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April 2006

Too Many Moles

Arch Dermatol. 2006;142(4):508. doi:10.1001/archderm.142.4.508

For a patient with numerous melanocytic nevi, whose self-description is oftentimes “I just have too many moles,” a practical clinical approach can prove quite useful. In general, an individual dermatologist will come to rely on a particular set of complementary methods that have often evolved over time. Of course, the goal is universal: to detect cutaneous melanomas when they are still thin and therefore less likely to have an impact on survival.

From the onset of the examination, a systematic approach is desirable if for no other reason than to avoid being overwhelmed by the sheer number of pigmented lesions, especially when the many melanocytic nevi are admixed with numerous solar lentigines. A method that I have found valuable is somewhat analogous to that used by a dermatopathologist when examining a section of skin microscopically: to examine the patient at the equivalent of ×4 and ×20 magnification, followed by inspection of selected areas of interest at ×100 magnification.

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