Multiple Moles (melanocytic naevi)
Patients with a greater number of moles are at greater risk of melanoma. 40% of melanoma originates from existing moles. Self-examination is crucial as a late presentation is almost always associated with a poor prognosis.
All patients should be encouraged to regularly self-examine and be given advice on good UV protection.
The Primary Care Dermatology Society provides useful documents to share with patients:
For description and images: http://www.pcds.org.uk/clinical-guidance/atypical-dysplastic-melanocytic-naevus
Patients with only a few atypical moles which have not changed and without a family history of melanoma need not be referred.
The patient should take and store photographs at home and self examine every 3 months for evidence of change.
When should a patient be referred to the dermatologist?
1. Large numbers of moles, both typical and atypical:
Atypical Mole Syndrome (AMS) is defined as patients with at least 50 moles, at least 2 of which appear atypical. Patients with AMS have approximately a 3% risk developing a melanoma de novo and should be referred routinely to the dermatologists.
2. Familial Atypical Mole and Melanoma Syndrome (FAMM)
Large numbers of typical and atypical moles AND a family history of Melanoma in one or more 1st or 2nd degree relatives. These patients have a high risk of melanoma and should be referred routinely to a dermatologist.
3. Clinical suspicion of melanoma
The patient should be referred via the 2ww pathway even if the criteria are not met where there is a strong clinical suspicion of melanoma. Suspicious pigmented lesions can also be referred urgently via the e-referral system when 2ww criteria are not met. The chosen referral pathway will depend on the clinician’s level of suspicion.
The Dermatologists only carry out surveillance on moles if there is a history of Dysplastic Naevus Syndrome (Atypical Mole Syndrome post histology) or melanoma.
Reference: The Primary Care Dermatology Society. Atypical (dysplastic) melanocytic naevus. Last updated 28/12/14. Available at: http://www.pcds.org.uk/clinical-guidance/atypical-dysplastic-melanocytic-naevus