She Wants to Whack all the Moles
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Joe R. Monroe, MPAS, PA, practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Physician Assistants.

A 57-year-old woman has been told she has “multiple skin cancers.” One mole is particularly worrisome to her. How can you help?

Question 1 of 1

Mole on back

A 57-year-old woman self-refers to dermatology for “multiple skin cancers” that she has been told she has. The lesions are scattered over her body—but one large mole on her upper back is particularly worrisome.

Her history includes removal, by shave technique, of a number of lesions from her trunk that she was told represented a type of melanoma. There has been no follow-up for any of them.

According to the patient, there is a family history of similar manifestations, but no resulting illness or death. She has had very little sun exposure in her lifetime—not even a sunburn or tan. She is otherwise healthy.

On her upper back is a 1.3-cm, nevoid, hair-bearing, brown ovoid nodule. Its surface is fleshy and raised slightly. The colors are somewhat irregular, though the configuration is symmetrical.

There are several similar—but smaller—lesions on the patient’s skin. She also has at least 20 scars, consistent with her history of past biopsies.

The large lesion on her back is removed by saucerization (deep shave) technique. The sample is sent to pathology, and the resultant report indicates a severely dysplastic nevus.

The next step to take would be

Excision with modest but clear margins

Reassurance only

Excision with wide margins

Referral to oncology

Clinician Reviews. 2019 December;29(12)

This quiz is not accredited for CME.

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