What is intradermal pigmented nevus?

Causes and symptoms

Only an experienced specialist can make the correct diagnosis. Diagnosis is carried out using various techniques.

First of all, an external inspection is carried out. The location, appearance, and shape of the nevus are analyzed.

If necessary, additional studies may be prescribed.

Methods:

1. A smear of discharge from a nevus,
2. Examination under a microscope using special staining substances.
3. Dermatoscopy. Using a special device, the structure of the nevus is examined.
4. Siascopy. The procedure allows you to examine the birthmark in quite detail and detail.
5. Biopsy. Carried out after removal, it allows you to determine oncology.

Treatment of intradermal nevus

If the pigmented nevus of the skin does not cause trouble, then treatment is not required. Removal of an intradermal birthmark is carried out if it is subject to permanent damage or there is a risk of degeneration into a malignant tumor. What signs are characteristic of growth degeneration?

Signs:

1. Fast growth,
2. Itching, inflammation,
3. Bleeding from the nevus, any other discharge,
4. Change in shape, appearance of asymmetry,
5. Painful sensations.

A person cannot influence the appearance of moles. It is necessary to monitor their condition and take certain measures to avoid the development of oncology.

1. It is necessary to reduce the time spent in the sun, and do not overuse the solarium.
2. You should not frequent baths and saunas.
3. You should be careful and try not to damage the nevi.
4. If there are suspicious changes or damage to an intradermal mole, you should go to the hospital.

Intradermal nevi do not cause much trouble to a person. It is necessary to note every change, take timely measures, and begin the necessary treatment.

Reviews:

My son has a dark oval spot on his neck. The doctor said it was an intradermal noncellular nevus. He prescribed laser removal.

Marina:

I went to the doctor because of many moles that looked like warts. He said to monitor their condition, if there are changes, then contact him immediately. He suggested removing those located on the neck so as not to injure them with the collar.

An example of intradermal nevus removal - video

Intradermal nevus is a benign neoplasm that occurs due to disruption of the cells responsible for melanin. Most often, such a mole does not pose a threat to human life; it can be detected at absolutely any age. Today we will talk about intradermal nevi, methods of their treatment and prevention.

How to recognize an intradermal mole

It is not easy to distinguish an intradermal nevus from an ordinary mole, but it is quite possible, you just need to know their main distinguishing features:

1. the surface is soft with light pressure;
2. the color is uniform and does not change over time;
3. the borders of the mole are clear, bright and even;
4. There is no inflammation under or near the mole.

Most often, a nevus in appearance resembles a round wart that protrudes from the skin (flat). Sometimes the neoplasm may have the shape of a blackberry (a round, bumpy “body” attached to the skin with a small thin stalk). There may be one or several intradermal moles on the body. If there are several nevi, they can be located in different places or be localized all in one.

The size of such birthmarks can range from 0.2 to 1-2 cm. The shade of moles also varies: from black to light brown or burgundy. Depigmented intradermal moles are those nevi that are practically colorless, whitish or colorless. Looking at them, you can see a network of capillaries or small inclusions of a dark brownish color. Over time, the nevus can change its size and color.

Most often, moles are located in the neck, armpits, inguinal folds, and under the mammary glands. These pigmented birthmarks are least likely to be located on the arms, legs, back or abdomen.

The structure of the nevus is carefully examined in medical laboratories under modern microscopes. Thanks to this, the number of cells that have accumulated in the layer of the skin is revealed. The benign quality of the neoplasm and the number of nuclei in the cells are determined.

Why do such neoplasms occur?

There is still no clear reason for the formation of intradermal nevi on the skin of the human body. Only a version or assumption that, according to scientists, can explain the process of the appearance of a neoplasm.

Even at the stage of intrauterine development of the child, melanoblasts, the so-called nevus cells, are formed, which play an important role in the formation of some of the baby’s organs, as well as its nerve nodes. In addition, melanin cells, which give the skin of the unborn child a certain color or shade, are formed in melanoblasts. The same birthmarks on a child’s body appear due to the accumulation of a certain number of immature nevus cells. Due to the fact that such moles form deep in the layers of the skin, they get their name intradermal nevus.

Among other things, the hereditary factor plays an important role in the formation of birthmarks. Often such neoplasms become more or less noticeable only after 12, and sometimes only after 30 years of a person’s life.

