Atypical Nevus

An atypical nevus, also called a dysplastic nevus or Clark’s nevus, is a benign melanocytic skin lesion that may share some of the clinical or microscopic features with malignant melanoma, but is NOT a melanoma or any form of cancer. However, the presence of atypical nevi may increase the risk of melanoma.  It can be a marker for someone who is at risk for developing malignant melanoma.  Most melanomas arise de novo, however your risk of developing malignant melanoma increases with the number of atypical nevi you have in your lifetime. Of course the number of atypical moles  is not the only risk factor in contributing to the development of a melanoma. The increased risk of melanoma depends not just on the the amount of atypical nevi that a person has, but also on their specific genetics, family history of melanoma, and other variables such as sun exposure, the number of sun burns, or other carcinogenic exposure.  Individuals who have ten or more dysplastic nevi are at a twelve fold increased risk of developing melanoma compared to the general population, according to The National Skin Cancer Foundation. For these reasons, Dr. Michele Green offers each new patient who visits her discreet NYC office, a complete skin examination to screen out for skin cancer.

What is the Best Way to Diagnose a Dysplastic Nevus?

The proper identification of an atypical mole from a malignant melanoma can sometimes be challenging. An experienced board certified dermatologist, however, should be able to properly diagnose and determine which moles need to be biopsied or removed for further testing. Some dermatologists may  utilize dermoscopy (microscopic magnifier used to examine the surface of the skin) while doing your skin exams, to help identify skin cancer.  For example, under dermoscopy, a dysplastic nevus can have the appearance of a fried egg. In addition, if you have a lot of moles, your dermatologist may also suggest having mole mapping. Mole mapping entails taking photographs of the entire body to monitor changes in your moles over time. This technique can also be useful in the early detection of skin cancer.

What is the Best Way to Manage a Suspicious looking Mole?

Any suspicious lesion will need to be biopsied. It can be difficult at times to differentiate between a normal mole, and other melanoyctic lesions. There are several types of biopsy techniques and the technique used is usually determined by the size of the lesion and the clinical suspicion of the lesion. A biopsy is the only conclusive way to determine whether a mole is an atypical nevus and not a malignant melanoma. An experience dermatologist, like Dr. Michele Green, will either perform an excisional biopsy, punch, or shave biopsy, and send the specimen to the lab for review and processing. The dermatopathologist will histologically review  the specimen under a microscope and provide an accurate diagnosis. According to the The Journal of the American Medical Association of Dermatology (JAMA)  “The agreement between the clinical diagnosis of an atypical mole and the pathologist’s interpretation of dysplasia has been reported as low as 60%.” This is why it is so important to have any suspicious lesion biopsied.

Source: Cancer.gov

There are instances in which the biopsy results reveals mild to moderate atypia.  Depending on the histologic interpretation of the atypia,  your dermatologist may need to remove more skin around the lesion or a deeper excision. In low grade lesions with mild atypia, there is usually no further treatment necessary. However, there are instances where the diagnosis indicates severe atypia. In these instances, it is usually recommended that further treatment be done in the management of the atypical mole removed. Typically most dermatopathologists will recommend a deeper shave or excisional biopsy to clear the margins and remove any underlying atypical cells.  Once the margins are clear, there is very little concern that the atypical nevus will require any further dermatologic treatment.

What is the Risk with an Atypical Nevus for Malignant Melanoma

A malignant Melanoma is a form of skin cancer which accounts for approximately 1% of all skin cancer seen in dermatology. Melanoma is a skin cancer which forms within the pigmented cells of the skin, also known as melanocytes. Any patient can develop  a malignant melanoma. High risk individuals are patients who have a family history of melanoma, first degree relatives with melanoma, or have had high risk sun exposure, excessive  tanning or sunburns, or chemical exposure. Early detection is essential in treating patients and in long term survival. Although fair skinned patients have a higher overall risk for melanoma, people of all skin types can develop melanoma.  Melanoma risk should be assessed during your annual skin exam to the dermatologist.  Most patients, Dr. Green has found, have no idea that they have skin cancer and encourages everyone who visits her office to have a complete skin cancer examination.

