Atypical nevus, dysplastic nevus, nevus with architectural disorder, or Clark's nevus

The field of Dermatopathology has produced no consensus when it comes to "funny-looking" moles, both on patients and under the microscope. (See figure II). The so-called dysplastic nevus syndrome was described in the past where a small subset of patients had multiple "funny-looking" moles and had a very high risk of developing melanoma. These same patients also had a strong family history of melanoma. These patients are in fact quite rare, where as these "funny-looking" moles are quite common. Nevi or moles, while not normal skin, are present on all of us. Without question, some melanomas (and some people say the majority of melanomas) can develop in pre-existing nevi or moles. At this point in time, we have no surefire way to predict which moles might develop into melanoma. Some Dermatopathologists will say that the dysplastic, atypical, or Clark's nevus is "pre-malignant" and needs complete removal or further surgery after an initial biopsy. This is actually not necessary in most cases. Some nevi or moles with this diagnosis are in fact quite atypical under the microscope with bizarre cells and, may in fact, be developing into melanoma and these relatively rare cases need further surgery. Without accurate genetic testing, we really can not be sure which of these moles might develop into melanoma, but for the minority of cases that truly are "atypical" further surgery is appropriate. Most of the funny moles that are taken off (see figure III) are slightly large, have irregular colors and irregular borders and thus can look like a melanoma (see figure I). Under the microscope they have certain identifiable characteristics, but with the exception of those few cases noted above, these moles usually do not need further treatment.

Atypical Nevus - Case

A patient was biopsied at a major Southern California University and the diagnosis of "dysplastic nevi with atypia" was made with recommendations in the pathology report for further surgery. The slides were retrieved with the patient's permission and were interpreted by Dr. Geisse as so-called Clark's nevi without significant atypia; thus needing no further treatment. Unfortunately, this is a common occurrence across the country happening even at some of our most preeminent universities. The lack of consensus on the management of these patients is in fact shameful and additional work needs to be done in this area. None of us want to miss a melanoma nor miss an opportunity to prevent the development of melanoma in a patient, but unnecessary surgery in this situation is commonplace. If your doctor has told you that you have an atypical nevus or pre-melanoma or pre-cancerous mole, re-interpretation of that biopsy would be appropriate to see whether or not you actually need additional surgery.