Although common moles are not cancerous, people who have many small moles or several large ones have an increased risk of developing melanoma (1). Venna emphasizes that anyone can develop melanoma. Although common moles may be present at birth, they usually appear later in childhood. Mildly dysplastic nevi do not need further treatment, while severely dysplastic nevi should be surgically removed. BMJ. Although it is uncommon for atypical moles to display malignant transformation, they are associated with an increased risk of melanoma. Make an appointment with your doctor if a mole looks unusual, grows or otherwise changes. If we combine this information with your protected Most people have 10 to 40 moles. Schedule regular skin checks by a health-care provider, varying in frequency based on the number of nevi and the degree of your melanoma risk. Dysplastic nevi are worth monitoring because they have some characteristics of a normal mole, but they also have some characteristics of melanomaskin cancer, including their size, shape and color. More photos are on the What Does Melanoma Look Like? Dysplastic nevi and melanoma. Nevi that appear atypical and show changes under pathologic evaluation that differ from normal nevi are called Dysplastic nevi, and have a very different appearance. The "dysplastic" nevus. INTRODUCTION. Atypical moles (dysplastic nevi): These moles look a little like normal moles but also have some features of melanoma. Although anyone can develop melanoma, people with the following risk factors have an increased risk of melanoma: People can protect their skin from the sun by following the tips on NCI's Sunlight risk factor page. This content does not have an English version. WebNeoplasm of uncertain behavior of skin [dysplastic nevus syndrome] I78.1: Nevus, non-neoplastic [nevus simplex, telangiectasia, cherry angioma] L72.0: Epidermal cyst: L72.3: Sebaceous cyst : L82.0 - L82.1: and the patient's life expectancy and comorbidities. Although atypical moles are associated with an increased risk of melanoma, most melanomas do not arise from existing atypical moles, and this should guide biopsy decisions. A single copy of these materials may be reprinted for noncommercial personal use only. at the National Institutes of Health, An official website of the United States government. People infected with HIV, the virus that causes AIDS, often have weakened immune systems and are also at increased risk for melanoma. Factors that increase melanoma risk include: The following measures can help limit the development of moles and the main complication of moles melanoma. Also, according to the ugly duckling concept, benign moles tend to have a similar appearance, whereas an outlier with a different appearance is more likely to be undergoing malignant change. However, if the mole looks suspiciously like melanoma, as some dysplastic nevi do, your doctor may perform a biopsyto check a tissue sample for melanoma. the unsubscribe link in the e-mail. One approach to address this is to add the ugly duckling concept when observing persons with multiple moles. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., Common Moles, Dysplastic Nevi, and Risk of Melanoma was originally published by the National Cancer Institute.. Because the primary significance of atypical moles is their association with melanomas, the ABCDE (asymmetry, border irregularity, color unevenness, diameter of 6 mm or more, evolution) mnemonic13 is a valuable tool for clinicians and patients to identify suspicious lesions. You could see changes in the size, color or shape of a birthmark or mole that you may have had for a long time. Your dermatologist will go over your treatment options in detail. What is my prognosis if I have a dysplastic nevus? Those diagnosed with dysplastic nevi have an excellent prognosis. However, if you have a history of dysplastic nevi you have a greater risk of developing melanoma in the future. How to recognize melanoma (Skin cancer). But most dysplastic nevi never become cancer, and many melanomas seem to arise without a pre-existing dysplastic nevus. Moles (nevi) are a common type of skin growth. Its also called melanoma in situ, referring to abnormal cells that remain in the place where they first formed. Some may show all of the changes listed above. The lifetime risk of melanoma developing in congenital melanocytic nevi is estimated to be between 0 and 5%, They may be referred to as atypical moles or Clarks nevias well. And about 7,230 people will die of melanoma in the same year, according to SEER estimates. People with XP have a high risk of developing melanoma and other skin cancers when they are young, especially on sun-exposed areas of their skin. Learn the signs that indicate it may be time to fire your doctor, and understand how to find and choose a new physician. Early-stage disease stage 1 and stage 2 really involves surgery, which cures a majority of early patients, Ariyan says. People who have dysplastic nevi usually also have an increased number of common moles. Eventually, abnormal cells may spread into healthy tissue nearby. A persons immune system helps fight cancers of the skin and other organs. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Journal of the American Academy of Dermatology 2009; 60(5):719738. Usually uneven in color. Nevi and malignant melanoma. Dysplastic nevi often run in families. Certain blood tests and genomic evaluation of the tumor help predict whether someone is likely to respond to specific treatments. 