Severely Dysplastic Junctional Nevus

A 57-year-old man presented for medical attention with a “funny-looking mole” on the lateral aspect of his left upper arm. The lesion was asymptomatic.

Key point: The eccentric placement of a darker spot within the overall lesion should raise suspicion for melanoma. The need for histologic examination is clear in such cases.

Treatment: The patient elected to have the entire lesion removed, rather than to undergo a biopsy. The macule proved to be a severely dysplastic junctional nevus. Because the lesion was already excised with a conservative margin of 5 mm of clear skin, treatment was considered sufficient. The patient will receive periodic recall skin surface examinations.

Note: This lesion’s asymmetry is the most worrisome feature. The clear margin of 5 mm is identical of that recommended for melanoma in situ, so no additional surgery was suggested.