A 34-year-old white roofer requests evaluation of a pigmented spot on his back, which he states is larger than his other moles. Although he currently practices reasonable sun avoidance and protection, in his youth he often worked without a shirt. Examination reveals a total of approximately 25 nevi scattered over his back, shoulders, and chest. These nevi show varying stages of maturation but nevi of similar stage resemble one another. The larger lesion is on his right scapular area. It is oval and measures 7 x 8 mm. The margin is sharp and even. The color is a uniform red-brown. The center is slightly raised on palpation but the skin lines are retained over the surface. There is no scale or other epidermal change.
1. What history questions should you ask this patient?
2. What should you ask this patient about the evolution of the larger lesion?
3. What are the primary lesions that you would expect to find in common benign nevi?
4. What are the secondary lesions that you would expect to find in common benign nevi?
5. Does this patient's physical exam suggest a form of atypical mole syndrome, and if so, why?
6. What should you tell the patient about the larger nevus?
7. Should the larger lesion be biopsied?
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