22^nd World Dermatology Congress

Biography

Biography: Natasha Tsekova Traykovich

Abstract

Differentiation of pigmented skin lesions, benign and malignant, is not a difficult approach and can be done only with a clinical examination by an experienced dermatologist. Proper and fast diagnosis is essential because it can increase patient survival, especially in malignant melanoma. In recent decades, dermatoscopy has developed to a state-of-the-art method for evaluating pigmented skin lesions and following well-defined criteria helps the confirmation of diagnosis.

Sometimes diagnosis of  pigmented lesions is a challenge, especially when the lesions are localized on the palmoplantar surface, nail matrix, or occur in children. For patients with large congenital melanocytic nevi, the risk of developing melanoma (cutaneous or extracutaneous) is estimated to be 5–10% over a lifetime, with approximately half of this risk during the first 5 years of life. Nevi that involve the nail matrix can present as longitudinal melanonychia, a tan, brown or black streak caused by increased melanin deposition in the nail plate. Although streaks that develop in childhood are usually benign, single bands that are dark in color or wide (6 mm), become darker or wider with time, are associated with nail dystrophy, or have extension of pigmentation beyond the nail fold warrant biopsy of the nail matrix to exclude melanoma. Sometimes difficult in practice is the diagnosis of Spitz nevi. Spitz nevi are benign, usually acquired proliferations of melanocytes with histopathologic features that sometimes overlap with those of melanoma. Therefore, proper diagnosis is essential.

Just as the evaluation of skin lesions at special anatomical sites can be demanding, some melanoma subtypes are particularly challenging to diagnose.

To avoid unnecessary worry, dermatologist need to be aware of the natural history and clinical spectrum of melanocytic nevi as well as features of pigmented lesions and patient phenotypes that should raise concern.