Atypical Mole (Dysplastic Nevus) Clinical Presentation

  • Author: Kimberly A Wenner, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 23, 2012
 

History

A detailed personal and family history should be obtained, with special attention regarding moles and melanomas.

Atypical moles may arise anytime during a patient's lifetime. Atypical moles can change over time, and new lesions may develop. Individuals with FAMM may have 1 to several hundred atypical moles, whereas those with nonfamilial (sporadic) atypical moles typically have only 1-10 lesions, although they may also present with several hundred lesions.

An individual with atypical moles who is from a family prone to melanoma has a high lifetime risk of developing a melanoma. Rapid and characteristic changes should prompt consideration for excision/biopsy to rule out melanoma.

Next

Physical

Patients with FAMM syndrome should have a complete cutaneous examination performed at the first office visit and then at least every 12 months for life.

Atypical moles often have a characteristic appearance, although individual lesions may not show all the findings. Typically, they are large pigmented lesions and frequently measure 5-15 mm in diameter. Atypical moles are usually larger than common moles. Borders are usually irregular, notched, and ill defined. Macular and papular areas may be present within a single lesion (also described as a "fried egg" appearance). Color is highly variable and ranges from tan to dark brown to pink.[19]

Atypical moles may appear anywhere on the body, but they most frequently occur on the back, the chest, the buttocks, the breasts, and the scalp. Lesions can be found in sun-exposed and sun-protected areas. Patients with FAMM syndrome may have more than 100 lesions, which is far greater than the average number of common moles (< 50) in most individuals.

Although the diagnosis of an individual atypical mole may be clinically simple, patients often have many nevi, which may make monitoring complex. An excisional biopsy should be considered in the initial evaluation of atypical mole for histologic confirmation of dysplastic nevi versus melanoma. Shallow scoop saucerizations including at least a 2-mm margin of clinically normal skin surrounding the pigmented lesion can be performed if the lesion is removed entirely and care is taken for adequate depth for accurate staging in melanoma.

Previous
Next

Causes

Atypical mole may be inherited (FAMM syndrome) or appear sporadically.[30] Sun exposure may play a part in the distribution patterns of these nevi, but it is not absolutely necessary because atypical moles also appear on sun-protected skin. Patients with FAMM syndrome are at an increased risk for the development of melanoma, although the individual risk is variable.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Kimberly A Wenner, MD  Assistant Chief of Dermatology, Madigan Army Medical Center

Kimberly A Wenner, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Scott M Acker, MD  Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham

Scott M Acker, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Clinical Pathology, and Southern Medical Association

Disclosure: Nothing to disclose.

Vinod B Shidham, MD, FRCPath  Professor, Vice-chair-AP, and Director of Cytopathology, Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center & Detroit Medical Center; Co-Editor-in-Chief and Executive Editor, CytoJournal

Vinod B Shidham, MD, FRCPath is a member of the following medical societies: American Association for Cancer Research, American Society of Cytopathology, College of American Pathologists, International Academy of Cytology, Royal College of Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Steven Brett Sloan, MD  Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Volunteer Clinical Instructor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Connecticut State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin Travers, MD  Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Munro DD. Multiple active junctional naevi with family history of malignant melanoma. Proc R Soc Med. Jun 1974;67(7):594-5. [Medline].

  2. Clark WH Jr, Reimer RR, Greene M, Ainsworth AM, Mastrangelo MJ. Origin of familial malignant melanomas from heritable melanocytic lesions. 'The B-K mole syndrome'. Arch Dermatol. May 1978;114(5):732-8. [Medline].

  3. Clark WH Jr, Elder DE, Guerry D 4th, Epstein MN, Greene MH, Van Horn M. A study of tumor progression: the precursor lesions of superficial spreading and nodular melanoma. Hum Pathol. Dec 1984;15(12):1147-65. [Medline].

  4. Annessi G, Cattaruzza MS, Abeni D, Baliva G, Laurenza M, Macchini V, et al. Correlation between clinical atypia and histologic dysplasia in acquired melanocytic nevi. J Am Acad Dermatol. Jul 2001;45(1):77-85. [Medline].

  5. Clemente C, Cochran AJ, Elder DE, Levene A, MacKie RM, Mihm MC, et al. Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme. Hum Pathol. Apr 1991;22(4):313-9. [Medline].

