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March 16, 2011 / molehunter

A trio of slightly asymmetrical naevi

I asked my wife to photograph some of my moles dermoscopically just to get some examples of normal. In fact, when I looked thought a few looked slightly odd. But then a lot of moles do. Something every beginner with the dermoscope needs to do is study as many moles as possible about which there is no anxiety, to get a feel for the range of normality, which is quite broad. At some stage, you have to decide what level of abnormality requires action and when to make a decision there is not enough wrong to worry about. This calls for experience and study, but also a bit of nerve-anecdotally, beginners with the dermoscope may refer or excise MORE lesions as what they see through the ‘scope  frightens them. It is definitely a good thing to learn in a clinic with an experienced mentor as well as read the books, blogs and on-line atlases.

It s always reassuring to see similarity between several of a patient’s moles. Slightly odd in the same way as the other moles is reassuring. I said slightly odd

This mole is 4mm diameter, not changing and is visibly 2 shades of brown and lacking perfect symmetry. There is a slightly off centre central hypopigmented patch. If every mole with this degree of abnormality were removed, surgical services would be overwhelmed and people would be covered with unnecessary scars. Several of my other moles look slightly odd in the same way. There is a case for photography to monitor change.

The third of this trio is asymmetric with darker network at the top end and perhaps a hint of a broadened network at 2 o’clock, but this is a minor level of abnormality and when set together with the other moles which all look slightly imperfect, reassuring. If you cut one of these, you’d probably have to cut them all AND half a dozen others. Bear in mind than only half of all melanomas arise from pre-existing naevi, the other half arise from ‘normal’ skin, so where do you stop?

These 3 small slightly odd naevi in my book are verging on very mild dysplasia, but this is very debateable. It is a matter of debate whether ‘dysplastic’ naevi progress to invasive malignancy, all the more so since dysplasia is only really diagnosed on histopathology once you’ve cut the mole out. Photo, advise and review is the most I would do for these 3 moles, but others might have a different view, comments on these and other images would be most welcome.

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