To the Editor.—
One of my patients is a 42-year-old lawyer. He has more than 50 dysplastic nevi on his skin. One superficial melanoma was excised from his leg 3 years ago. His two sons, aged 7 and 9 years, have their father's mole pattern. Both have had excisions of dysplastic nevi. The patient's father had a melanoma.Such families are alarming to most dermatologists. We are anxious about dealing with these patients. Will we miss a significant melanoma? Should we care for these people ourselves? Should we refer them to specialty clinics? What is the best way to screen and test for these multiple, atypical skin lesions?In his editorial "The Dysplastic Nevus Syndrome," Dr Clark1 elucidates important features of this syndrome, but I believe that he fails to give dermatologists practical guidelines for managing patients. My criticism is with the pedantic, rigid tone of Dr Clark's recommendations.