Atypical Naevus (Dysplastic Mole) Assessment in London – Consultant Dermatology Care

What Is an Atypical Naevus?

An atypical naevus is a mole with features outside the usual pattern for common moles. It may be larger than average, have slightly uneven or “smudged” borders, and show more than one shade of brown. In dermatology you may also hear the term dysplastic naevus; this describes a set of clinical and microscopic features but does not mean cancer. Many people have one or two atypical moles; some families develop many and have what’s known as an atypical mole syndrome. The presence of atypical naevi signals a skin type that is more sun-sensitive and more likely to make numerous moles over a lifetime.

Crucially, most atypical naevi are benign and stable. The reason we pay them attention is twofold: they can occasionally be difficult to distinguish from early melanoma, and people who have several atypical moles are at higher overall risk of melanoma somewhere on the skin (including from a brand-new lesion). Accurate assessment helps decide whether to monitor, photograph or remove a particular mole—without removing everything unnecessarily.

How to Spot Concerning Features

The classic screening aid is ABCDE:

• A – Asymmetry: one half doesn’t match the other in shape or structure.
• B – Border: irregular, notched or blurred edges.
• C – Colour: multiple tones (tan, brown, black, pink, grey, white or blue) or uneven distribution.
• D – Diameter: 6 mm or larger (about a pencil rubber). Size is only one clue—small melanomas exist.
• E – Evolving: any change in size, shape, colour, elevation, or new symptoms such as bleeding, crusting or persistent itch.

Another powerful concept is the “Ugly Duckling” sign—the mole that looks different from your personal pattern (for example, one markedly darker spot among many light freckles, or a lone flat patch among mostly domed moles). Pay attention to new lesions in adulthood, a mole that stands out, or one that behaves differently from the rest.

Skin of Colour Considerations

Melanoma can occur in every skin tone, though patterns vary. In medium to deep skin, early colour differences may be subtle; sometimes a lesion darkens or looks grey-black rather than red-brown. Special areas include the palms, soles and nails (acral sites), where a new streak or evolving spot warrants review. Because redness is less obvious, we focus on change over time, edge irregularity, new symptoms, and the Ugly Duckling sign. Dermoscopy helps distinguish normal pigment patterns from atypical ones and reduces unnecessary biopsies.

Who Is at Higher Risk of Atypical Naevus?

• Many moles (especially >50) or several atypical naevi.
• Fair or freckle-prone skin, red or blonde hair, light eye colour.
• History of sunburns (particularly blistering burns) or frequent sunbed use.
• Personal or family history of melanoma or atypical mole syndrome.
• Immunosuppression (certain medicines or medical conditions).

Having risk factors does not mean you will develop melanoma, but they guide how often we recommend skin checks and whether digital monitoring would be useful.

How We Assess an Atypical Mole

Our assessment combines a careful history (onset, change, symptoms, sun exposure) with a total body skin examination. Using dermoscopy—a magnified, polarised light tool—we analyse pigment network, streaks, dots, globules and other structures that differentiate benign from suspicious features. Dermoscopy greatly improves diagnostic accuracy compared with the naked eye alone.

Where helpful, we offer clinical photography and digital mole mapping to track patterns over time. This is especially valuable for people with many moles, where the goal is to detect new or changing lesions early while avoiding unnecessary removals.

Monitor or Remove? Making the Right Call

Not every atypical naevus needs removal. We generally recommend one of three paths:

1. Reassure & monitor: for stable lesions with benign dermoscopic features. We may photograph and recheck at agreed intervals.
2. Short-interval review: if a mole is equivocal, we document and re-examine in a short period (often 6–12 weeks). Genuine melanoma usually continues to evolve; benign lesions do not.
3. Excision biopsy: when suspicion is present or the lesion is changing. We remove the whole lesion with a narrow margin (typically a few millimetres) and send it to the laboratory for histology. This provides a definitive answer and, if melanoma is confirmed, the initial treatment is already complete.

We avoid partial biopsies (such as small punch samples) for suspicious pigmented lesions because they can miss the most informative area. A complete excision gives the pathologist the full architecture to examine.

What “Dysplasia” Means on the Pathology Report

When a removed mole is benign but atypical under the microscope, the report may grade dysplasia as mild, moderate or severe. This grading reflects how unusual the cells and growth pattern look compared with a normal mole—not the same thing as melanoma.

• Mild dysplasia: usually needs no further treatment if the mole has been fully removed or if edges are close but not involved, provided the clinical picture is reassuring.
• Moderate dysplasia: management depends on margin status and clinical judgement; many can be observed if margins are clear and the lesion matches a benign pattern.
• Severe dysplasia: often managed with a conservative re-excision to ensure clear margins, as features approach the borderline with melanoma in situ.

We discuss results in plain language, outline options and agree a follow-up plan that balances safety and over-treatment.

What to Expect If a Mole Is Removed

Excision is performed under local anaesthetic in clinic. After numbing, a small ellipse of skin containing the mole and a narrow cuff of normal skin is removed. The wound is closed with fine stitches and a dressing. The procedure takes around 20–30 minutes for a typical lesion.

Aftercare: keep the area clean and dry for the first day, then follow simple wound-care instructions. Stitches are removed or reviewed at the appropriate time depending on site (often 5–14 days). Expect a neat line scar; early scars are pink and slightly firm before maturing to a flatter, paler line over months. We advise on scar care, including sun protection and, where useful, silicone gel or sheets. Risks include bleeding, infection, thicker scarring (more common on shoulders/chest) and, rarely, wound separation.

Prevention & Everyday Protection

• Sun-smart habits: seek shade, especially 11am–3pm; wear hats and UV-protective clothing.
• Sunscreen: use SPF 30+ broad-spectrum; apply generously and reapply every two hours (and after swimming/sweating).
• Avoid sunbeds: artificial UV increases melanoma risk.
• Monthly skin checks: learn your personal mole pattern; photograph any that are hard to view; note the Ugly Duckling and the ABCDE/E changes.
• Nails, palms and soles: check these “hidden” sites as well as the back, scalp and behind ears.

Children, Teenagers & Pregnancy

Moles often enlarge naturally during growth spurts and can darken slightly in pregnancy due to hormonal change. We focus on change in pattern rather than size alone. Any new, evolving or symptomatic lesion should be assessed. For anxious families, a baseline set of photos and education on warning signs provides reassurance without unnecessary procedures.

When to Seek Prompt Assessment

• A new, evolving pigmented lesion in adulthood.
• A mole that bleeds, crusts, becomes tender or itches persistently.
• Rapid change over weeks to months, especially in outline or colour.
• An “Ugly Duckling” that stands out from your usual mole pattern.

Early review is worthwhile. If features are concerning, we proceed to excision without delay.

Why Choose Skinhorizon?

We provide high-quality advanced dermatology with consultant oversight. For atypical moles, precision matters: dermoscopy to improve accuracy, photography and sensible follow-up for high-mole counts, and decisive excision biopsy when a lesion changes. We aim for clear answers, neat scars and proportionate care that avoids both unnecessary removals and missed diagnoses.

Your First Visit — What to Expect

1. History & risk review: personal/family history, sun exposure and your goals.
2. Full-skin exam & dermoscopy: targeted assessment plus a general check to avoid overlooking new lesions.
3. Plan: reassurance/monitoring, short-interval review or same-day/soon excision if warranted.
4. Education: ABCDE/Ugly Duckling guidance and a simple self-check routine; written safety-net advice.
5. Follow-up: results discussion and individualised schedule, particularly if you have many moles or higher risk.