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Dermatopathology: Practical & Conceptual October - December 1996
Dysplastic Nevus:: National Institutes of Health Consensus Development Conferences, 1983 and 1992— Consensus?
Daniela Massi, MD
Timothy A. Nielsen, MD
A. Bernard Ackerman, MD
Key Questions Posed by the Organizers
“Dysplastic Nevus”: Clinical Aspects
“Dysplastic Nevus”: Histopathologic Aspects
“Dysplastic Nevus”: Cytologic Atypia
Prevalence of “Dysplastic Nevi”
“Dysplastic Nevus Syndrome”
Risk of Melanoma
Management of “Dysplastic Nevi”
1983 NIH Consensus Development Conference:
"Dysplastic nevus," clinically and histopathologically
1992 NIH Consensus Development Conference:
"Atypical moles" clinically, and "Nevus with architectural disorder" histopathologically. The Panel eschewed the designation DN and proposed substitutes for it in these words: "Because of the controversy surrounding use of the term "dysplastic nevus," it seems appropriate to discontinue use of that diagnosis and to describe these lesions as "nevus with architectural disorder" with a statement as to the presence and degree of melanocytic atypia. . . . The clinical lesions should be described as "atypical moles."
The recommendation of the Panel of the 1992 NIH Consensus Development Conference to avoid use of the term "dysplastic nevus" was highly laudable. That advice came almost 10 years after the Panel of the NIH Consensus Development Conference of 1983 had given its imprimatur to the term DN. Realization at last that the name DN was confusing and misleading implied comprehension of the fact that the appellation DN was potentially injurious to patients physically by virtue of unnecessary surgical removal, often wholesale, of them and psychologically by reason of fear consequent to having been labeled with the name of a syndrome that denoted inordinate risk for development of melanoma. Despite exhortations by the NIH Panel of 1992 to discontinue use of the term DN, that designation continues to be employed routinely in histopathology reports and in publications of all kinds. The phrase "nevus with architectural disorder," which was embraced by many pathologists worldwide following its having been sanctioned by the NIH in 1992, is as unfathomable as the name DN. How can there be consensus about the meaning of architectural disorder if there is no agreed-upon definition of architectural order? Only normal skin (or any normal organ) can be said to possess "order" architecturally. In regard to legitimacy of the term "atypical mole," there are neither typical nor atypical moles. Nevi can be classified in various ways, such as congenital, e.g., nevus spilus, "blue nevus," and giant hairy nevus, or acquired, e.g., Unna, Spitz, and Clark, but they cannot be specified as "atypical" because no agreed-upon definition of "typical mole" has ever been formulated—or ever will be.
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