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Patient Case: Naevi (Moles)

Patient Case: Naevi (Moles)

Discussion

A 32-year-old woman presents to a dermatology clinic with concerns about a dark brown mole on her upper back that she has had since childhood. She reports that it has grown slightly over the years but has remained asymptomatic. The lesion is about 6 mm in diameter, round, and well-demarcated, with a uniform color and smooth surface. She has several other smaller, similar lesions scattered on her arms and legs. She denies any pain, itching, or recent changes in color, shape, or texture.

Her past medical history is unremarkable, and there is no family history of melanoma or other skin cancers. She has fair skin and a history of frequent sun exposure due to outdoor activities.

On examination, the lesion is symmetric, evenly pigmented, and lacks ulceration or irregular borders. Dermoscopy reveals a homogenous brown pattern without atypical features. The dermatologist reassures the patient that the mole is a benign melanocytic naevus but advises regular self-monitoring for any changes.

Questions
  1. Which feature of the patient’s mole suggests that it is benign?
    A) Asymmetry in shape and color
    B) Presence of ulceration
    C) Well-demarcated border and uniform color
    D) Rapid growth and irregular texture
  2. Which factor increases this patient’s risk of developing malignant melanoma?
    A) History of sun exposure
    B) Presence of a single mole
    C) Dark skin type
    D) Lack of family history of melanoma
  3. What is the best next step in managing this patient’s condition?
    A) Immediate surgical excision
    B) Reassurance and self-monitoring for changes
    C) Biopsy of the lesion
    D) Cryotherapys
  4. Which of the following changes in a mole should prompt urgent dermatologic evaluation?
    A) Gradual growth over many years
    B) Development of uniform dark pigmentation
    C) New onset of pain, ulceration, or bleeding
    D) Presence of multiple similar moles on different body parts
Reveal answers

Answers

  1. C) Well-demarcated border and uniform color
    • Benign naevi typically have a smooth, well-defined border and a uniform color. In contrast, malignant lesions often show asymmetry, irregular borders, and color variation.
  2. A) History of sun exposure
    • Chronic sun exposure increases the risk of melanoma, particularly in fair-skinned individuals. Other risk factors include a high number of moles, atypical moles, and family history of melanoma.
  3. B) Reassurance and self-monitoring for changes
    • Since the mole has remained stable with no suspicious features, the best approach is patient education and regular self-examination. If any changes occur, further evaluation would be needed.
  4. C) New onset of pain, ulceration, or bleeding
    • A mole that suddenly changes in color, shape, size, or symptoms (such as pain or bleeding) should be promptly evaluated for possible malignant transformation.