Differential diagnosis of dysplastic nevi

Differential diagnosis of melanocytic lesions is a significant clinical problem, especially in cases of dysplastic nevi, which have ambiguous dermatoscopic characteristics. Inaccurate diagnosis can lead to unnecessary surgical interventions or, conversely, to late detection of melanoma. Objective — to develop more objective and reliable methods for assessing the risk of progression of melanocytic lesions.Materials and methods. In this study, we investigate the potential of integrating dermatoscopic features and immunohistochemical markers to improve the differential diagnosis and prognosis of melanocytic lesions. Results and discussion. An approach to the differential diagnosis of dysplastic nevi (DN) based on the integration of dermatoscopic and immunohistochemical (IHC) criteria was developed. 95 melanocytic lesions were retrospectively analyzed. Dermatoscopically, DN is characterized by structureless areas (87 %), atypical globules (53.7 %), and mesh (42.6 %). IHC: significant increase in Ki-67 (p < 0.001) and decrease in SOX-10, p16, PTEN (p < 0.05) in melanomas. The following correlations were confirmed: age/grade of malignancy (p = 0.021), Ki-67/grade of malignancy (p < 0.001). Conclusions. The diagnostic value of dermatoscopic criteria was confirmed. The expression of Ki-67 and PTEN can be used to assess the risk of malignancy of melanocytic lesions. The results obtained will contribute to the development of prognostic models of the risk of malignancy of DN and the optimization of diagnostic algorithms. We have demonstrated that combining clinical, dermatoscopic, and morphological data allows for improved risk stratification and a more individualized approach to the treatment of melanocytic lesions.