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Evaluating Atypical Nevi

Atypical Nevi is the medical term for moles. Atypical nevi, also called "dysplastic nevi" or Clark's nevi, are acquired moles that have unusual features both in terms of how they look clinically and how they look when biopsied (removed and examined under a microscope).

To the untrained eye, these moles can mimic a malignant melanoma. They may have any combination of the following qualities that are indicators of a malignant melanoma: they may appear asymmetrical, have irregular borders, be unevenly and/or very darkly colored, be larger than a pencil eraser, be unevenly elevated above the skin surface, or some combination of these. An Advanced Dermatology physician should be consulted to determine the exact nature of the mole.

Microscopically, atypical nevi have a characteristic appearance in terms of their architecture (how the cells are arranged relative to each other in the skin) and their cytology (how each individual cell looks) that is different from those of "typical" moles. The degree to which atypical moles are unusual microscopically can be graded as mild, moderate, or severe.

One mildly atypical nevus is generally not cause for great concern in and of itself, although people who have a lot of these moles tend to be at a higher risk for developing a melanoma over their lifetime compared to people who do not. Having a lot of unusual looking moles is an external marker of genetically increased risk of melanoma, especially if there is a family history of melanoma; this is true regardless of the patient's history of tanning or sunburns. (UV exposure is a separate risk factor.)

Being "moley" and having a lot of unusual looking moles – particularly when there is a family history – is referred to as "dysplastic nevus syndrome" or "familial atypical mole syndrome". Mildly atypical nevi are not necessarily any more likely to become cancerous than any "typical" mole the patient might have.

However, nevi with moderate or severe atypia may be more likely to become cancerous over time, so it is advised that they be removed completely. The difficulty lies in determining which moles need to be removed and how much surgery is needed to remove them. This is a discussion you should have with your Advanced Dermatology physician or other experienced skin cancer specialist.

Managing Atypical Nevi
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Managing Atypical Nevi

It is very important for patients with unusual looking moles to have an annual Total-Body Skin Cancer Examsm in order to determine which moles, if any, are abnormal enough to remove. Regular annual skin checks are needed to identify any changes that may occur that require immediate attention and treatment. During a skin check, an Advanced Dermatology provider will determine which moles should be biopsied and which ones can be monitored. More frequent follow-up exams may be needed if skin cancer is found.

In addition to scheduling your annual skin check, you will want to regularly monitor your moles at home to determine if any changes occur and consult your dermatologist as needed.

Preventing Atypical Nevi from Becoming Skin Cancer
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Preventing Atypical Nevi from Becoming Skin Cancer

While nothing can ensure a mole will not become cancerous down the road, sun protection measures are important. Having atypical nevi is a genetically determined trait, but excessive exposure to UV light over time increases your risk not only of malignant melanoma but of other types of skin cancer as well. A combination of regularly scheduled in-office exams, frequent self-monitoring at home, targeted biopsy of selected nevi, and sun protection measures is a very effective strategy in managing your atypical nevi.

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