The term “dysplastic nevus” is a misnomer and should be abandoned. Dysplastic nevus is not just a name, it is the root of the concept that histomorphology (or any morphologic examination including dermatoscopy) is able to predict the fate of a benign melanocytic proliferation. There is no evidence that this hypothesis is true but there are observations that falsify it. Preferably a specific diagnosis should be made based on dermatoscopic pattern and, if this is not possible, on clinical or dermatoscopic grounds alone the term “nevus, not otherwise specified” should be used.
Key points
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The hypothesis that the “dysplastic” nevus is a precursor of melanoma has not been supported by empiric data. The term “dysplastic nevus” is a misnomer because in pathology “dysplasia” describes an intermediate state between a benign and a malignant neoplasm.
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The statement that the diagnosis of a dysplastic nevus is based only on histopathologic criteria and does not correlate with clinical criteria is a clever way to immunize the concept against falsification.
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The strong correlation between melanoma risk and the phenotype of large and numerous nevi has erroneously been interpreted as a causal relationship.
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The terms “dysplastic” and “atypical” nevus are often used by clinicians and pathologists to express their diagnostic uncertainty but it has nothing to do with biologic uncertainty.
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There are parts of a melanoma that may look like a nevus clinically, dermatoscopically, and histopathologically, which led to the unjustified assumption that the inconspicuous part of the melanoma is a precursor nevus.
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