ABSTRACT
The main target in the management of patients with multiple melanocytic nevi is early detection of melanoma and reduction of unneeded biopsies.
Melanoma is associated with a well-defined set of features influencing the risk stratification level in patients with multiple melanocytic nevi. The major risk factors include personal history of melanoma, familial melanoma, global density of melanocytic nevi, and the number of common and/or atypical nevi. In this setting the atypical or dysplastic nevus syndrome associated with multiple atypical moles (+50) is strongly related to a higher risk of melanoma. Greene and colleagues1 estimated that a person with dysplastic nevi and at least two family members with melanoma had a 500-fold increased melanoma risk. Meta-analysis by Gandini et al. showed a significant correlation between number of nevi (common and atypical) and melanoma development.2 Furthermore atypical nevi count represents a highly significant predictive marker of melanoma risk.2 A systematic review has recently shown a large variation in recommendations for digital monitoring and exam intervals (ranging from 3 months to 12 months) and a lack of evidence-based guidelines regarding surveillance practices for highrisk patients.3 However, in this setting of patients, clinical and instrumental evaluations in specialized dermatological centers associated with lifetime clinical exams are widely recommended.3
