How to treat, what to call atypical moles

Are they a signal of a patient being at higher risk for melanoma? Do they actually increase the risk of melanoma because they, themselves, are pre-malignant lesions?

Clark's nevi, atypical nevi, dysplastic nevi, nevi with architectural disorder - dermatologists don't all call the relatively common skin lesions by the same name, and some don't call them the same thing all the time.

Jeffrey Knispel, M.D., Danbury, Conn., says, "I call it an atypical mole. Most people don't call it dysplastic nevi anymore. I think the term is so hard to define that from my experience the term is not used too much anymore. They grade them now, I think, as mildly atypical, moderately atypical and severely atypical nevi." On the other hand, farther down the coast, in Myrtle Beach, S.C., Robert S. Purvis, M.D., responds, "We usually use dysplastic nevi."

Why? He laughs. "The terminology for these nevi has come full circle. They were called dysplastic nevi and then it was thought it wasn't a well-defined term, so the nevi were named after the person who first described them, but at this point, most dermatologists have in their mind what a dysplastic nevus is. The term is so well-known now that it is fairly well-accepted."

A number of dermatologists have decided that in their practices the term is relative to its usage.

Juanita Pawaney, M.D., Lake Success, N.Y., says, "I actually will interchangeably say 'atypical nevi' when I'm looking clinically and 'dysplastic nevi' after I get the pathology report back confirming that it is actually dysplastic."

Erin Scott Gardner, M.D., in St. Louis, Mo., answers, "(I use) both - people are familiar with both terms and it's still not a completely settled issue. You have proponents on both sides of the debate. Speaking with patients, I would call it atypical nevus. I would typically use 'dysplastic nevus' discussing a histologic finding around the microscope."

The question also brought a laugh from Benjamin Raab, M.D., in Aurora, Ill.

"I call them whatever the pathologist calls them - pretty much dysplastic nevi. To me, that is more of a dermatopathology diagnosis, so as a clinician I look at the lesion and determine whether they follow the ABCD designation. Atypical nevi and dysplastic nevi are the same."

Treatments

Treatments for these moles also vary. Doctors rely on visual assessment, photography, dermoscopy, shave biopsies and excision to determine whether the moles are atypical or melanocytic. Sometimes their approach depends on whether they consider the moles premalignant or simply an indicator that the patient is at increased risk of developing melanoma.

Dr. Gardner says, "Certainly, regular examination is the cornerstone of monitoring a patient who has many lesions like that. If one has a particularly large number of unusual lesions, then photography can play a role.

"Generally, I think monthly personal examination should go along with physician examination, and patients are instructed how to do that.

"If a patient has five or 10 suspicious lesions, I would say those have got to go. If a patient had so many nevi that they couldn't all be removed, I would inform them that the gold standard for determining whether a lesion is malignant or not is a histologic examination, but then you have to discuss with them the morbidity of removing large numbers of lesions over the course of time and the usual risks of infection or scarring."