  6. Klein LJ, Barr RJ. Histologic atypia in clinically benign nevi. A prospective study. J Am Acad Dermatol. Feb 1990;22(2 Pt 1):275-82. [Medline].

  7. Lebe B, Pabuççuoglu U, Ozer E. The significance of Ki-67 proliferative index and cyclin D1 expression of dysplastic nevi in the biologic spectrum of melanocytic lesions. Appl Immunohistochem Mol Morphol. Jun 2007;15(2):160-4. [Medline].

  8. Massi D, Naldini A, Ardinghi C, Carraro F, Franchi A, Paglierani M, et al. Expression of protease-activated receptors 1 and 2 in melanocytic nevi and malignant melanoma. Hum Pathol. Jun 2005;36(6):676-85. [Medline].

  9. Clarke LE. Dysplastic nevi. Clin Lab Med. Jun 2011;31(2):255-65. [Medline].

  10. NIH Consensus Conference. Diagnosis and treatment of early melanoma. JAMA. Sep 9 1992;268(10):1314-9. [Medline].

  11. Cannon-Albright LA, Goldgar DE, Meyer LJ, Lewis CM, Anderson DE, Fountain JW, et al. Assignment of a locus for familial melanoma, MLM, to chromosome 9p13-p22. Science. Nov 13 1992;258(5085):1148-52. [Medline].

  12. Nobori T, Miura K, Wu DJ, Lois A, Takabayashi K, Carson DA. Deletions of the cyclin-dependent kinase-4 inhibitor gene in multiple human cancers. Nature. Apr 21 1994;368(6473):753-6. [Medline].

  13. Bale SJ, Dracopoli NC, Tucker MA, Clark WH Jr, Fraser MC, Stanger BZ, et al. Mapping the gene for hereditary cutaneous malignant melanoma-dysplastic nevus to chromosome 1p. N Engl J Med. May 25 1989;320(21):1367-72. [Medline].

  14. Celebi JT, Ward KM, Wanner M, Polsky D, Kopf AW. Evaluation of germline CDKN2A, ARF, CDK4, PTEN, and BRAF alterations in atypical mole syndrome. Clin Exp Dermatol. Jan 2005;30(1):68-70. [Medline].

  15. Chaudru V, Laud K, Avril MF, Minière A, Chompret A, Bressac-de Paillerets B, et al. Melanocortin-1 receptor (MC1R) gene variants and dysplastic nevi modify penetrance of CDKN2A mutations in French melanoma-prone pedigrees. Cancer Epidemiol Biomarkers Prev. Oct 2005;14(10):2384-90. [Medline].

  16. Uribe P, Wistuba II, Gonzalez S. Allelotyping, microsatellite instability, and BRAF mutation analyses in common and atypical melanocytic nevi and primary cutaneous melanomas. Am J Dermatopathol. Jun 2009;31(4):354-63. [Medline].

  17. [Guideline] IARC Working Group. Special Report: Policy A Review of human carcinogens- Part D: radiation. The Lancet. 2009/08;10:751-752. [Full Text].

  18. [Best Evidence] IARC Working Group. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Cancer. 2006;120:1116-22.

  19. Tsao H, Sober AJ. Atypical melanocytic nevi. In: Freedburg IM, ed. Fitzpatrick's Dermatology in General Medicine. Vol 1. 6th ed. New York, NY: McGraw-Hill; 2003:906-16.

  20. Kraemer KH, Greene MH, Tarone R, Elder DE, Clark WH Jr, Guerry D 4th. Dysplastic naevi and cutaneous melanoma risk. Lancet. Nov 5 1983;2(8358):1076-7. [Medline].

  21. Cooke KR et al. Dysplastic naevi in a population-based survey. Cancer. 1989;63:1240.

  22. Bevona C, Goggins W, Quinn T, Fullerton J, Tsao H. Cutaneous melanomas associated with nevi. Arch Dermatol. Dec 2003;139(12):1620-4; discussion 1624. [Medline].

  23. Geller AC, Swetter SM, Brooks K, Demierre MF, Yaroch AL. Screening, early detection, and trends for melanoma: current status (2000-2006) and future directions. J Am Acad Dermatol. Oct 2007;57(4):555-72; quiz 573-6. [Medline].

