eMedicine Specialties > Dermatology > Benign Neoplasms

Atypical Mole (Dysplastic Nevus): Follow-up

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

Follow-up

Further Outpatient Care

Patients with atypical moles (AMs) should be routinely monitored and have a complete cutaneous examination at least every 12 months. More frequent examinations may be indicated if compounding risk factors exist.30 Atypical moles may change over time; however, melanocytic lesions that develop 1 or more of the following conditions may require immediate excision and histologic examination:

  • Sudden enlargement in size
  • Development of irregular or notched borders
  • Inflammation
  • Increase in pigmentation
  • Mottling of previously uniform pigment
  • Bleeding and/or ulceration
  • Symptoms of pain or pruritus

Deterrence/Prevention

Currently, no therapy is available to prevent the development of atypical moles. Multiple studies are ongoing to evaluate therapies for eradication of atypical nevi and chemoprevention of progression to melanoma. Some of the treatments under study include imiquimod, retinoids, statin medications, and cyclooxygenase inhibitors.31,32

Because sun exposure and UV light may modify the number, the appearance, and the progression of some cases of atypical mole, patients are encouraged to avoid the sun and to routinely use a broad-spectrum sunscreen with a sun protection factor of 30 or greater, in addition to avoiding UV tanning beds.

Prognosis

An individual with an isolated atypical mole has little risk of developing a melanoma and should not be identified as melanoma prone.

Patients with familial atypical mole and melanoma (FAMM) syndrome are at an increased risk for the development of a melanoma. The cumulative risk of melanoma in patients with FAMM syndrome may approach 100%. Furthermore, these patients are at an increased risk for the development of multiple, primary melanomas. The likelihood of a second melanoma developing over the course of 10 years may be as high as 35% in patients with FAMM syndrome, compared with 17% in controls who had an isolated sporadic melanoma. Melanomas that are detected early and removed quickly, because of proper and routine screening, tend to be thin, allowing for a good prognosis.

Patient Education

Patients should be taught self-examination to detect changes in existing moles and to recognize the clinical features of melanoma. Patients should be advised to avoid the sun whenever possible and about adequate sun protection. Patients should be advised to avoid UV tanning beds.

For excellent patient education resources, visit eMedicine's Procedures Center. In addition, see eMedicine's patient education article Mole Removal.

Miscellaneous

Medicolegal Pitfalls

Concern evolves around a failure to consider the diagnosis of malignant melanoma in a changing pigmented lesion. All melanocytic lesions should be histologically interpreted by an individual with proper training and experience because inaccurate histologic diagnosis may lead to improper management.

Special Concerns

If a patient is diagnosed with FAMM syndrome, recommend that all first-degree relatives be examined. In 2009, selection criteria for genetic assessment of patients with familial melanoma were proposed to test for the CDK2NA mutation33 :

  • Individuals with 3 or more primary invasive melanomas
  • Families with at least one invasive melanoma and 2 or more cases of melanoma and/or pancreatic cancer among first- or second-degree relatives on the same side of the family

Case reports suggest a possible association between uveal melanoma and patients with FAMM syndrome.34 Baseline eye examination may be indicated in the workup of persons with FAMM syndrome.

A subset of FAMM syndrome kindreds will also have hereditary pancreatic cancer (FAMM-PC syndrome), also associated with the CDK2NA mutation, and screening for pancreatic cancer may be advisable in certain patients and families.35

 


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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