SAN FRANCISCO – While scanning the acquired moles on the skin of a child, 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 growth–looking 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 well–color irregularity (C), diameter larger than 5 mm (D), and elevation (E). Teens can develop symmetric, two-toned moles that are no cause for alarm but simply a sign of evolution. Dysplastic nevi can be found in sun-exposed areas, but also on the scalp, buttocks, or other sun-protected sites.
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 specialist review. 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. SDEF and this news organization are wholly owned subsidiaries of Elsevier.