  24. Silva JH, Sá BC, Avila AL, Landman G, Duprat Neto JP. Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma - review article. Clinics (Sao Paulo). 2011;66(3):493-9. [Medline]. [Full Text].

  25. Marinkovic M, Janjic Z, Nikolic J. Dysplastic nevus--a risk factor of developing skin melanoma clinical and epidemiological study with retrospective review of literature. Med Pregl. May-Jun 2011;64(5-6):315-8. [Medline].

  26. Kanzler MH, Swetter SM. Malignant melanoma. J Am Acad Dermatol. May 2003;48(5):780-3. [Medline].

  27. de Snoo FA, Kroon MW, Bergman W, ter Huurne JE, Houwing-Duistermaat JJ, van Mourik L, et al. From sporadic atypical nevi to familial melanoma: risk analysis for melanoma in sporadic atypical nevus patients. J Am Acad Dermatol. May 2007;56:748-52. [Medline].

  28. Banky JP, Kelly JW, English DR, Yeatman JM, Dowling JP. Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol. Aug 2005;141(8):998-1006. [Medline].

  29. Salopek TG. The dilemma of the dysplastic nevus. Dermatol Clin. Oct 2002;20(4):617-28, viii. [Medline].

  30. Elder DE, Goldman LI, Goldman SC, Greene MH, Clark WH Jr. Dysplastic nevus syndrome: a phenotypic association of sporadic cutaneous melanoma. Cancer. Oct 15 1980;46(8):1787-94. [Medline].

  31. Roesch A, Burgdorf W, Stolz W, Landthaler M, Vogt T. Dermatoscopy of "dysplastic nevi": a beacon in diagnostic darkness. Eur J Dermatol. Sep-Oct 2006;16(5):479-93. [Medline].

  32. Babacan A, Lebe B. Grade of Atypia in Dysplastic Nevi and Relationship with Dermal Fibroplasia. Turk Patoloji Derg. 2012;28(1):17-23. [Medline].

  33. Farrahi F, Egbert BM, Swetter SM. Histologic similarities between lentigo maligna and dysplastic nevus: importance of clinicopathologic distinction. J Cutan Pathol. Jul 2005;32(6):405-12. [Medline].

  34. Tripp JM, Kopf AW, Marghoob AA, Bart RS. Management of dysplastic nevi: a survey of fellows of the American Academy of Dermatology. J Am Acad Dermatol. May 2002;46(5):674-82. [Medline].

  35. Somani N, Martinka M, Crawford RI, Dutz JP, Rivers JK. Treatment of atypical nevi with imiquimod 5% cream. Arch Dermatol. Mar 2007;143(3):379-85. [Medline].

  36. Francis SO, Mahlberg MJ, Johnson KR, Ming ME, Dellavalle RP. Melanoma chemoprevention. J Am Acad Dermatol. Nov 2006;55(5):849-61. [Medline].

  37. Leachman SA, Carucci J, Kohlmann W, Banks KC, Asgari MM, Bergman W. Selection criteria for genetic assessment of patients with familial melanoma. J Am Acad Dermatol. Oct 2009;61(4):677.e1-14. [Medline].

  38. Singh AD, Damato B, Howard P, Harbour JW. Uveal melanoma: genetic aspects. Ophthalmol Clin North Am. Mar 2005;18(1):85-97, viii. [Medline].

  39. Lynch HT, Fusaro RM, Lynch JF. Hereditary cancer syndrome diagnosis: molecular genetic clues and cancer control. Future Oncol. Apr 2007;3(2):169-81. [Medline].

  40. Ackerman AB, Mihara I. Dysplasia, dysplastic melanocytes, dysplastic nevi, the dysplastic nevus syndrome, and the relation between dysplastic nevi and malignant melanomas. Hum Pathol. Jan 1985;16(1):87-91. [Medline].

  41. Lynch HT, Frichot BC 3rd, Lynch JF. Familial atypical multiple mole-melanoma syndrome. J Med Genet. Oct 1978;15(5):352-6. [Medline].

  42. Tsao H, Niendorf K. Genetic testing in hereditary melanoma. J Am Acad Dermatol. 2004;51(5):803-808. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.