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 gradually over a lifetime

While most melanocytic nevi are benign, some may evolve over time and require medical evaluation.

NORMAL VS. ATYPICAL (DYSPLASTIC) NEVI

NORMAL (COMMON) MELANOCYTIC NEVI

Common nevi typically:

Appear after birth
Enlarge proportionally with body growth
Are usually smaller than 5 mm
Are evenly pigmented or symmetrically speckled tan or brown
Have smooth, well-defined borders
Occur in numbers ranging from 10 to 40, scattered over the body
Increase in size and number during childhood and puberty
May become more noticeable during pregnancy
Are more commonly found on sun-exposed areas above the waist

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.

These lesions are considered biologically intermediate between common acquired nevi and melanoma.

Atypical nevi may:

Be larger than 6 mm
Have irregular or indistinct borders
Show uneven or dark pigmentation
Contain multiple shades of brown, black, or pink
Be raised centrally with flatter edges
Appear very different from one another
Occur in large numbers (sometimes exceeding 100)
Be found on sun-exposed and non–sun-exposed areas, including the back, scalp, buttocks, and below the waist

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

A severely dysplastic nevus may be clinically and microscopically indistinguishable from early melanoma, making appropriate evaluation critical.

FOCUSED SKIN EXAMINATION

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

Digital dermatoscopy is an essential part of evaluating melanocytic nevi. Surface digital dermatoscopy provides detailed visualization of:

Pigment distribution
Lesion structure
Border irregularity
Surface patterns

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

Dermatoscopy helps assess the potential for malignancy, but it cannot provide a definitive diagnosis. When a lesion appears suspicious, biopsy may be recommended to establish an accurate diagnosis.

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

DIAGNOSIS

Definitive diagnosis of a suspicious melanocytic lesion is made through biopsy and histopathologic examination.

In selected cases, complete surgical excision with clear margins may be recommended rather than shave or punch biopsy, depending on lesion characteristics and clinical concern.

SURGICAL REMOVAL OF ATYPICAL MOLES

Treatment of dysplastic nevi depends on the degree of atypia identified on pathology.

MILDLY DYSPLASTIC NEVI

Usually do not require additional treatment
Clinical observation and photographic monitoring of the biopsy site may be recommended

MODERATELY DYSPLASTIC NEVI

Management is individualized
Decisions are based on patient age, personal and family history, lesion location, biopsy margins, and patient preference

SEVERELY DYSPLASTIC NEVI

Complete surgical excision with clear margins is recommended, due to the difficulty in distinguishing these lesions from early melanoma

IMPORTANT CONSIDERATIONS

Not all moles require removal
Change in size, color, shape, or symptoms warrants evaluation
Regular skin examinations are important for patients with multiple or atypical nevi
Early evaluation improves diagnostic accuracy and outcomes

EXPERT CARE

Our office provides comprehensive evaluation and management of melanocytic nevi, including digital dermatoscopic monitoring, biopsy, and surgical excision when indicated. Care is individualized based on clinical findings and patient-specific risk factors.

📞 Call (847) 518-9999 to schedule a consultation or total body skin exam.

Medical Disclosure
This information is provided for educational purposes only and does not replace a personalized medical evaluation. Treatment recommendations vary based on individual findings. Outcomes may vary, and no specific medical or cosmetic result can be guaranteed.