SAN FRANCISCO While scanning the acquired moles on the skin of a child or adolescent, consider whether individual moles look like they are part of a pack or if there is one that stands out"the ugly duckling," Dr. Lawrence F. Eichenfield advised.
Mild variations in nevi are okay if several nevi look the same, but when there are many mildly atypical nevi, look for an atypically atypical lesion, Dr. Eichenfield said at a conference on women's and pediatric dermatology sponsored by Skin Disease Education Foundation.
In children, the asymmetry (A) and border irregularity (B) tend to be the most useful of the ABCDEs in identifying worrisome changes in nevi. "That makes sense because what you're looking for is uncontrolled growthlooking for one part of the mole doing something different from the other part," said Dr. Eichenfield, chief of pediatric and adolescent dermatology at the University of California, San Diego.
Remember the other ABCDEs of worrisome changes in nevi as wellcolor irregularity (C), diameter larger than 5 mm (D), and elevation (E).
Dysplastic nevi tend to be large (6-15 mm) with irregular borders, indistinct margins, or mixed colors (tan, brown, dark brown, and pink) instead of uniform tan or brown pigmentation.
Adolescents often develop symmetric, two-toned moles that are no cause for alarm but simply a sign of evolution.
"Just like some teenagers have some mixed features to themand in fact they can look a little funkyso can the moles be like that. They can have features of two types of moles at the same time," he explained.
Dysplastic nevi can be found in sun-exposed areas typical of nevi but also on the scalp, buttocks, or other sun-protected sites. A mole on the scalp may be an indication that the child eventually will develop a high number of moles (more than 50), which increases the risk for melanoma, but the scalp nevi themselves regress over time and become less worrisome, Dr. Eichenfield said.
Frequently, atypical nevi have a macular component, which gives them a pebbly or fried-egg appearance, he noted. Benign scalp nevi, too, often look like fried eggs. Finding a truly atypical nevus necessitates expert dermatopathologic review, often with multiple readers, he suggested.
Be alert for children with atypical moles and two immediate family members with a history of melanoma. Ten percent of these children will develop melanoma before age 20, and 80%-90% will develop melanoma in their lifetimes.
"If you're a pediatrician, get them to a dermatologist. If you're a dermatologist, you should probably have serial photography" for monitoring, or refer them to someone who can do this, Dr. Eichenfield said.
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When there are many mildly atypical nevi, look for an atypically atypical lesion. DR. EICHENFIELD