An atypical mole is generally considered by many Dermatologists to be a marker of someone who is at an increased risk of future development of a type of skin cancer called melanoma. These moles were originally described by a Dermatologist and Pathologist at the University of Pennsylvania in the 1970s, Dr. Wallace Clark, as “dysplastic nevi,” or “Clark’s nevi,” in certain families where people had generally darker and more numerous moles and also several family members had developed a type of skin cancer called melanoma. Since the 1970s, large studies have shown that as many as 2-4% of the American population carries at least one mole that meets the original description of an atypical mole, and these lesions occur in people of any age.
What is meant by the word “mole,” or “nevus?”
A mole or nevus is a collection of pigment-producing cells in the skin, called melanocytes. Melanocytes occur in the skin, but they can also occur in the back of the eye and in the nervous tract of the body, too. Nevi occur in junctional, compound, and intradermal types, depending upon which level of the skin that the melanocytes reside in. The average person has between 5 and 35 moles, which generally develop between the ages of 5 and 35, though they can also be present at birth (in which case they’re called “congenital” nevi).
Are nevi or moles dangerous?
Nevi in and of themselves are not considered high risk, but it’s an ironic fact that after exposure to Ultraviolet Light (UV rays) from the sun or from tanning salons, the very cells that have been protecting us from damage to our DNA can change into premalignant or malignant cells. A malignant melanocyte is the start of a melanoma, and melanoma will be diagnosed in over 190,000 Americans this year, causing approximately 7250 fatalities, or about one American death every 50 minutes. If detected early, melanoma is often very treatable by a minor outpatient procedure, but if detected late, it can compromise one’s health and well-being.
So what does an atypical mole (atypical nevus or dysplastic nevus) look like?
They tend to be darker than the person’s other moles, sometimes with a raised center and a flatter edge. But their appearance can vary. There are also certain criteria used by skin pathologists to define what amount to an atypical mole under the microscrope, after the mole has been removed.
Can a person be born with an atypical mole, or do they develop in childhood?
Most atypical moles develop in childhood, but some can actually be present at birth.
Do atypical moles need to be completely removed?
There is still some debate between experts in the field on this topic. Many Dermatologists – including myself – feel that it’s a good idea to attempt to remove atypical moles completely – because some of these moles later develop into melanoma.
If a person has had at least one atypical mole (dysplastic nevus) removed, is regular monitoring by a Dermatologist helpful?
We now know that people with a history of an atypical mole can develop melanoma both within such moles, and in their normal skin. So getting a check-up at least once or twice a year is a wise move.
If a person has many dark or atypical moles, the Dermatologist may consider taking medical photos of the ones that are under close observation, to help in watching for changes. Some such patients with atypical mole have dozens of or even scores of dark moles, so close observation of the remaining moles is the best course of action.
Below is a pigmented lesion called a 'cafe au lait' mark, generally considered quite benign by most Dermatologists. Note its uniformly brown color, and symmetrical nature. it would generally be considered low risk.
Below is a type of melanoma - called lentigo maligna melanoma. Note its color variability - with different shades of brown.
Below is a dark lesion that could be considered for removal - to get it checked for atypical changes. But depending upon the patient's history - whether this lesion has been present for many years or not - it may also be reasonable to keep this lesion under close observation.
How can I get more information, or a chance to look at pictures of atypical moles or even of melanoma?
A best first move is a consultation with a Board-certified Dermatologist for a skin check-up, an especially high priority for people with skin lesions that could be cancerous. Check out “Understanding the Melanoma Crisis: Scarlet’s Story,’ a 2018 movie sponsored by my Dermatology practice on the SkinStayWell Channel of Youtube. Scarlet Akins was pregnant and studying to become a teacher when at the age of 26, she was found to have melanoma within a mole on her knee.
You or a family member can find Board-certified Dermatologists close to you at the American Academy of Dermatology’s “Find a Dermatologist” site. Just plug in your zip code, and you’ll get a list of Dermatologists close to you. My own Dermatology practice is in Cordova, Tennessee, a suburb of Memphis, TN, but there are over 13,500 Dermatologists in the United States.
Furthermore, the American Society for Dermatologic Surgery supports a search site (ASDS.org) that allows people to find Dermatologists willing to participate in free skin cancer screening, by zip code, through their Choose Skin Health program. The Skin Cancer Foundation also supports a screening program at different cities annually, around the country. All three organizations have photos of melanoma on their web sites. The American Society for Mohs Surgery also has information on this topic on their web site.
Remember: the bottom line, as stated by Benamin Franklin, is “an ounce of prevention is worth a pound of cure.” Because early detection definitely saves lives ....
George Woodbury Jr. M.D.
Board-certified Dermatologist at Rheumatology and Dermatology Associates PC