If you are diagnosed with an atypical nevus, the statistical risk of developing malignant melanoma rises, and Dr. Green recommends having biannual skin exams in these cases.

Although Melanoma accounts for only one percent of skin cancers, it is the most deadly form of skin cancer, as confirmed by the statistics from the National Cancer Foundation and the American Skin Cancer Society.

In fact according to the The American Academy of Dermatology approximately 9,500 new cases of skin cancers are diagnosed daily. Of that number diagnosed, nearly twenty Americans die from a melanoma daily.

What Does an Atypical Nevus or Atypical Mole Look Like?  

Atypical moles are irregular in shape with borders that fade into the skin. Atypical moles can be found  anywhere on the skin. Due to the nature of their development they can have variation in the color of the lesions and their size.  A single lesion can be colorful with color variations from flesh colored, pink, reddish pink, dark brown, and multiple variations of pink and brown.  They are often flat or raised with pebbly like areas. Atypical nevus have what we refer to in health care as the ABCDE resemblance to a malignant melanoma. What this means is that atypical nevi share similarities to melanoma however, they are differentiated by their clinical histology.

The ABCDE mnemonic, which is the standard used in dermatology, stands for asymmetry, border irregularity, color unevenness, diameter of 6 mm or more, and evolving and is utilized during exams by your dermatologist, like Dr. Michele Green, to identify a suspicious lesion.

• Asymmetry – it is irregular in shape, size, diameter and color.
• Border Irregularity – imperfect edges that are scalloped.
• Color – variation in pigmentation that is not uniform. Some moles may have variations of the same pigment or color or multiple shades of pigmentation. They range in color from flesh colored, tan, brown and even bluish in color.
• Diameter – Melanomas are usually greater than 6mm in thickness at the time of diagnosis  however there have been instances where they are smaller.
• Evolving – Has there been a change in the appearance of the mole over the past weeks or months.

In addition to this concept the “ugly duckling”  method is sometimes used. The  “ugly duckling” methodology isolates the mole that is different from all the other moles or the “outlier”. If it is different then it is the most suspicious and should be biopsied.

According to the Journal of the American Academy Of Dermatology,  atypical moles may be larger than other common moles. They are typically irregular with indistinct borders and most commonly present  in fair skinned individuals who have had a lot of sun exposure.

Atypical moles can be found  anywhere on the skin. Due to the nature of their development they can have variation in the color of the lesions and their size.  A single lesion can be colorful with color variations from flesh colored, pink, reddish pink, dark brown, and multiple variations of pink and brown.

Where on the Body are Dysplastic Nevi Located?

Dysplastic nevi are located anywhere on the body.  Generally, they can be found in areas ofincreased sun exposure, such as the extremities. However, since most atypical or dysplastic nevi are genetic, they can be located anywhere on the body, including non sun-exposed areas of your skin.  You can even have dysplastic nevi located on the scalp, that is why it is important to even have your scalp examined.  Most individuals with dysplastic nevi also tend to have an increase in the number of common nevi as well. As a result, it is important that you have annual visits with your dermatologist, which include a thorough head to toe examination.

What is Familial Atypical Multiple Mole Melanoma Syndrome or FAMMM?

According to The American Academy of Dermatology (J am acad dermatol), Familial Atypical Multiple Mole Melanoma, (FAMMM), is a genetic condition characterized by the presence of multiple melanocyctic nevi, usually more than 50, and a family history of malignant melanoma.   This syndrome is associated with mutations in the CDKN2A gene and some patients have an increased risk of pancreatic cancer as well as other malignancies. Typically one of more first or second degree relatives (parent, sibling, child, etc) has malignant melanoma and many moles, some of which are atypical. Patient’s suffering with this melanoma syndrome have an increased lifetime risk of developing a melanoma and must be monitored closely.

Atypical mole syndrome

Atypical moles are nevi (flesh colored or pigmented lesion on the skin). These naevi are formed from the pigmented cells within the skin also known as melanocytes.  In the general Caucasian population, approximately 2 to 8% have atypical moles.

