Atypical Mole (Clark Nevus or Dysplastic Nevus) Treatment & Management

Updated: Apr 04, 2017
  • Author: Manuel Valdebran, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

All patients diagnosed with one or more atypical mole should undergo a complete cutaneous examination. Patients should be taught self-examination to detect changes in existing moles and to recognize clinical features of melanomas. Several studies have shown that regular cutaneous examinations combined with baseline and serial color photographs of the patient's cutaneous surface ultimately decrease biopsies and lead to earlier diagnoses of melanoma. [34]

Patients with atypical moles should avoid all UV-emitting tanning devices and excessive sun exposure and should routinely use a broad-spectrum sunscreen with a sun protective factor of 30 or greater.

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Surgical Care

Because melanomas may develop de novo on the skin and because the risk of any one atypical mole developing malignant transformation is low, the prophylactic removal of all atypical moles does not prevent the development of melanoma and is not recommended. Changing lesions and any lesion worrisome for melanoma must be removed.

A narrow-margin excisional biopsy or saucerization may be appropriate and can produce adequate tissue for histologic examination. If a suspicious mole is too large for simple excision and is in either a cosmetically sensitive location or a functionally sensitive location, a limited biopsy may be considered. However, because of sampling error, the diagnosis may be inaccurate. [51] To decrease the risk of an inaccurate diagnosis, obtaining more than one biopsy specimen should be considered. A wider saucerization or excision may be indicated if there is significant atypia and a margin involved, but data suggest that reexcision of low-grade lesions is not necessary. [52, 53, 54, 55, 56]

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Consultations

Atypical moles are clinically challenging, and clinical experience with pigmented lesions is often necessary for proper diagnosis. Persons with unusual nevi, familial atypical multiple-mole melanoma (FAMMM) syndrome, or many nevi, usually benefit from consultation with a dermatologist.

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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. [57, 58]

Because sun exposure and UV light may modify the number, appearance, and 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.

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Long-Term Monitoring

Patients with atypical moles 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. [59] Patients are also encouraged to perform monthly self-skin examinations, with a family member or significant other examining areas of the body that are difficult to self-visualize. Atypical moles may change over time; however, melanocytic lesions that develop one 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

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