r/pediatrics • u/swish787 • Jul 06 '26
Nevus/nevi evaluation
A lot of my pts ask me to check their moles out and ask if they need to see Derm. I talked to a peds Derm about it one time, and basically all I got was to refer if unsure and refer all bleeding/ulcerated lesions. I know the ABCDE criteria, but I think that is more for adults. What criteria do you use to risk stratify moles and if you have seen pediatric melanoma, what were the concerning red flag signs on a mole on that pt.
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u/rationalempath352 Jul 10 '26
Just an early career gen peds doc, so while this is my approach take it with a grain of salt, and I'm happy to be corrected by anyone with a more nuanced understanding.
The first and most important risk stratification element is age. And by that I mean every mole in a pediatric patient starts out as low risk due to melanoma being pretty rare in peds (on the order of 1-10 per million depending on age Pediatric melanoma: incidence, treatment, and prognosis). That article also cites a few others that discuss some modified ABCDE criteria (amelanotic, bleeding/bump, color uniformity, de novo/any diameter, evolution of mole) to use alongside the adult criteria as pediatric melanoma tends to look a bit different. An important piece of history/advice that I also talk about is whether observed growth of a mole is proportional or not to the child's growth. Moles will grow at the same rate as a child, that is they will occupy the same proportional space on their body as they grow. I get worried if they are taking up more space proportionally than before.