We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Precursors to Malignant Melanoma

JAMA. 1984;251(14):1864-1866. doi:10.1001/jama.1984.03340380046022.
Text Size: A A A
Published online


The incidence of melanoma and the number of deaths from it are increasing in many areas of the world. There is evidence that early recognition and surgical removal of melanoma make this a highly curable cancer. In recent years, medical scientists have become aware of a possible association between certain preexisting pigmented skin lesions and cutaneous melanoma. This interest has developed from identification of two suspected precursors to cutaneous melanoma: (1) acquired abnormal moles known as dysplastic nevi, present both in the general population and in certain melanoma-prone families, and (2) certain congenital nevi. Identification and appropriate management of such precursors could substantially reduce the incidence of and mortality from melanoma.

In an effort to resolve some of the questions surrounding these issues, the National Institutes of Health convened a Consensus Development Conference on Precursors to Malignant Melanoma on Oct 24 through 26, 1983. After a day and a half of presentation by experts of data on these two types of lesions and their potential for becoming cancerous, a consensus panel that included representatives from dermatology, pathology, oncology, family medicine, immunology, epidemiology, and the general public considered the scientific evidence and agreed on answers to the following key questions:

  1. Can dysplastic nevi and congenital nevi be defined clinically and histologically?

  2. Are these nevi precursors to melanoma? What are the prevalence, natural history, and determinants of these precursors?

  3. What is appropriate management of patients with dysplastic nevi and congenital nevi regarding diagnosis, treatment, follow-up, familial screening, and education?

  4. What directions should be taken for future research on precursor lesions to melanoma?

Conclusions  This conference highlighted an important advance in our understanding of melanoma through the identification of a familial syndrome in which multiple dysplastic nevi are associated with development of melanomas. The investigation of patients with this syndrome affords an opportunity not only to advance our knowledge of the biology of melanoma but also to aid the identification of treatable precursor lesions and early melanomas. The result may be a reduction in mortality in these patients.The consensus panel found that melanoma may arise de novo as well as in association with preexisting melanocytic nevi. The panel also agreed that the dysplastic nevus, a distinctive lesion both clinically and histologically, has been identified in this context, particularly in melanoma-prone families. Dysplastic nevi are both markers and precursors for familial melanoma. Melanoma may develop also in congenital nevi, especially when the lesion is larger than 20 cm.Strategies for treatment and follow-up should be formulated individually, on the basis of the risk of melanoma to each patient. Patients with dysplastic nevi and a family history of melanoma should be followed up frequently, with documentation of lesions and excision of changing nevi. The relatives of patients with melanomas should be examined for dysplastic nevi and melanoma in view of the familial aggregation of both lesions. Patients with congenital nevi should be followed up periodically for changes. Need for education in examination of lesions by patients, relatives, and health professionals is emphasized.The scarcity of existing information on precursors of melanoma coupled with its increasing incidence indicate a continuing need for research. Epidemiologic, clinical, and laboratory studies are required of populations known to be at increased risk for melanoma as well as of general populations. Pilot studies should be initiated to evaluate the feasibility of and methodology for large-scale prospective studies. The feasibility and effectiveness of proposed interventions also should be determined. Laboratory studies should be directed toward understanding how pigment cells in precursor lesions undergo transformation.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.