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June 2001
Case submitted by Stephen Schleicher, MD
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CASE:
A moderately obese 44-year-old man is referred by his family
physician for evaluation of moles. According to the patient,
the number of lesions had been gradually increasing over the
previous several years, and several had become appreciably
darker. He claims no personal or family history of skin cancer.
Examination reveals multiple nevi ranging from 0.3 cm to 1.2
cm in diameter. Most are uniformly pigmented, although some
display areas of focal darkening, central elevation, and slight
border irregularity.
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White men typically have a dozen or so acquired
nevomelanocytic nevi, which are usually medium or dark brown
and have a sharply demarcated border. So-called dysplastic nevi
have a darkened center; a tan to reddish periphery gradually
fades into the surrounding skin. Central elevation creates a
"fried egg" appearance. Patients who have numerous nevi are
at increased risk for malignant melanoma and should be instructed
about adequate sun protection and the necessity of periodic
skin examination. |
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
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