This occurs because nevus cells are transformed in several stages:

1. in infancy, intradermal nevi are barely noticeable because they are located shallow under the epithelium;
2. with age, nevus cells gradually begin to change and move deeper into the skin, at the first stage penetrating between the epithelium and dermis;
3. then so-called border birthmarks are formed;
4. After a certain period of time, melanoblasts move to a deeper layer (dermal). After this, the mole becomes much more noticeable and enters the final stage of transformation;
5. the shape changes, which can be convex with a wide base or round and attached to a leg;
6. at the final stage, nevus cells stop producing melanin, and some become discolored.

What are intradermal moles?

Doctors divide neoplasms into several types:

1. intradermal papillomatous nevus or verrucous;
2. intradermal pigmented nevus or melanocytic;
3. intradermal noncellular nevus.

All of them are non-cancerous.

Intradermal papillomatous nevus or verrucous

Visually, such a mole has a shape resembling a large round wart, often on a small stalk, which is significantly smaller than the base of the nevus itself. This formation occurs most often on the head under the hair. The sizes vary from 5 mm to 1-1.5 cm, the surface is lumpy and rough. The color can be light brown, dark burgundy, dirty brown, even black. Upon external examination, some intradermal nevi grow hair of short length, quite hard and dark. The size of the mole may increase over time. It is recommended to remove such nevi if they bother a person, are subject to constant mechanical stress, or there is a risk of catching and tearing off a mole.

Intradermal pigmented nevus or melanocytic

Melanocytic nevus is a borderline formation that has a very clear and bright color. The color lasts for a long time due to the content of a large number of melanin cells. The size of a mole can range from 2 to 5 mm. The shape of a birthmark may change throughout life. The surface of the nevus can be either rough or lumpy or smooth. Moles of this type most often form in the groin, on the neck, in the armpits or under the mammary glands.

Intradermal noncellular nevus

In appearance, such a mole resembles a small convex oval, most often formed on the face or neck. They require mandatory treatment or removal, especially if they significantly spoil a person’s appearance. Such nevi appear to a greater extent in adolescence, when puberty occurs.

Symptoms of intradermal nevus

The size of birthmarks ranges from the size of a millet grain to lesions that cover large areas of the body. Borderline and mixed nevi look like flat or slightly raised soft hairless formations above the skin with a smooth and sometimes warty-papillomatous surface, dark brown in color. These nevus cell formations are more likely to undergo malignant transformation.

The earliest signs of malignancy include a sharp increase in their size, the appearance of subsidiary formations (small nodules on the surface of the birthmark or in its circumference), an increase or loss of uniform pigmentation, the formation of a pigmented zone around the birthmark, and the appearance of pinpoint pigment spots in the circumference of the nevus.

An intradermal nevus has the appearance of a dense dome-shaped formation, often covered with bristly hair, with a smooth, sometimes papillomatous surface, of various colors - from normal skin color to dark brown. Malignancy of an intradermal nevus is extremely rare.

How to know when it's time to see a doctor

To prevent melanoma, it is recommended to monitor the condition of the mole and consult a dermatologist if suspicious elements are detected.

According to the ABCDE system, when examining a mole, pay attention to the following signs:

A – asymmetry – asymmetry of the mole;

B – border irregularity – uneven edge of a mole;

C – color – unequal color of different parts of the mole;

D – diameter – the diameter of the mole is more than 6 millimeters;

E – evolving – variability of the mole.

Why is the growth of intraepidermal nevus dangerous?

Everyone knows that moles can degenerate into one of the most malignant tumors - melanoma.

It should be noted right away that these cases are not nearly as common as is commonly believed, and if a mole has increased in size, this is just a reason to visit a specialist.

However, this does not mean at all that you should not pay attention to the changes that occur with moles, especially for those neoplasms that are located on the face or hands and other open areas of the body exposed to constant exposure to ultraviolet radiation, and those moles that can be constantly injured by clothing or decorations.

1. The mole is growing. This means very rapid growth over a period of weeks or months.
2. The mole is bleeding. Attention should be paid to both bleeding due to injury and spontaneous bleeding.
3. The mole itches. Itching in the area of ​​the nevus indicates that it is either exposed to external influences, or changes occur within the body.
4. The mole changes color. Here you need to pay attention to darkening or uneven coloring of a previously “normal” mole.
5. A pigment spot has appeared around the mole.Doctors warn that people with moles on the face, pigmented structures more than 1 cm in diameter, and also with more than 100 moles on the entire body are much more likely to develop malignant nevi. That's why:
6. If you have returned from vacation and discovered that a mole is growing on your face, or a mole is growing and itching, do not waste time, go to the doctor.
7. If you have recently experienced childbirth and have moles growing on your body that have not previously shown visual changes, consult a specialist, as hormonal changes during pregnancy and lactation could negatively affect the condition of the neoplasms.
8. If you begin to notice that, due to constant friction against a collar or chain, a mole on your neck has sharply increased, do not be lazy and visit a doctor.

