MELANOCYTIC NEVI (MOLES)

OVERVIEW

Melanocytic nevi, commonly known as moles, are pigmented skin lesions that develop from melanocytes, the pigment-producing cells of the skin. Nevi may be flat or raised and can appear anywhere on the body.

Melanocytic nevi may be:

Congenital, present at or shortly after birth, or
Acquired, developing during childhood, adolescence, or adulthood

While most melanocytic nevi are benign, changes in a mole or the development of an unusual pigmented lesion warrant medical evaluation.

NORMAL VS. ATYPICAL (DYSPLASTIC) NEVI

NORMAL (COMMON) MELANOCYTIC NEVI

Common nevi typically:

Develop during childhood, adolescence, or early adulthood
Are usually small, symmetric, and well circumscribed
Have a round or oval shape with smooth, regular borders
Show relatively uniform pigmentation
May be flat, raised, or become more elevated over time
Can occur on both sun-exposed and protected skin

The number, size, color, and appearance of normal nevi vary considerably between individuals.

ABCDE MOLE WARNING — EARLY DETECTION MATTERS

The ABCDE features are early warning signs, not requirements for diagnosis.
A lesion does not need to meet all criteria to be concerning.

Seek medical evaluation if a mole shows any single change or unusual feature, including:

A — Asymmetry
One side looks different from the other.
B — Border
Edges appear irregular, blurred, or not well defined.
C — Color
Uneven color or new shades of brown, black, red, pink, white, or blue.
D — Diameter
Larger than 6 mm, or any lesion that is growing, regardless of size.
E — Evolving
Any new change, including growth, darkening, shape change, bleeding, crusting, or itching.

Most melanomas are detected because they look different from a person's other moles or because they change — not because they meet every ABCDE feature.

ATYPICAL (DYSPLASTIC) MELANOCYTIC NEVI

Atypical, or dysplastic nevi, are melanocytic lesions that demonstrate architectural disorder and/or cytologic atypia on histopathologic examination.

Dysplastic nevi share certain clinical and histopathologic features with melanoma but remain distinct melanocytic lesions. The presence of multiple dysplastic nevi is also an important marker of increased melanoma risk.

Atypical nevi may:

Be larger than common acquired nevi
Have irregular or indistinct borders
Show uneven or dark pigmentation
Contain multiple shades of brown, black, pink, or red
Have both flat and raised components
Look noticeably different from a person's other moles
Occur in large numbers
Be found on both sun-exposed and non–sun-exposed skin

Patients with multiple dysplastic nevi have an increased risk of melanoma, particularly when other melanoma risk factors are present.

Severely dysplastic nevi can show substantial histopathologic overlap with early melanoma, making accurate diagnosis and appropriate management particularly important.

FOCUSED SKIN EXAMINATION

A focused skin examination allows evaluation of specific lesions or areas of concern, based on the patient's concerns and clinical findings.

Digital dermatoscopy provides an important additional level of evaluation for melanocytic nevi. Surface digital dermatoscopy provides detailed visualization of:

Pigment distribution
Lesion structure
Border characteristics
Dermoscopic patterns and structures

Images are displayed on a computer screen and can serve as both a diagnostic and educational tool, helping patients better understand their skin findings.

Dermatoscopy helps identify patterns and structures that may increase or decrease clinical suspicion, but it cannot establish a definitive histopathologic diagnosis. A suspicious lesion requires biopsy and microscopic examination of the tissue for definitive diagnosis.

The extent of the skin examination is discussed with the patient, and only areas consented to by the patient are examined.

DIAGNOSIS

A suspicious mole cannot always be diagnosed by appearance alone. Biopsy is the procedure used to remove all or part of the lesion and obtain a tissue specimen for diagnosis. The specimen is then sent to a pathology laboratory, where it is processed and examined microscopically by a pathologist or dermatopathologist.

For lesions clinically suspicious for melanoma, complete excisional biopsy with a narrow margin is generally preferred when feasible, because examination of the entire lesion allows more complete assessment of its microscopic characteristics and depth.

The biopsy technique is selected according to the size, location, morphology, and degree of clinical concern.

The pathology report provides the definitive tissue diagnosis and determines whether the specimen represents a common benign nevus, a dysplastic (atypical) nevus, melanoma, or another type of skin lesion. When a dysplastic nevus is identified, the pathology report describes the degree of atypia and biopsy margin involvement, which helps guide the next step in management.

MANAGEMENT OF ATYPICAL (DYSPLASTIC) MOLES

A pathology diagnosis of a dysplastic (atypical) nevus does not mean that melanoma or skin cancer was found. Dysplastic nevi are classified according to the degree of atypia identified during microscopic examination, and not every dysplastic nevus requires additional surgical removal.

Management is based on the degree of atypia, biopsy margin status, residual clinical lesion, and the patient's overall pattern of melanocytic nevi and melanoma risk.

MILDLY DYSPLASTIC NEVI

Mild dysplasia does not imply progression to melanoma. When a mildly dysplastic nevus has been adequately sampled, additional surgical excision is usually not required.

Management typically consists of clinical observation and continued skin surveillance.

MODERATELY DYSPLASTIC NEVI

Moderately dysplastic nevi demonstrate more pronounced atypia but do not meet diagnostic criteria for melanoma. There is no universal requirement for automatic surgical excision.

Management considers the biopsy margins, residual lesion, clinical appearance, number of atypical nevi, personal or family history of melanoma, overall melanoma risk, and patient preference.

For some patients, complete excision provides greater diagnostic certainty. For others, continued clinical surveillance is appropriate.

SEVERELY DYSPLASTIC NEVI

Severely dysplastic nevi are not melanoma, but the degree of architectural disorder and cytologic atypia can show significant histopathologic overlap with early melanoma.

For this reason, complete surgical excision with clear margins is recommended.

IMPORTANT CONSIDERATIONS

Not all moles require removal
New or changing lesions deserve particular attention
Patients with numerous or atypical nevi benefit from regular skin surveillance
Suspicious melanocytic lesions require histopathologic diagnosis rather than cosmetic destruction

Evaluate Changing or Concerning Moles

New, changing, unusual, or symptomatic moles should be medically evaluated to establish the diagnosis and determine appropriate management.

📞 Call (847) 518-9999 to schedule a skin evaluation.

Medical Disclaimer
This information is provided for educational purposes only and does not replace individualized medical evaluation. Treatment recommendations depend on clinical findings, diagnostic requirements, and patient-specific factors. Outcomes may vary, and no specific medical result can be guaranteed.

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