Treatment recommendations for dysplastic nevi (DN), also known as atypical moles, have long been shrouded in controversy. Not often malignant and not even necessarily precancerous, these mysterious melanoma-like lesions nonetheless sometimes evolve into actual melanomas, and their very existence represents a heightened risk that the patient may sooner or later develop the disease. Thus, treatment approaches run the gamut: some physicians routinely remove all of them, while some prefer watching and waiting, excising them completely only when biopsies reveal cancerous cells. In our lead story, Drs. Kavitha Reddy and Gary Rogers discuss what factors must be weighed in deciding between watchful waiting and complete excision. Their recent research has offered some intriguing guidelines regarding which DN have a higher propensity for transforming into melanomas or harboring potential melanomas, with patients benefiting from complete removal, and which DN may be left alone and safely followed over time.
In our second article, Drs. Swetter, Clarke, and Keegan explore the reasons why men with melanoma die at a much higher rate than women with the disease. As they point out, men’s unawareness of and inattentiveness to melanoma’s early warning signs have typically been blamed for their higher mortality. But while these factors are certainly pertinent, leading to later detection, recent work by Swetter and colleagues has suggested that innate biological differences between the genders may also play a significant role. Female hormones possibly serve a protective purpose while male hormones may worsen the disease. Furthermore, women may naturally have a more successful immune response to melanoma. While the authors acknowledge that much further research is needed, their insights and hypotheses clearly deserve serious consideration.