Despite the fact that all these can be completely harmless changes that do not threaten anything, except, perhaps, a cosmetic defect, sometimes such symptoms become the first signs of a dangerous disease, which is better to prevent than to fight it in the future. The consultation does not take much time and almost never requires any specific tests or studies. The specialist will carefully collect an anamnesis (you can help him with this if you remember in advance, before the visit, the time the mole appeared, the time during which changes occurred in it, and whether your closest relatives had similar cases) and will examine the neoplasm. If in doubt, a dermato-oncologist will join the examination.

You can also get rid of unwanted moles by cryodestruction (the nevus is “frozen” with liquid nitrogen), electrocoagulation (exposure to high-frequency electric current) or laser.

Laser removal is considered the most aesthetic, therefore it is preferable for the face, neck and décolleté. However, any altered mole is subject to mandatory laboratory examination after removal. Do not risk your health and beauty - do not use folk remedies and do not try to remove moles yourself, especially those that have undergone changes.

Treatment options for intradermal mole

Intradermal nevi have several treatment options:

1. laser therapy (nevus treatment is performed with laser);
2. cryodestruction (formation is frozen with liquid nitrogen);
3. surgical method (the mole is removed with a scalpel);
4. electrocoagulation (the nevus is cauterized with a special electric knife);
5. radiosurgery (the mole is removed using a radio knife).

Before prescribing treatment, the doctor is guided by the size of the mole, its appearance, color, location, as well as the likelihood of it becoming malignant.

If there is even the slightest risk of the nevus turning into melanoma, the doctor will definitely prescribe removal of the mole with a scalpel. During this procedure, tissue located near the tumor is also removed to prevent tumor development.

Many doctors consider laser surgery to be the most effective treatment for intradermal nevi. It is especially good for removing large birthmarks that are more than 3 cm in diameter, as well as skin melanoma.

Laser surgery has a number of advantages over other methods of treating nevi:

1. There is no bleeding during removal, because all small vessels are immediately cauterized;
2. healthy tissues and cells are not affected, which means they are not injured;
3. there is no need for postoperative sutures;
4. the rehabilitation period after the operation is minimal;
5. There are practically no scars left.

Disadvantages of treatment methods

When using the traditional, most common method - surgical, along with excision of the nevus, healthy tissue necessarily enters the surgical field. Infection of the surgical wound with subsequent suture dehiscence is possible. In the absence of any complications, healing occurs by primary intention, the sutures are removed after 7-12 days. To improve the aesthetics of the seam, the edges of the incision are modeled. Electrosurgical treatment makes it possible to excise the nevus almost bloodlessly, however, the nerves and their endings in the area of ​​surgical interest are subjected to extreme (stress) effects with the development of “electric shock”, which, due to the development of further neurotrophic disorders, inhibits the repair processes in the skin, slowing down for 5-7 days healing that occurs according to the type of secondary intention.

Cryotherapy of nevi with liquid nitrogen depends on the subjective choice of cold exposure time, which affects the depth of freezing of the skin and underlying tissue. Upon achieving the final goal - cryonecrosis, along with the elimination of the nevus, the period of cleansing from necrotic masses is extended (7-10 days), after which skin repair processes begin with the formation of a new integumentary epithelium (epidermis).

High energy CO₂-laser treatment allows you to excise the nevus in such a way that the surrounding tissues are not affected. In this case, perifocal edema practically does not develop or its manifestations are so minimal that already from the 2-3rd day the initial manifestations of healing of the surgical skin defect are visually recorded.

The morphological basis of skin biology is such that the epithelial cells of the epidermis are constantly renewed throughout a person’s life. Such physiological regeneration occurs due to the functional activity of the cambial, germinative cells of the Malpighian layer of the epidermis.

Any therapeutic effect on the skin after the elimination of the nevus stimulates the germ cells of the Malpighian layer to more intensive growth and reproduction. This is not physiological, but reparative regeneration, since before the removal of the nevus, the skin at its location was viciously formed, and surgical treatment is, in fact, destructive, i.e. non-physiological. In this aspect of considering the problem of treating nevi, it is necessary to take into account the alternative path of development of reparative regeneration.

