Introduction

Melanocytic naevi arise as a result of proliferation of melanocytes, the cells in the skin that
produce pigment. Although there are many types of melanocytic naevi, this chapter focuses on
the most common melanocytic naevi, often referred to as 'moles', which are acquired
melanocytic naevi and dermal melanocytic naevi.
Aetiology

The cause of moles is unknown

Moles have historically been classified by their histological appearance as

being junctional (focal proliferation of melanocytes at the dermal-epidermal
junction), compound (a combination of junctional activity and intradermal
naevus cells) and intradermal (groups of mature naevus cells in the dermis
only). The evolutionary theory was that naevi progress from junctional to
compound and then intradermal

However, with the advent of dermoscopy there is a thinking that moles do

not progress as above and instead originate as either:
o

Acquired melanocytic naevi - the melanocytes are found

predominantly at the dermal-epidermal junctional. Large numbers of
lesions are an indicator of increased melanoma risk, not as a direct
result of the lesions present but melanoma de novo

Dermal melanocytic naevi - nests of melanocytes are found in the

dermis, and are probably congenital

History

Most moles become apparent during childhood or early adult life

The number of moles that an individual has is related to genetic factors and exposure to
UV radiation, greater exposure normally results in the development of a larger number of
moles

Patients with greater numbers of moles have an increased risk of melanoma

In later life many moles slowly fade away

Clinical findings

Acquired melanocytic naevi

Morphology
o

Flat or slightly raised

Generally symmetrical with a smooth border

Colour - often brown but can be pink or blackish depending on skin

type (darker lesions most common in skin types IV-VI). The colour
tends to be evenly distributed throughout the lesion, although
sometimes more pronounced in the centre and occasionally more
pronounced at the edge (see below). Lesions lighten with age

Dermoscopic features
o

The pattern tends to progress from having a globular rim in young

people, to a predominantly reticular network in adults and then
homogenous in older people as the naevi involute

In most patients the network is darker in the centre and fades to the
edge. However, in some cases, eg skin type I or lesions on the scalp,
the network is more pronounced at the periphery. Regardless, with
benign lesions the network should take on a symmetrical appearance

Melanocytic lesions on the palms & soles, and face take on different
dermoscopic appearances. Refer to the chapters on acral
melanoma and lentigo maligna melanoma respectively

For more information refer to the section on dermoscopy

Pattern comparison
o

It is important to examine all of a patient's moles - a melanoma / other

skin cancer is likely to look different to the others

Dermal melanocytic naevi

Morphology
o

Thickened and often protrude from the skin surface

May become dome-shape or papillomatous and wobbly to palpate

Colour - often brown. Lighten with age

Dermoscopic features
o

Tend to be uniform or darker in the centre

A globular / cobblestone pattern

In older patients lesions may be relatively banal and show little

remaining pigment

For more information refer to the section on dermoscopy

Management
Step 1: regular moles

Teach the patient on the self-examination of moles

The chances of any one individual mole becoming malignant is very low and, as such,
prophylactic excision should not be performed

Treatment for harmless moles should only be done if the lesion is causing problems
such as catching on clothing. Proud lesions are best removed by shave excision. All
samples must be sent for histology. Only a health professional accredited in skin
surgery should perform the procedure

Step 2: large numbers of regular moles

Patients with large numbers of moles are at an increased risk of melanoma

Teach the patient on self-examination of moles and give advice about good
UV protection

Encourage the patient to take photographs of their skin and store the images
on a home computer - the patient and partner / relative should perform a skin
examination every three months and compare with the images to look for
change

Step 3: atypical moles

Are known as atypical melanocytic naevi or histologically dysplastic naevi

Refer to the related chapter on Atypical melanocytic naevus

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