Dermatology/Mole

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Question
QUESTION: Hi
I recently noticed a small black mole on my husbands neck. I am not sure if its new or something that has been forever. He showed his doctor and he said it was nothing. Does this look concerning to you? Should her consult a dermatologist? Can moles be this ark and not be concerning? It also is more flat than raised and and kind of shapes like a freckle more so than a round circle.

http://i1209.photobucket.com/albums/cc393/kkingery83/551AFC0E-7382-4CA2-8402-CDB

ANSWER: A dysplastic nevus, (or naevus; pl. nevi or naevi) is an atypical melanocytic nevus; a mole whose appearance is different from that of common moles. Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevi can be found anywhere, but are most common on the trunk in men, and on the calves in women. In 1992, the NIH recommended that the term “dysplastic nevus” be avoided in favor of more descriptive language.
Cancer
According to the National Cancer Institute, doctors believe that dysplastic nevi are more likely than ordinary moles to develop into a type of skin cancer called melanoma. However, currently, most dermatologists do not believe that dysplastic nevi develop into melanomas. But individuals with multiple dysplastic nevi are at much higher risk for developing melanomas. Because of this, moles should be checked regularly by a doctor or nurse specialist, especially if they look unusual; grow larger; or change in color, or outline; or if any changes occur.
The controversy over the malignant potential of dysplastic nevi is highlighted by the publications and opinions of Dr. Clark and Dr. Ackerman. Essentially, Dr. Clark proposed that the melanocytic nevus evolve into a melanoma in stages - benign to dysplastic, then dysplastic to melanoma. Dr. Ackerman refuted this theory, by proposing that you either have a benign nevus, or a melanoma. There is no transition stage; and the melanoma is a melanoma on day one of its development. Today, most dermatologists believe that an individual with multiple dysplastic nevi do not need to have them all removed. The patient and doctor simply need to be exceedingly careful in identifying a melanoma growing among the dysplastic but benign lesions.
Self skin exam monthly is very important. Some dermatologist recommend that an individual with either histologic diagnosis of dysplastic nevus, or clinically apparent dysplastic nevi should be examined by an experienced dermatologist with dermatoscopy once a year (or more frequently).


A melanoma showing irregular borders and colour, diameter over 10 mm and asymmetry (ie A, B, C and D.)
To detect melanomas (and increase survival rates), it is recommended to learn what they look like (see “ABCDE” mnemonic below), to be aware of moles and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.
A popular method for remembering the signs and symptoms of melanoma is the mnemonic “ABCDE”:
Asymmetrical skin lesion.
Border of the lesion is irregular.
Color: melanomas usually have multiple colors.
Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
Evolution: The evolution (ie change) of a mole or lesion may be a hint that the lesion is becoming malignant.
The E is sometimes omitted, as in the ABCD guideline. A weakness in this system is the D. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and likely all melanomas were melanomas on day 1 of growth, which is merely a dot a millimeter in size. An astute physician will examine all abnormal moles, including ones less than 6 mm in diameter. Unfortunately for the average person, many seborrheic keratosis, some lentigo senilis, and even warts breaks most if not all of the ABCD rules, and can not be distinguished from a melanoma without a trained eye or dermatoscopy.
A recent and novel method of melanoma detection is the “Ugly Duckling Sign” It is simple, easy to teach, and highly effective in detecting melanoma. Simply, correlation of common characteristics of a person’s skin lesion is made. Lesions which greatly deviate from the common characteristics are labeled as an “Ugly Duckling”, and further professional exam is required. The “Little Red Riding Hood” sign, suggests that individual with fair skin and light colored hair might have difficult to diagnose melanomas. Extra care and caution should be rendered when examining such individuals as they might have multiple melanomas and severely dysplastic nevi. A dermatoscope must be used to detect “ugly ducklings”, as many melanomas in these individuals resemble non-melanomas or are considered to be “wolves in sheep clothing”. These fair skinned individuals often have lightly pigmented or amelanotic melanomas which will not present with easy to observe color changes and variation in colors. The borders of these amelanotic melanomas are often indistinct, making visual identification without a dermatoscope (dermatoscopy) very difficult.
People with a personal or family history of skin cancer or of dysplastic nevus syndrome (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.

I would have removed the mole as it is dark.  It is always better to be safe and biopsy than to miss a dysplastic Nevus.

---------- FOLLOW-UP ----------

QUESTION: So do you think it is dysplastic due to its color being black? I have a few black moles that I have shown my dermatologist and she said they were nothing. I have an appointment in February I think I will take him with me and show it to her in person. His doctor looked at it and said it was nothing to worry about. Does it look like a melanoma?

Answer
The mole could be dysplastic.  The only sure way to tell is a biopsy.  If a patient is worried about a mole, I always biopsy the lesion.  It is better to be safe. I had a patient that said the mole had changed but the mole looked normal. I did a biopsy and the path report said 90 % of the mole looked normal but off of one edge was a melanoma.  It never hurts to biopsy.

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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