In cases where it is complete and is characterized by the identity of new epidermal cells in structure and function, we can talk about full regeneration (restitution). However, there are clinical situations of incomplete regeneration (substitution), when the epithelization of the skin defect is incomplete, and it is replaced by connective tissue with the formation of a scar. In rarer and worse situations, reparative regeneration acquires pathological features in the form of hyper- or hyporegeneration. In the first case, it is an ugly keloid scar made from excessive collagen or an overgrown traumatic neuroma from nerve endings; in the other - chronicity of the inflammatory process, the sluggish persistence of which does not provide the opportunity for epithelization of the surgical skin defect after removal of the nevus.

Taking into account the above, it should be emphasized how important the professional competence of the surgeon, oncologist, and most importantly, the significant personal experience of the doctor when choosing a specific method of treating nevi is important.

The authors of the article wish readers to maintain a high level of sanitary culture, which contributes to the manifestation of oncological alertness to congenital and newly formed moles, especially in cases when they begin to acquire a more saturated brown or black color, uneven contours, increase in size, lose previously sprouted hairs, crack, peel, ulcerate, bleed, become inflamed.

If the unshakable status of a mole has changed in any way, this is a very convincing argument for visiting an oncology clinic. The removed material is subject to histological examination.

Complications

Almost the only, but most dangerous complication of a mole is malignancy. In this case, a harmless mole turns into melanoma.

Prevention of degeneration of a mole into melanoma

It is impossible to somehow influence the occurrence of a birthmark. Prevention makes sense only if the resulting formation has even the slightest chance of degenerating into melanoma. What to do:

1. Avoid direct sunlight on the area with intradermal nevus;
2. try not to sunbathe too much with the part of the body on which there is such a mole;
3. do not go to the solarium, especially if the birthmarks are large or there are many of them.

If you find any growths on the skin, try to contact your doctor as soon as possible to make sure that the growth is truly benign and there is no or minimal risk of developing melanoma.

Intradermal nevus is a type of nevus, or mole, which refers to benign pigmented skin tumors of a congenital or acquired nature. This type of nevus is formed when specialized skin cells - melanocytes, which produce the pigment melanin, accumulate in the deep layers of the dermis. It can be single or multiple, localized more often in the face, neck, torso, and occurs mainly in adulthood or old age. In most cases, it does not require treatment, but only observation over time. Removal is resorted to when the formation is traumatized and there is a risk of malignant degeneration.

A nevus, or birthmark, appears on the surface of the skin from pigment cells when there is an excess of melanin pigment in them. The skin consists of a superficial layer - the epidermis and a deeper layer - the dermis. Depending on where melanocytes accumulate, there are several types of nevi:

1. epidermal, localized in the upper layer - the epidermis;
2. borderline, located on the border of the epidermis and dermis;
3. intradermal, formed in the thickness of the dermis.

Causes

There may be several reasons for the formation of birthmarks.

The appearance of moles in a certain place on the human body can be genetically programmed. Congenital birthmarks are an embryonic developmental defect, the basis of which is a disruption in the process of movement of melanoblasts, the precursors of melanocytes, from the neuroectodermal tube into the skin. The accumulation of pigment cells in the skin causes the formation of nevi.

One of the functions of the melanin pigment is to absorb ultraviolet rays. Thanks to this, the deep layers of the skin are protected from radiation damage. When exposed to excessive ultraviolet rays, the pigment is produced more intensely, which, in turn, provokes the formation of moles. The main source of natural ultraviolet radiation is the sun. In addition, these may be artificial sources used for various purposes, including artificial tanning. Prolonged exposure to the sun and abuse of tanning beds is fraught with the development of pigmented formations.

Hormonal changes (adolescence, pregnancy, menopause) and surges (stress, endocrine pathologies, etc.) are provoking factors in the formation of pigmented neoplasms of the skin.

The appearance of many nevi, intradermal pigmented ones, is noted, including in the case of acute inflammatory bullous dermatoses (skin diseases accompanied by the formation of blisters), after polychemotherapy. Injuries and various viral infections that reduce the body's defenses stimulate the growth and increase in the number of moles.

Signs

Pigment formations localized in the thickness of the dermis usually have a dome-shaped or warty appearance. If we are talking about intradermal papillomatous nevus, then its shape may resemble a papilloma - a soft benign formation on a stalk or broad base. Color varies from light shades of brown to almost black. Sometimes there are almost no pigment intradermal formations that are whitish or pink in color.

The sizes vary: from 1-2 mm to several centimeters. Regular, or melanocytic, nevi increase in size as the human body grows. They are often not visible on the surface of the skin of newborns, but begin to appear already in the first years of life. By size they are distinguished:

1. small (from 0.5 to 1.5 mm);
2. medium (up to 1 cm);
3. large (more than 1 cm in diameter).

