Perkins Allen, Duffy R Lamar
University of South Alabama College of Medicine, Mobile, AL, USA.
Am Fam Physician. 2015 Jun 1;91(11):762-7.
Atypical moles are benign pigmented lesions. Although they are benign, they exhibit some of the clinical and histologic features of malignant melanoma. They are more common in fair-skinned individuals and in those with high sun exposure. Atypical moles are characterized by size of 6 mm or more at the greatest dimension, color variegation, border irregularity, and pebbled texture. They are associated with an increased risk of melanoma, warranting enhanced surveillance, especially in patients with more than 50 moles and a family history of melanoma. Because an individual lesion is unlikely to display malignant transformation, biopsy of all atypical moles is neither clinically beneficial nor cost-effective. The ABCDE (asymmetry, border irregularity, color unevenness, diameter of 6 mm or more, evolution) mnemonic is a valuable tool for clinicians and patients to identify lesions that could be melanoma. Also, according to the "ugly duckling" concept, benign moles tend to have a similar appearance, whereas an outlier with a different appearance is more likely to be undergoing malignant change. Atypical moles with changes suggestive of malignant melanoma should be biopsied, using an excisional method, if possible.
非典型痣是良性色素性病变。尽管它们是良性的，但具有一些恶性黑色素瘤的临床和组织学特征。它们在皮肤白皙的个体以及阳光暴露较多的个体中更为常见。非典型痣的特征是最大直径达6毫米或以上、颜色斑驳、边界不规则以及质地呈卵石样。它们与黑色素瘤风险增加相关，因此需要加强监测，尤其是对于痣超过50颗且有黑色素瘤家族史的患者。由于单个病变不太可能发生恶变，对所有非典型痣进行活检在临床上既无益处也不具有成本效益。ABCDE（不对称性、边界不规则、颜色不均、直径6毫米或以上、演变）记忆法是临床医生和患者识别可能为黑色素瘤的病变的宝贵工具。此外，根据“丑小鸭”概念，良性痣往往外观相似，而外观不同的异常者更可能正在发生恶变。如果可能，对于有提示恶性黑色素瘤改变的非典型痣应采用切除法进行活检。
