Torres-Cabala Carlos A, Plaza Jose A, Diwan A Hafeez, Prieto Victor G
Department of Pathology, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
J Cutan Pathol. 2010 Aug;37(8):860-5. doi: 10.1111/j.1600-0560.2009.01377.x. Epub 2009 Jul 15.
Little is known about the significance of severe architectural disorder in small melanocytic lesions with features of dysplastic nevi (DN).
Using previously reported criteria, 355 consecutive DN were scored for architectural disorder and cytologic atypia. The DN were classified according to their size as small (equal or less than 3 mm) or large (greater than 3 mm).
Of these 136 (38.3%) DN were classified as small. Grades of architectural disorder and cytologic atypia were equally distributed in small and large DN. Forty lesions were diagnosed as dysplastic nevi with severe architectural disorder (DNSAD). Thirteen DNSAD were small; of these, 84.6% were junctional. DN showing only mild to moderate architectural disorder were found to be predominantly compound. DN with severe cytologic atypia were mainly large (8/10 cases) with no particular type (junctional or compound) predominance. Seven cases displayed both severe architectural disorder and severe cytologic atypia; only one of these cases (a junctional lesion) measured less than 3 mm.
Small melanocytic lesions displaying severe architectural disorder are mainly junctional and tend to show only mild cytologic atypia. Caution is needed when interpreting the degree of architectural disorder in these small melanocytic lesions, in order to avoid overdiagnosis of melanoma.
关于具有发育异常痣（DN）特征的小黑素细胞性病变中严重结构紊乱的意义，人们了解甚少。
采用先前报道的标准，对连续355例DN的结构紊乱和细胞学非典型性进行评分。根据大小将DN分为小（等于或小于3mm）或大（大于3mm）两类。
在这些DN中，136例（38.3%）被分类为小。结构紊乱和细胞学非典型性分级在小和大的DN中分布相同。40个病变被诊断为具有严重结构紊乱的发育异常痣（DNSAD）。13个DNSAD为小病变；其中，84.6%为交界性。仅表现为轻度至中度结构紊乱的DN主要为混合性。具有严重细胞学非典型性的DN主要为大病变（8/10例），无特定类型（交界性或混合性）占优势。7例同时表现出严重结构紊乱和严重细胞学非典型性；这些病例中只有1例（交界性病变）小于3mm。
表现出严重结构紊乱的小黑素细胞性病变主要为交界性，且往往仅表现出轻度细胞学非典型性。在解释这些小黑素细胞性病变的结构紊乱程度时需要谨慎，以避免黑色素瘤的过度诊断。