Intradermal moles can be single or multiple. Their number reaches its maximum during puberty. After 50 years, their number may gradually decrease. The localization is varied, most often - the skin of the face, neck, and torso.

There is some preferential location in children depending on gender: in girls, moles are more often found on the limbs, in boys - on the head and torso.

Diagnostics

The doctor finds out when the neoplasm appeared and whether there was a change in its color, shape, or diameter. If there were any, how long ago and what caused them. The presence and severity of clinical symptoms are clarified.

The location, size, shape, and color of the mole are assessed. This helps make a preliminary diagnosis.

A method that allows you to evaluate skin tumors in the superficial and deeper layers. It is carried out using a dermatoscope. The procedure does not involve violating the integrity of the skin. The advantages of the method also include high sensitivity and specificity. Digital dermatoscopes allow you to capture images and store photos in an electronic database, which facilitates the monitoring process. Examination under magnification allows for differential diagnosis between benign and malignant intradermal pigmented formations.

If a nevus is present, a biopsy (taking a tissue sample for histology) is usually not performed. Any traumatic impact can give impetus to the malignant degeneration of certain types of pigmented formations, especially borderline ones. If a patient consults a doctor with an injured mole, then it is permissible to take a smear from its surface, since the integrity of the formation is already compromised and there is often discharge. In the laboratory, the smear is examined by a cytologist.

What is the danger of pigment formations

Intradermal nevus is a benign neoplasm, but the effect of ultraviolet radiation and mechanical trauma, especially repeated ones, increase the risk of its degeneration into melanoma. The latter is one of the most aggressive human malignant tumors.

Early clinical manifestations of melanoma may include:

1. change in the color of the formation (intense pigmentation, its unevenness);
2. fast growth;
3. itching;
4. ulceration, inflammatory changes, bleeding.

The occurrence of one or more of the listed symptoms requires immediate contact with a specialist.

Treatment tactics

Most intradermal pigmented nevi are safe and do not require treatment, only dynamic observation. Moles have to be removed if their integrity is damaged, especially repeatedly. This is usually due to their localization, which does not allow avoiding periodic mechanical trauma: on the palms, soles, neck, waist. Often pigment spots are removed for aesthetic reasons.

There are several ways to remove intradermal pigmented neoplasms.

A traditional technique in which mole resection is performed with a scalpel under local or general anesthesia. The disadvantages of the method include the appearance of scars formed after excision. However, the nature of the postoperative scar depends largely on the suture material and the qualifications of the operating doctor: it is possible to apply an almost invisible cosmetic suture.

A non-contact technique based on the use of high frequency radio waves. The required effect is achieved due to the thermal energy generated in the tissue when it is exposed to high-frequency radio waves emitted by a special Surgitron apparatus. Sterility, bloodlessness, low trauma, absence of noticeable scars after healing of a postoperative wound are the undeniable advantages of the method.

The conversion of high-frequency current into thermal energy is the basic principle of operation of an electrosurgical high-frequency device used in dermatology for excision of intradermal tumors. The technique makes it possible to coagulate vessels damaged during surgery, which reduces operation time and blood loss.

The method is based on the effect of low temperature on fabric. To achieve the desired effect, liquid nitrogen supplied through a special cryoprobe is most often used as a cooling solution. During cryodestruction, the surrounding tissues are practically not damaged, no bleeding occurs, and rough scars are not formed during the healing process.

The technique involves the use of a carbon dioxide or neodymium laser. The advantages of laser removal include the ability to accurately dose the radius and depth of exposure, and the ability to maintain the integrity of surrounding tissues. After removing small formations, there are practically no traces left.

You can choose different methods for removing moles only if you are absolutely sure of their benign nature. If the formation is traumatized or there is the slightest suspicion of its malignancy, one should resort only to surgical excision, which should be carried out by an oncologist. It must be removed radically, and subsequent histological examination is required.

How to reduce the risk of nevus malignancy

To eliminate the risk of malignant degeneration of a mole, you should:

1. avoid excessive sun exposure;
2. do not overuse artificial tanning;
3. avoid injury;
4. If suspicious signs appear, visit a dermatologist.

It is necessary to regularly monitor the appearance and number of moles. Immediate contact with a specialist if their contours, size, or color changes will help prevent the development of melanoma.

Video

We offer you to watch a video on the topic of the article.

Education: Rostov State Medical University, specialty "General Medicine".

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