Nevus (or naevus, plural nevi, from noevus, Latin for birthmark) is the medical term for sharply-circumscribed and chronic lesions of the skin. These lesions are commonly named birthmarks and moles. By definition, nevi are benign. Using the term nevus and nevi loosely, most physicians and dermatologists are actually referring to a variant of nevus called the “melanocytic nevus”, which are composed of melanocytes. Histologically, melanocytic nevi are differentiated from lentigines (also a type of benign pigmented macule) by the presence of nests of melanocytes, which lentigines (plural form of lentigo) lack.
Classification is based on cell line of origin. Melanocytic nevi are derived from melanocytes. Epidermal nevi are derived from keratinocytes or derivatives of keratinocytes. Connective tissue nevi are derived from connective tissue cells like adipocyte and fibroblasts. Vascular nevi are derived from structures of the blood vessels.
Normal Evolution or Maturation of Melanocytic NevusClinical diagnosis of a melanocytic nevus from other nevi can be made with the naked eye using the ABCD guideline, or using dermatoscopy. The main concern is distinguishing between a benign nevus, a dysplastic nevus, and a melanoma. Other skin tumors can resemble a melanocytic nevus clinically, such as a seborrheic keratosis, pigmented basal cell cancer, hemangiomas, and sebaceous hyperplasia. A skin biopsy is required when clinical dianosis is inadequate or when malignancy is suspected.
All melanocytic nevi will change with time – both congenital and acquired nevi. The “normal” maturation is evident as elevation of the lesion from a flat macule to a raised papule. The color change occur as the melanocytes clumps and migrates from the surface of the skin (epidermis) down deep into the dermis. The color will change from even brown, to speckled brown, and then losing the color and becomes flesh colored or pink. During the evolution, uneven migration can make the nevi look like melanomas, and dermatoscopy can help in differentiation between the benign and malignant lesions.