You see a mole on your skin that just looks... different. It's bigger than your other moles, doesn't have a regular shape, or has more than one shade of brown. Skin cancer is the first thing that comes to mind for anyone in this situation. Most of the time, atypical moles aren't cancerous, but they are a very important sign. A dysplastic nevus, also called an atypical mole, is a sign that you are more likely to get melanoma in your life. To manage this risk, you need to work closely with your doctor over a long period of time. Direct Primary Care (DPC) is the best place for this proactive and personalized skin monitoring.
A dysplastic nevus is a mole that looks different on the outside and under the microscope. People think they are in a "gray area" between a mole that is completely normal and a melanoma.
They are NOT cancer, but they ARE a very important risk factor.
The most important thing to know is that if you have one or more dysplastic nevi, you are more likely to get melanoma at some point in your life. This higher risk is twofold: first, a dysplastic nevus has a small chance of turning into a melanoma; second, people with unusual moles are more likely to get a new melanoma on another part of their skin. If you have 10 or more atypical moles, your risk of getting melanoma is 12 times higher.
The ABCDEs of Melanoma:
Knowing the signs of melanoma is the best way to keep an eye on your skin. Keep the ABCDEs in mind:
Asymmetry means that one half of the mole doesn't match the other half.
Border: The borders are not straight, are scalloped, or are not well-defined.
Color: The color changes from one area to another; it can be brown, tan, black, or sometimes white, red, or blue.
Diameter: The mole is bigger than a pencil eraser, which is about 6mm in diameter.
Evolving: The mole is getting bigger, changing shape, color, or is a new lesion.
Direct Primary Care (DPC) is a membership-based model that gives patients unlimited, direct access to their doctor. The DPC model's focus on prevention, access, and in-office procedures is a game-changer for keeping skin healthy and lowering the risk of melanoma. This is why DPC is the best option for this condition:
Long-term, proactive skin monitoring:
DPC is made to stop things from happening and find them early.
Total Body Skin Exams (TBSE) once a year: During your annual physical, your DPC doctor has time to do a full skin exam from head to toe. This is something that is often skipped in a quick 15-minute visit.
The Strength of Continuity: A doctor who has seen you year after year and knows your "map of moles" is in the best position to find a new or changing lesion that is hard to see.
Easy, in-office biopsies:
DPC can quickly and cheaply answer questions about a mole that looks suspicious.
A "See and Biopsy" Method: A lot of DPC doctors are very good at doing simple skin procedures. During the same visit, they can find a mole that looks suspicious and do a skin biopsy in the office, such as a shave or punch biopsy.
Avoiding the Runaround: This saves you time, trouble, and a lot of money on a separate dermatology referral and procedure fee just for a simple biopsy.
A Partnership in Making Decisions Together:
The management approach following a biopsy result indicating "dysplastic" can be complex.
A Deep Conversation: Your DPC doctor has the time to sit down with you and talk about your pathology report in detail.
A Plan Just for You: They can talk about what the best next step is and make a decision together. If a mole is slightly unusual and has clear edges, the best thing to do is usually to watch it. If the mole is very atypical, it might be best to refer it for a full re-excision. You and the other person make this choice together, taking into account your own risk factors and comfort level.
Case 1: Jessica, 42, has a lot of unusual moles and a family history of melanoma. As part of her physical, her DPC doctor checks her skin all over her body every year. The doctor sees a mole on her back that looks a little different than it did last year during one visit. That day, the doctor does a shave biopsy in the office. The result is a nevus that is moderately dysplastic and has clear edges. Jessica has a long telehealth visit with the doctor to go over the results, reassure her, and remind her of their plan to keep a close eye on her.
Case 2: David, 58, has a mole biopsied by his DPC doctor. The lab report says that it is a "severely dysplastic nevus with positive margins." The doctor tells David about the result and then personally calls a trusted local dermatologist to speed up the referral process. This makes sure that David gets the best care possible.
Q: I have a mole that isn't normal. Is this a sign that I will get melanoma?
A: Not always. This just means that your overall risk is higher than someone who doesn't have any unusual moles. Because of this, you need to be more careful about protecting your skin from the sun and checking it regularly. Most of the time, individual dysplastic nevi don't turn into melanoma. Regular checkups are the most important thing to do to catch any new or changing spots early.
Q: My biopsy showed a "moderately dysplastic nevus," and my doctor isn't suggesting any more surgery. Is that a good idea?
A: Yes, in a lot of cases. For mildly or moderately atypical moles where the first biopsy took out the whole visible lesion and the pathology report shows clear margins, modern evidence supports that observation is a very safe and appropriate approach. This keeps you from having to have a second procedure that isn't needed. You should talk to your DPC doctor about this decision because it's not an easy one.
Q: Is it possible for my DPC doctor to take care of all my skin care needs?
A: DPC doctors are very good at handling most common skin problems, such as doing routine skin exams and simple biopsies of suspicious lesions. For patients who are at very high risk (for example, those who have many unusual moles and a strong family history of melanoma) or who need complicated surgical excisions, they will work with a dermatologist and send you to them for specialized care.
DPC is a clear advantage for patients who are worried about their skin health and the risk of melanoma because it is very good at proactive, long-term surveillance. The DPC model of continuity is the best way to do regular, thorough skin exams on the whole body, which are the most important part of preventing melanoma.
Offering easy and cheap procedures in the office: Often able to do the skin biopsies that need to be done right in the office, which saves patients time, money, and trouble by not having to see a specialist.
Making real shared decision-making easier: DPC's gift of time gives us the chance to have the detailed, evidence-based conversations we need to choose the best management plan after a biopsy.
An unusual mole doesn't mean you have cancer, but it does mean you need to keep an eye on your skin health for the rest of your life. You need a partner who will watch over you for the rest of your life to do that. Direct Primary Care gives you the proactive skin checks, personalized risk assessment, and trusted advice you need to keep your skin safe and live without worry.
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