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Patient Story
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A teenage boy presents with concern over a mole on his back that his mother says is growing larger and more variable in color. His mother, who is present with him, reports that his father had a melanoma that was caught early and successfully treated. The edges are irregular and the color almost appears to be “leaking” into the surrounding skin. He reports no symptoms related to this lesion. On physical exam, the nevus is 9 mm in diameter with asymmetry, variations in color and an irregular border (Figure 146-1). A full-body skin exam did not demonstrate any other suspicious lesions. Dermoscopy showed an irregular network with multiple asymmetrically placed dots off the network (Figure 146-2). A scoop saucerization was performed with a DermaBlade taking 2-mm margins of clinically normal skin (Figure 146-3). The pathology showed a completely excised compound dysplastic nevus with no signs of malignancy. No further treatment was needed except yearly skin exams to monitor for melanoma.

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FIGURE 146-1

Growing 9-mm pigmented lesion on the back with asymmetry, variations in color and an irregular border. Pathology after excision revealed this to be a compound dysplastic nevus. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 146-2

Dermoscopy of this compound dysplastic nevus shows an irregular network with multiple asymmetrically placed dots off the network. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 146-3

A scoop saucerization was performed with a DermaBlade taking 2-mm margins of clinically normal skin. Although this could have been an early thin melanoma, the pathology showed a completely excised compound dysplastic nevus with no signs of malignancy. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Dysplastic nevi (DN)/atypical moles are acquired melanocytic lesions of the skin whose clinical and histologic definitions are controversial and still evolving. These lesions have some small potential for malignant transformation and patients with multiple DN have an increased risk for melanoma.1

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The presence of multiple DN is a marker for increased melanoma risk, similar to red hair, and, analogously, cutting off the red hair or cutting out all the DN does not change melanoma risk. The problem with DN is that any one lesion suspicious for melanoma must be biopsied to avoid missing melanoma, not to prevent melanoma from occurring in that nevus in the future.

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Synonyms
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Atypical nevus, atypical mole, Clark nevus, nevus with architectural disorder, and melanocytic atypia.1

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Epidemiology
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  • DN are uncommon in children; in a study of Swedish ...

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