Grading Dysplastic Nevi: Easy as Present or Not

Dr. Barrett likened dysplastic lesions to amoebae. These lesions "go through quiescent phases and they go through active phases," he said. "If we do serial photographs, we can document this change. If the lesion is quiescent and you biopsy it, you see no atypia because there is minimal cellular activity. If you biopsy it in an active phase, it's going to have some degree of atypia. That doesn't mean that atypia equates with dysplasia or premalignancy. That's what I think is happening."

No cytologic atypia can be seen in this slide from a patient with dysplastic nevi, per Dr. Terry L. Barrett.

The atypia seen above is considered mild according to Dr. Barrett's modified dysplastic nevi grading system.

This patient has severe cytologic atypia. Dr. Barrett avoids the term moderate when assessing atypia. Photos courtesy Dr. Terry L. Barrett