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A 44-year-old man presents with concern over a mole on his back that his wife says is growing larger and more variable in color. The edges are irregular and the color almost appears to be “leaking” into the surrounding skin. He reports no symptoms related to this lesion. On physical exam, the nevus is 9 mm in diameter with asymmetry and variations in color and an irregular border (Figure 165-1). A full-body skin exam did not demonstrate any other suspicious lesions. Dermoscopy showed an irregular network with multiple asymmetrically placed dots off the network (Figure 165-2). A scoop saucerization was performed with a DermaBlade taking 2-mm margins of clinically normal skin (Figure 165-3). Although this could have been an early thin melanoma, the pathology showed a completely excised compound dysplastic nevus with no signs of malignancy. No further treatment was needed except yearly skin exams to monitor for melanoma.

Figure 165-1

Growing 9-mm compound dysplastic nevus on the back of a 44-year-old man. There is asymmetry and variations in color and an irregular border. (Courtesy of Richard P. Usatine, MD.)

Figure 165-2

Dermoscopy of this compound dysplastic nevus shows an irregular network with multiple asymmetrically placed dots off the network. (Courtesy of Richard P. Usatine, MD.)

Figure 165-3

A scoop saucerization was performed with a DermaBlade taking 2-mm margins of clinically normal skin. Although this could have been an early thin melanoma, the pathology showed a completely excised compound dysplastic nevus with no signs of malignancy. (Courtesy of Richard P. Usatine, MD.)

Dysplastic nevi (DN)/atypical moles are acquired melanocytic lesions of the skin whose clinical and histologic definitions are controversial and still evolving. These lesions have some small potential for malignant transformation and patients with multiple DN have an increased risk for melanoma.1

The presence of multiple DN is a marker for increased melanoma risk just as red hair is, and, analogously, cutting off the red hair or cutting out all the DN does not change that risk of melanoma. The problem with DN is that any one lesion that is suspicious for melanoma must be biopsied to avoid missing melanoma, not to prevent melanoma from occurring in that nevus in the future.

Atypical nevus, atypical mole, Clark nevus, nevus with architectural disorder, and melanocytic atypia.1

  • Two percent to 9% of the population has atypical moles (AMs).2,3 In a Swedish case-control study, 56% of cases (121 patients with melanoma) and 19% of 310 control subjects had nevi fulfilling the clinical criteria for DN.4 Among patients with melanoma, the rate of DN ranges ...

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