Pathophysiology
- Junctional nevi: Flat, dark macules. Nevus cells at dermal-epidermal junction. Most common in children/young adults
- Compound nevi: Slightly raised. Nevus cells at both junction and dermis
- Intradermal nevi: Dome-shaped, flesh-colored. Cells entirely within dermis. Very low malignant potential
- Dysplastic (atypical) nevi: Irregular borders, mixed colors, >6 mm. Elevated melanoma risk, especially with family history
- Blue nevi: Blue-gray from deep dermal melanocytes. Generally benign
- Spitz nevi: Pink-to-red papules in children. Can mimic melanoma histologically
Signs and Symptoms
Hallmark Indicators
- Normal nevi: Symmetrical, well-defined borders, uniform color, diameter <6 mm, stable over time
- ABCDE warning signs: Asymmetry, irregular Border, Color variation, Diameter >6 mm, Evolving
- Suspicious changes: Bleeding, ulceration, rapid growth, surrounding satellite lesions
- "Ugly Duckling" principle: A mole that looks significantly different from all others on the body
Red Flags and Rule-Outs
- Any lesion meeting ABCDE criteria: Document and refer to dermatology
- Rapidly changing mole: Urgently refer — potential melanoma
- Bleeding or ulcerating mole: Do not massage. Refer immediately
- Distinguish from seborrheic keratosis (waxy, "stuck-on" appearance) and skin tags (soft, pedunculated)
MT Considerations
- Stable, benign nevi: No modification required — massage proceeds normally
- Suspicious or changing nevi: Avoid direct pressure/friction. Document and refer professionally
- Post-excision nevi: Avoid surgical scar until healed. Standard scar management thereafter
- Documentation: Chart location, size, and description of any suspicious lesion
- Client education: Mention importance of skin self-examination and annual dermatology checks for high-risk clients
- Never remove or disrupt any lesion — entirely outside MT scope of practice
CMTO Exam Relevance
- ABCDE criteria are the testable standard for evaluating suspicious nevi
- MTs observe extensive skin surface — skin assessment is within MT professional responsibility
- Document and refer suspicious lesions. This is observation, not diagnosis
- Stable nevi do not require avoidance. Dysplastic nevi with active change require medical assessment
- "Ugly Duckling" principle identifies outlier moles that warrant referral
Key Takeaways
- Nevi are common benign melanocyte proliferations. Most are stable and benign throughout life
- The ABCDE criteria and "Ugly Duckling" principle identify nevi warranting medical referral
- MTs observe large skin areas inaccessible to the client — professional skin observation is within scope
- Stable nevi do not require avoidance. Suspicious or changing nevi should be documented and referred
- Never attempt to treat, remove, or apply direct friction to suspicious lesions