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How to manage dysplastic nevi?

Malvehy, J.

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doi: 10.1097/01.cmr.0000382749.09636.fa
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In the era of molecular biology and new discoveries in stem cells and nevogenesis the controversy about the significance of dysplastic nevus syndrome is still unsolved. If discussion about the importance of these lesions as true precursors of melanoma still remains, it seems clear that they are risk markers of this malignancy in patients with a particular phenotype.

In the clinical setting the management and the early detection of malignant melanoma in the patient with multiple atypical melanocytic lesions may be a diagnostic challenge. The prophylactic excision of moles in these patients is not justified attending to the number need to treat to remove one single melanoma. Moreover the detection of early melanoma that clinically may be similar to atypical moles needs the use of diverse strategies. The introduction of new concepts based in pattern recognition and comparative analyses could be of great interest in self-skin examination or first level screening by general practitioners. In addition to this it seems clear that the use of dermoscopy by trained doctors and the introduction of digital dermoscopy and total body photography in pigmented lesions clinics are useful in the management of difficult patients avoiding a great number of unnecessary excisions. All these strategies have limits and their positive impact is seen in selected high risk patients. Therefore the use of any of those strategies should be introduced according to the estimated risk and difficulty of every patient with dysplastic nevi. This empirical categorisation, is based on the personal and familial background (melanoma, skin cancer, carriers of genetic risk factors, other) and the number of difficult atypical lesions exhibited by the patient. Finally the state of medical care (cost, expertise, policies of primary and secondary prevention in skin cancer) and patient believes are also important to understand the differences in the management of dysplastic nevi in different countries. In the future we will need to understand how to use our strategies in dysplastic nevus syndrome according to the accurate stratification of risk and cost benefit.

© 2010 Lippincott Williams & Wilkins, Inc.