eMedicine Specialties > Dermatology > Benign Neoplasms

Atypical Mole (Dysplastic Nevus): Differential Diagnoses & Workup

Author: Kimberly A Wenner, MD, Assistant Chief of Dermatology, Madigan Army Medical Center
Coauthor(s): Steven Brett Sloan, MD, Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Director of Nail Disease Clinic and Chief of Dermatology, Newington Veterans Affairs Medical Center; Vinod B Shidham, MD, FRCPath, FIAC,, Professor, Director of Cytopathology Fellowship Training Program, FNAB Service, and International Cytopathology Fellowship, Department of Pathology, Medical College of Wisconsin; Co-Editor-in-Chief and Executive Editor, CytoJournal; Scott M Acker, MD, Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: Oct 21, 2009

Differential Diagnoses

Blue Nevi
Seborrheic Keratosis
Dermatofibroma
Spitz Nevus
Lentigo
Malignant Melanoma
Nevi, Melanocytic

Other Problems to Be Considered

Combined nevus

Workup

Imaging Studies

In general, imaging studies are not necessary for atypical moles (AMs).

Dermoscopy (epiluminescence microscopy) can be used to evaluate atypically pigmented lesions. However, clinical use of this method relies on experienced individuals. In trained individuals, dermoscopy can improve accuracy in identifying melanoma verses atypical nevi.28 See Dermoscopy for more information.

Total body photography has been shown to aid in detection of evolving melanomas and encourage patients to do self-skin examinations. This is expensive, requires special equipment and training, and may best be used in a pigmented lesion clinic.26

Procedures

All patients who have or had an atypical mole should have an examination of the entire cutaneous surface. A recent change in a pigmented lesion should alert the clinician to consider an excision or a biopsy to rule out the development of malignant melanoma.

Histologic Findings

Typical histopathologic features, which are superimposed on those of a typical junctional or compound nevus, include the following (Note: Some clinical atypical moles are normal histologically):

  • An increased number of single melanocytes along the basal layer, with elongation of rete ridges
  • Cytologic atypia of melanocytes with enlarged, hyperchromatic nuclei in the junctional component: Atypia is usually confined to the shoulder region of the nevus. Diffuse atypia is more worrisome.
  • A horizontal arrangement of melanocytes, which generally vary in shape from round to spindled, although an occasional epithelioid configuration may also be identified
  • A tendency for melanocytes to aggregate into variably sized nests, which fuse with adjacent rete ridges to produce bridging
  • The presence of lamellar and concentric dermal fibroplasia
  • The presence of a lymphocytic infiltrate (patchy or diffuse) in the superficial dermis
  • Extension of the junctional component many rete ridges beyond the last dermal nest to produce "shoulders"

The above changes may appear focally in any given lesion, and they may not be evident unless multiple histopathologic sections are studied.

The World Health Organization Melanoma Program has proposed a similar list of characteristics/criteria for dysplastic nevi. Criteria are divided into 2 major and 4 minor criteria. An individual lesion requires 2 major and 2 minor criteria to be classified as a dysplastic nevus.5 Currently, most dermatopathologists are not using this classification scheme. However, the establishment of widely accepted criteria may eventually result in the uniform selection of patients for trials and population studies.

More on Atypical Mole (Dysplastic Nevus)

Overview: Atypical Mole (Dysplastic Nevus)
Differential Diagnoses & Workup: Atypical Mole (Dysplastic Nevus)
Treatment & Medication: Atypical Mole (Dysplastic Nevus)
Follow-up: Atypical Mole (Dysplastic Nevus)
References
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References

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Further Reading

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Keywords

AM, active junctional nevi, atypical melanocytic nevi, B-K mole, Clark's nevi, dysplastic nevi, dysplastic mole

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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)

Steven Brett Sloan, MD, Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Director of Nail Disease Clinic and Chief of Dermatology, Newington Veterans Affairs Medical Center
Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society, New England Dermatological Society, and Texas Dermatological Society
Disclosure: Nothing to disclose.

Vinod B Shidham, MD, FRCPath, FIAC,, Professor, Director of Cytopathology Fellowship Training Program, FNAB Service, and International Cytopathology Fellowship, Department of Pathology, Medical College of Wisconsin; Co-Editor-in-Chief and Executive Editor, CytoJournal
Vinod B Shidham, MD, FRCPath, FIAC, 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.

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.

Medical Editor

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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

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: Nothing to disclose.

CME Editor

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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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