Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Nevi and Pigmented Lesions 1049

management

Benign

■Lesions may be observed or removed for cosmesis.

■Atypical (dysplastic) nevi are removed if they have changed or there

is high degree of suspicion for melanoma; they should be excised

completely w/ small margin of clinically normal skin; often saucer-

ized excision is acceptable.

■Narrow excision (2-mm margins) of lesions suspected to be mela-

noma

Malignant

■See “Melanoma.”

specific therapy

N/A

follow-up

Benign

■Observation

■Cosmetic considerations

■Patients w/ multiple atypical moles or positive family hx of malignant

melanoma:

➣At increased risk for developing melanoma

➣Regular follow-up at q 6–12 month intervals

➣Use of baseline photographs for evaluation of new &/or changing

lesions

Counseling

■Sun protection measures

■Behavioral alteration

■Protective clothing: hats, tightly woven clothing

■Avoid midday sun.

■Regular use of broad-spectrum sunscreens SPF 15 or higher

■Avoid tanning salons.

complications and prognosis

Complications

■Surgical complications (bleeding, infection, scarring)

Prognosis Dysplastic nevi

■Lifetime risk of developing subsequent melanoma:

➣7% if no family hx of melanoma

➣50–100% w/ personal &/or family hx of melanoma