Clinical Crossroads: A Young Light-Skinned Woman With Multiple Moles

To the Editor.—Dr Robinson¹ states that patients presenting for the first time for evaluation of atypical mole syndrome should have biopsies performed on 2 of the most clinically atypical nevi, since these biopsies would be used to confirm the clinical diagnosis of atypical moles and would also determine the degree of atypia present. However, it is not necessary to perform these 2 biopsies to establish a diagnosis of atypical moles or atypical mole syndrome. Furthermore, these biopsies would not help in assessing which patients with atypical mole syndrome are at increased risk for developing melanoma. When the atypical mole syndrome was first described, the diagnosis of the syndrome, by definition, required that biopsies be performed on 2 of the most atypical nevi.² However, over the years there has been a shift in the definition and method of diagnosing atypical or dysplastic nevi and of the atypical mole syndrome. The definition and/or diagnosis now relies on the clinical characteristics of the nevus without requiring histopathologic confirmation.^3- 5 The histopathologic features and degree of atypia required for confirming the diagnosis of dysplastic nevi are still not uniformly agreed upon.⁶ Furthermore, the presence and degree of cellular atypia has not, to date, been correlated with risk of melanoma. Hence, other than in a research setting, the degree of cellular atypia is not necessary in establishing a diagnosis of atypical moles or in identifying atypical mole syndrome patients at greater risk for developing melanoma.