Atypical mole syndrome or dysplastic nevus syndrome is characterized by an individual who has more than 100 moles, one or more moles which is 8 mm or larger in diameter, and one or more atypical moles. People who have 10 or more atypical moles have a twelve times greater risk for developing malignant melanoma. Halpern was one of the first dermatologists to document the increased risk of melanoma with dysplastic nevi.

Atypical moles are often found in individuals with a family history of atypia or degree relatives. In some studies atypical moles and an increase in melanoma was seen in individuals who are experiencing  hormonal changes such as pregnancy or teens going through puberty.

This is why is It is so vital that if you have  atypical moles, or a family history of atypical moles, to  be especially vigilant in surveillance and proper follow up. Consistent routine dermatology  visits is the key to early detection, melanoma detection, and prevention.

Cutaneous Melanoma

Cutaneous melanoma is another form of malignant melanoma and accounts for more than 10,000 deaths per year. according to the American Academy of Dermatology. With early detection, this form of skin cancer has a 98 percent survival rate.

What’s the difference between moles and freckles?

There are unique differences between moles and freckles which can be distinguished by there appearances. Freckles are superficial and are due to pigment changes in the superficial layer of the skin. Freckles are formed when the melanocytes, the cell responsible for producing melanin, (melanin determines the the pigment or color of our skin), absorbs too much ultraviolet light. When the melanocytes get too much sun exposure; it causes an increase in melanin production. This increased production of melanin results in freckle formation.

Moles, or melanocytic nevi, which is the term often used in health care, are typically darker in appearance than freckles. Moles are not superficial like freckles and look more like skin growths.  Melanocytic nevi are typically more deeply pigmented, generally larger than freckles, and symmetric. Nevi generally  cannot be treated with the same types of lasers or chemical peels that you can treat with freckles.

Self Examination, Prevention and Early Detection 

In addition to frequent routine dermatology follow up visits, you can also do self examination at home. By doing self skin examinations you can also identify early changes and bring it to the attention of your dermatologist.

When doing self examination you should examine your entire body including your toes. By doing so you will be able to identify changes in existing moles, and new growths or lesions.

It is also important to note that in addition to new moles, any existing lesion that does not heal quickly or routinely warrants attention that includes a lesion that appears irritated or itches.

As with the development of most moles they arise from sun exposure. If you have a familial history of skin cancer or you have had a diagnosis of dysplastic or atypical nevus you should limit your sun exposure.

Since sun exposure is a contributing factor to atypical nevus you should limit your time outdoors especially  during the peak hours of 10am and 4pm when the rays of the sun are the strongest.

In addition to sun limitation be mindful that during the winter months or at times when it may seem like there isn’t much sun that the presence and effects of the sun still poses a threat.

If you have a history of atypical nevus you should wear protective clothing. Invest in clothing with built in SPF. In addition, wear wide brimmed hats, long sleeve shirts and long pants. This will minimize your sun exposure.

You should also wear sunglasses to protect your eyes from sun damage. Your sunglasses should provide both UVA and UVB sun protection.

While  outdoors, you should always wear broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher. Your sun protection should be applied at least 30 minutes before going outdoors to ensure proper absorption and efficacy and it should provide both UVA and UVB rays protection. You should reapply sunscreen every two hours while outdoors and reapply after activities which involves water sports and swimming.

According to the American Academy of Dermatology yearly skin cancer examinations are extremely important to early melanoma detection.Dr. Michele Green starts each consultation with a full-body skin exam. In addition, she counsels every patient on sun avoidance and the proper sun protection. If there is a new or changing mole that you are concerned with and you see changes in the size, color, border, or shape of the mole, please inform Dr. Green to evaluate these changes.

If you’re concerned about the appearance of a new mole or dark spot on your skin, please don’t hesitate to contact us online today or call 212-535-3088. Dr. Michele S. Green, a board certified NYC dermatologist, practices the latest techniques and is at the forefront of skin cancer detection and treatment.