A Teenager with Multiple Moles
A teen athlete comes in for his preseason physical. Everything looks good until he lifts up his shirt.
A Teenager with Multiple Moles: Can you make the diagnosis?
At his preseason physical, a 16-year-old athlete appears healthy enough to participate in sports.
Multiple moles are noted on the adolescent's chest.
Many nevi of assorted shapes, sizes, and colors are noted on the teen's chest and back.
Closer inspection reveals asymmetric papular lesions with indistinct borders and variegated color. Many are >6mm in diameter.
Moles less than or equal to 6 mm in diameter are considered "typical." Nevi larger than that are cause for additional examination.
The differential diagnosis for multiple nevi of atypical size is: A. Squamous cell carcinoma; B. Dysplastic nevi (new nomenclature applies); C. Photosensitivity; D. Nothing to worry about.
A family history of skin cancer in this situation is a strong indication for familial atypical multiple mole melanoma (FAMMM) syndrome (previously known as dysplastic nevi).
In families with FAMMM 10% of kindred may experience a first melanoma before age 20 years! More than one-third of offspring will have atypical nevi.
Invasive melanomas in children with FAMMM have been reported in significant numbers by age 10 years.
The role of the primary care physician is to make a dermatologic referral and to also follow the patient; keeping a photographic record is recommended.
The ABCD signs of melanoma: Asymmetry; Border; Color; Diameter.
Referral of a patient with pigmented lesions at risk for melanoma: suspicious nevi, rapidly growing/changing; multiple nevi in abnormal pattern; possible familial melanoma kindred.
Referral of a patient with pigmented lesions at risk for melanoma:for surgical consultation; concern for a related genetic syndrome.
The 16-year-old basketball player appears healthy and the past medical history reveals nothing to the contrary. What is revealing is the sight of the adolescent's torso when he raises his shirt for physical examination. Join Dr Jonathan Schneider in the virtual clinic by clicking through the slides below. What's your diagnosis?
