Video Production by Josh Melendez

This updated atypical moles video discusses the range of dysplastic nevi (atypical moles) from mild to severe and briefly covers treatment scenarios.

Important Footnotes:

For Mild or Mild-Moderately Atypical Mole: We normally recommend MONITORING these. If they show signs of growing back (darkness, bump, tenderness, …) then we should consider excising. If you want the atypical mole excised instead of monitoring, that is an option.

For Moderately Atypical Mole: We normally recommend EXCISING these. There is some debate on if these can just be monitored.

For Moderate-Severely Atypical Mole: These should be EXCISED.

For Severely Atypical Mole: These should be EXCISED.

Video Links:

Take the Quiz!

Video Transcript:

The concept of an atypical mole is hotly debated in dermatology. And so, if you get 10 dermatologists in a room, you’re probably going to get 20 different opinions. And so we made this video to try to break it down, make it more bite-sized for you.

All right, so atypical mole, what are they? Let’s start with what a normal mole is. We have normal moles. We all have them. They’re not big deals. All we have to do is look at them once a month in the mirror. Make sure they’re not changing or growing or misbehaving in some way or form. And if they change, grow, or misbehave, like bleed or itch or something like that, then go see your local dermatologist. ‘Cause we need to look at them to make sure they’re okay. So that’s a normal mole.

On the other side of the spectrum is melanoma. That is a skin cancer that happens from the melanocytes or the pigment producing cells in your body. Melanomas are really, really bad. And we have videos on what a melanoma skin cancer is, so please watch those for more information. And in between the concept of a normal mole, and the melanoma, is this concept of an atypical mole. Now, please do not think that the normal progression is to go from a normal mole to an atypical mole, and then to melanoma and that’s predetermined and destined. It’s, it’s not that at all. We know what a normal mole is, and we know what a melanoma is, and then everything in the middle, and we usually classify everything in the middle as either mild, moderate, or severely atypical. And each one of those has its own sort of recommendations.

Now the vast majority of dermatologist think that a mildly atypical mole that does not return after a biopsy., all we have to do is watch those, to make sure they don’t return. The vast majority of us do not recommend excising those, or removing a mildly atypical mole under normal circumstances. Now on the flip side of the coin is the severely atypical mole, and the vast majority of dermatologists recommend cutting those out, and stitching it up, and then watching the area very closely, make sure it doesn’t come back.

Now in the middle is the moderately atypical mole. And that’s where we really don’t have good consensus on what to do with these. Some dermatologists recommend removing them, and some recommend just monitoring them. I think almost all of us agree that if an atypical mole returns, whether that’s a mild or a moderate, but they probably should be excised. But if you just take a biopsy of a moderately atypical mole, that’s where there’s a lot of question and debate. So please, talk to your local dermatologist about what they recommend for you.

Now, what do atypical moles mean? Can I give you an exact percentage of what a mild or moderate or severely atypical mole, what percentage of those will turn into melanomas? And I can’t. We say they have a unknown biologic potential of turning into melanoma. Now for milds that is so low, that we usually recommend just monitoring them to make sure they don’t come back, and if they do we cut them out. For moderate, that’s where all the debate is, and for severely atypical moles, most of us agree that it has a relatively reasonable chance of turning into a melanoma, and so they should be cut out. But by no means does having either a mild, moderate, or severe guarantee that you’ll have a melanoma. In fact chances are more likely than not, they will not turn into melanomas.

Guys, it’s really hard for us to design a study, and dermatologists say, “Hey, you have a bunch of moderately atypical moles. Let’s just wait and follow you over 10 years, and see us something bad happens.” That’s not really ethical. And so we have to do is, we have to rely on data on people who have these, and then don’t have them treated, and then actually do return for follow up, and follow them over a number of years to see how many turn into melanomas. And we just don’t have the actual numbers for those. And what makes the topic a little bit more confusing is that every time you get one of these moles biopsied, each pathologist who reads these, reads and classifies and grades these a little bit different. So, if you were to send your mole to someone on the east coast versus someone on the west coast to read and tell you how atypical it is, you’d likely get a different grade. One might say mild, one might say moderate. Also, that’s what makes this conversation a little bit more confusing.

Now, the one thing we do know about these atypical moles that we’re fairly certain about, is that the more atypical moles you have, the increased risk you carry of developing a melanoma somewhere on your body. And again melanomas are the bad skin cancers. That’s what we want to avoid, and catch it as early as possible, and treat it as quickly as possible to avoid significant ramifications for you and your health. So if you’ve only ever had one atypical mole, your chances of getting a melanoma are a little bit increased from the general population, but not by that much. But if you had 10 or 15 or 20 atypical moles, your chances of developing a melanoma somewhere on your body are greatly increased. So we have to be very careful, and monitor you often. 

Now if you’ve only ever had one atypical mole, we still want to see you at least once a year, and look you over, and we still encourage you to look your body over once a month in the mirror, to notice if there’s anything new or changing or growing. But if you’ve had tons and tons of these, we might be seeing you multiple times a year, so that we can do our job, and you do your job, and the two will meet in the middle, and we’ll keep you healthy.

Now, what about prevention of these atypical moles? Because honestly, prevention is way better than treatment for almost every topic out there. There are two basic things that you can do to help not get more atypical moles. Number one is, you guessed it, stay out of the tanning beds and do not stay in the sun without protection. So, please always have a hat on and some protective clothing, and sunscreen on the exposed parts of your body. Now, we have a video that talks about sunscreens and which ones we recommend, so, please watch that. And number two, please eat healthfully and exercise regularly. The better we treat our bodies, the better our bodies will treat us back. And if we have a really good diet full of good fruits and veggies and you know, all the stuff that we know that we should be doing? Our whole bodies from head to toe, from skin to heart, it will do better. And we all know that exercising is good for our mind, body and spirit. So, please talk to your local doctors to make sure that you are cleared for the exercise routine that you’re considering, and then please get 30 minutes of good exercise a day.

Your local dermatologist is here to talk to you about this topic of atypical moles. We’re here to have a conversation. So please, if you have any questions, talk to your local dermatologist. Have a conversation with them. If you’re uncomfortable or have any other questions, get a second opinion. We’re here for you. We’re here to help you become comfortable in your skin.

Thank you so much for watching this video. If you found it valuable, please subscribe below so that you can get up-to-date content when it’s released. And please share with your friends and family so that when they’re going through similar things, they have the knowledge that they need. 

About the author

Dr. Anderson with Doctors Quarterly Magazine - Cropped
Dr. Reagan Anderson

Dr. Anderson is a Board Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and is actively involved in patient and healthcare provider education on dermatology conditions and treatment.

Colorado Dermatology Institute
8580 Scarborough Drive / 1220 Lake Plaza Drive
Colorado Springs, Colorado