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Tuesday, July 29, 2014
Skin Care and Diseases
Follow up for dysplastic nevus
What`s the recommended follow up (if any) after an atypical nevus is removed? I haven`t been to a dermatologist (relocated) since mine was excised a year and a half ago. My sister who had an atyp. nevus is checked every 6 mos, and my sister who had a basal has a "body scan," whatever that is. I`d feel like a hypochondriac going to a new derm., and all this checking sounds like overkill to me (in my particular case). None of us actually had a melanoma.
Dysplastic nevi are fairly common especially in individuals of northern european ancestry. Those from the UK, from Holland, Germany or even from Poland or Russia who are of celtic ancestry might have these nevi. In and of themselves, they do not mean much except that the person or his ancestors are from northern euope. And such individuals do have some risk for melanoma, not be cause of the nevi but because they have fair skin color, often blue eyes and red hair. These signs indicate that the person is a a 3-4 fold increased risk for developing a melanoma compared to others from southern europe like Italy or Greece. For such individuals of northern european ancestry, depending on age and sun exposure, maybe it is not necessary to have annual exminations, but the person should himself keep an eye on his moles and contact a dermatologist if any changes are noted. It is not a bad idea to go by once a year for a routine examination, especially after age 40 years. Melanomas can affect a person at any age, but are much more common between the ages of 40 and 60 years with a peak incidence around age 54 years. The purpose of the exams is to use vigilance to minimize risk of a melanoma. That means finding a melanoma early when they are very curable.
If the person has many nevi, regardless of type, meaning over 125 to 150, they have an even greater risk for melanoma. And if they have a family history of melanoma, dysplastic nevi and numerous nevi, then they have a very high risk of getting a melanoma, maybe as high as 50%.
Each person should be examined by a knowledgeable person. If they have lots of nevi, especially if they are atypical, then total body photos are recommended and the person should have a complete skin examination at least annually, maybe as often as every 3-6 months. The frequency depends on age, other risk factors, sun exposure, and other factors.The photos are used to compare the patient to determine if any moles have changed. Changing moles generally should be removed unless there are compelling reasons not to do so.
James J Nordlund, MD
College of Medicine
University of Cincinnati