Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Dermatol. May 2, 2015; 4(2): 114-119
Published online May 2, 2015. doi: 10.5314/wjd.v4.i2.114
Identifying and managing naevus dysmorphia in clinical practice
Andrew G Affleck, Emma Wray, Zoë Chouliara
Andrew G Affleck, Dermatology Department, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
Emma Wray, ST1 in General Medicine, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, United Kingdom
Zoë Chouliara, Person Centred Care, School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh EH10 5LG, United Kingdom
Author contributions: Affleck AG and Wray E designed the report; Affleck AG and Wray E collected the patient’s clinical data; Affleck AG and Chouliara Z drafted then finalized the report and wrote the paper.
Ethics approval: N/A.
Informed consent: Signed consent forms from three patients for the use of images are available and are included with this submission.
Conflict-of-interest: No conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Andrew G Affleck, Consultant Dermatologist, Dermatology Department, Ninewells Hospital, Level 8, Dundee DD1 9SY, United Kingdom.
Telephone: +44-1382-660111-33004 Fax: +44-1382-633916
Received: September 29, 2014
Peer-review started: September 29, 2014
First decision: October 28, 2015
Revised: January 25, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: May 2, 2015

Naevus dysmorphia is a form of appearance concern/body image dissatisfaction, which describes a preoccupation with the appearance of a clinically small melanocytic naevus. The naevus is perceived by the patient to be disfiguring. Such perception leads to maladaptive behaviours and is often associated with low mood, as well as high levels of anxiety and social avoidance. Affected individuals form a diverse group. However, what they have in common is that the distress experienced is disproportionate to the objective visual appearance of the mole. There is a range of severity of the impact on the individual’s well being. Naevus dysmorphia may or may not be a cutaneous manifestation of body dysmorphic disorder (BDD). It is essential that patients with naevus dysmorphia are identified and distinguished from patients requesting removal of a mole for other uncomplicated cosmetic reason. Patients with naevus dysmorphia can be challenging to treat and communicate with. Surgical excision of the naevus will not address the underlying psychopathology and so it may not result in long-term positive outcome. Ideally, a detailed psychological assessment and formulation can be made potentially followed by psychological therapy tailored to the needs of the individual. A therapeutic trial of appropriate psychopharmacological course may be indicated in certain cases, e.g., when symptoms of a depressive disorder, anxiety disorder or BDD are present. A case series of 10 patients with naevus dysmorphia is presented, in order to highlight the above issues.

Keywords: Naevus dysmorphia, Body dysmorphic disorder, Body image dissatisfaction, Psychological distress

Core tip: Naevus dysmorphia is a form of body image dissatisfaction. A preoccupation with a simple melanocytic naevus that causes significant distress to the individual and impacts on their wellbeing are central features. Symptoms are often consistent with body dysmorphic disorder but the impact can be less severe. Patients tend to present to dermatology or cosmetic surgery requesting removal of a mole. An extended history is needed to fully assess the perceived “problem”. Excision alone will not necessarily address the underlying psychological issues. Liaison with clinical/health psychology and/or psychiatry can be desirable in individual cases.