierende Melanozytennester, Proliferation einzelner Melanozyten basal und suprabasal (sog. „lentiginöse Melanozytenhyperplasie“), atypische Melanozyten und subepidermale Fibroplasie. Das biologische Verhalten (gewöhnliche Nävusvariante oder Melanomvorläufer?) lässt sich mit den bisher zur Verfügung stehenden Methoden noch nicht verlässlich einschätzen. Die weitergehende Entwicklung molekularbiologischer Techniken sollte es ermöglichen, die prognostische Einschätzung des dysplastischen melanozytären Nävus objektiver und reproduzierbarer zu gestalten. Vor diesem Hintergrund sind für die alltägliche Praxis die komplette Entfernung der Läsion und die klinische Befundkontrolle zu empfehlen.

Abstract

Dysplastic nevus is still a controversial entity both clinically and histologically. The occurrence of dysplastic nevus especially in the context of dysplastic nevus cell syndrome is associated with an increased risk for melanoma. The following minimal histological criteria should be fulfilled: nests of melanocytes varying in size and shape, bridging and confluent, proliferation of single melanocytes basal and suprabasal, cytoplasmic and nuclear atypia of melanocytes and subepidermal fibroplasia. The biological behavior (common nevus variant or precursor of melanoma?) is difficult to evaluate by presently available methods. The further development of new molecular biology techniques may allow a better prognosis of dysplastic nevi in an objective and reproducible manner. Against this background complete excision followed by clinical surveillance has to be recommended for the routine practice.

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Danksagung

Ein besonderer Dank gilt den ärztlichen Kollegen des Heinz-Werner-Seifert-Instituts für Dermatopathologie, Bonn, für die stete diagnostische Unterstützung und die anregenden Diskussionen.

Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Bierhoff gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Heinz-Werner-Seifert-Institut für Dermatopathologie Bonn, Trierer-Str. 70–72, 53115, Bonn, Deutschland

    E. Bierhoff

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Bierhoff, E. Dysplastischer melanozytärer Nävus. Pathologe 36, 46–52 (2015). https://doi.org/10.1007/s00292-014-2061-5

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