From the Guidelines
Melanocytic nevi (moles) generally do not require treatment unless there are concerns about malignancy, and prophylactic removal is recommended for atypical or suspicious nevi showing warning signs captured by the ABCDE criteria. The decision to remove a melanocytic nevus as a prophylactic measure for fear of transforming to melanoma should be based on the presence of suspicious features, such as asymmetry, border irregularity, color variation, diameter greater than 6mm, and evolution or changes over time 1. Additional concerning features that may warrant removal include rapid growth, ulceration, bleeding, itching, or pain. Prophylactic removal should be considered for congenital giant nevi (>20cm), as these carry a higher lifetime melanoma risk of 5-10% 1. Nevi in difficult-to-monitor locations, such as the scalp, genitals, between toes, or on the back, may also warrant removal. The procedure typically involves excisional biopsy with narrow margins (1-2mm) followed by histopathological examination 1. For cosmetic removal of benign nevi, shave excision may be performed. Regular skin self-examinations and annual dermatological evaluations are recommended for patients with multiple nevi or risk factors for melanoma. Some key points to consider when evaluating melanocytic nevi include:
- The ABCDE criteria for evaluating suspicious nevi
- The presence of concerning features, such as rapid growth or ulceration
- The location of the nevus, with difficult-to-monitor locations potentially warranting removal
- The importance of regular skin self-examinations and annual dermatological evaluations for patients with multiple nevi or risk factors for melanoma. Early detection and removal of suspicious nevi is crucial, as melanoma survival rates decrease significantly once the cancer has metastasized 1.
From the Research
Treatment of Melanocytic Nevus
- The treatment of common acquired melanocytic nevus (CAMN) is mostly desired for cosmetic purposes, and several "faster and less traumatizing" techniques have been developed 2.
- Shave excision is a minimally invasive and easily performed procedure for removing benign melanocytic lesions, with a low rate of recurrence and acceptable cosmetic outcome 3, 4.
- Dermoscopy can be used as a noninvasive tool for assessing residual pigment after shave excision, reducing the risk of recurrences 2.
Prophylactic Removal of Melanocytic Nevus
- Approximately 33% of melanomas are derived directly from benign melanocytic nevi, but the vast majority of melanocytic nevi will never progress to melanoma 5.
- Certain clinical and/or dermatoscopic features may provide a decision-making aid in the management of different melanocytic nevi, including the risk of transformation into melanoma 6.
- The assessment of melanocytic nevi should consider criteria such as the time of occurrence, growth tendency, distribution, and comparison with other nevi of the respective individual 6.
Recurrence and Complications
- Recurrence rates after shave excision of melanocytic nevi can range from 13% to 40%, depending on the technique and follow-up period 2, 3, 4.
- Complications such as hypopigmentation, hyperpigmentation, and erythema can occur after shave excision, but are generally mild and temporary 4.
- The use of dermoscopy for follow-up can help in early recognition of recurrence and appropriate treatment 2.