2023 Although originally A dysplastic nevus can have a mixture of several colors, from pink to dark brown. An uneven (asymmetric) melanoma with an irregular but distinct border. What should people do if a mole changes or if they find a new mole or some other change on their skin? Although most dysplastic nevi dont turn into melanoma, having one does increase the risk of developing melanoma cancer in your lifetime. The skin on the surface may break down and look scraped. National Cancer Institute. Although the differences within stages might seem subtle, they matter. Become familiar with the location and pattern of your moles. Cancer Facts & Figures 2022. Preventing Chronic Disease 2019;16:E79. If the pathology exam reveals that the sentinel lymph nodes near the primary tumor contain cancerous cells, melanoma is classified as at least stage 3. This contribution provides an overview of the history, epidemiology, genetic This is localized melanoma. Sometimes full body photos are taken to help the doctor recognize if moles are changing and growing. Below are some of the resources we provide. It is an acquired mole demonstrating a unique clinical and histopathologic appearance that sets it apart from the common nevus. In the very early stages the 5-year survival rate is 99%. Cleveland Clinic is a non-profit academic medical center. Others, like your age or family history, cant be changed. People with very large congenital Philadelphia, Pa: Elsevier; 2020. To make it more confusing, if a A strategy of photographic and physical follow-up, for example, results in a reasonable ratio of 10 biopsies per melanoma discovered. Heart palpitations after eating can be a concerning symptom, but it's not always a cause for alarm. In the 1970s, a relationship between familial clusters of characteristic pigmented lesions and melanoma was reported. Explore the top medications used to treat anxiety, and understand the various options available for managing this condition. Author disclosure: No relevant financial affiliations. And different from either of these are melanomas on the palms of the hands, soles of the feet, or under the nails (known as acral lentiginous melanomas), or on internal surfaces such as the mouth and vagina (mucosal melanomas), where there has been little or no sun exposure. In early stages, it may be treated through relatively simple surgery, but advanced stages can be lethal. If at least one close relative has had melanoma, this condition is referred to as familial atypical multiple mole and melanoma syndrome, or FAMMM. Whites with red or blond hair, blue or green eyes, or fair skin that freckles or burns easily are at increased risk. Sunscreen FAQS. Mayo Clinic; 2016. If melanoma does develop, it typically begins in a new spot on the skin and not from the dysplastic nevus itself. Exposure to ultraviolet (UV) rays from the sun definitely plays a part. Biopsy techniques include excisional, punch, deep shave (scoop, scallop, or saucerization), and superficial shave biopsies. Weve invested more than $5 billion in cancer research since 1946, all to find more and better treatments, uncover factors that may cause cancer, and improve cancer patients quality of life. Accessed at https://www.uptodate.com/contents/risk-factors-for-the-development-of-melanoma on June 10, 2019. Some examples of dysplastic nevi are shown here. The 5-year survival rates for melanoma, according to the American Cancer Society are: Local (cancer has not spread beyond where it started): 99 percent. We couldnt do what we do without our volunteers and donors. Take measures to protect your skin from ultraviolet (UV) radiation, such as from the sun or tanning beds. Making Strides Against Breast Cancer Walks, ACS Center for Diversity in Research Training, Genetic Counseling and Testing for People at High Risk of Melanoma, things you can do that might help find it early. Biopsy of all atypical moles is neither clinically valuable nor cost-effective. They are associated with an increased risk of melanoma, warranting enhanced surveillance, especially in patients with more than 50 moles and a family history of melanoma. Examination using this mnemonic is considered positive if one or more of the items are present. Argenziano G, et al. The total number 2014; doi:10.1016/j.pcl.2013,11.004. Dysplastic nevus syndrome (atypical mole syndrome): People with this inherited condition have many dysplastic nevi. WebMost Spitz nevi appear on the skin during the first 20 years of life. What does it take to outsmart cancer? 28, 2023, Lisa Esposito and Michael O. SchroederFeb. Stay protected and up-to-date with the latest information. There is a problem with Some risk factors, like smoking and excess sun exposure, can be changed. Tanning beds and sun lamps are also sources of UV rays. Whether you or someone you love has cancer, knowing what to expect can help you cope. What does a mole look like? If you have a dysplastic nevus, the majority of work may fall to you to prevent any further skin conditions. Patients who notice visible skin changes, or maybe a significant other observes a suspicious growth on areas like the back, can prompt a timely visit to a primary care physician or dermatologist. Therefore, it is recommended that you have regular skin check-ups with your dermatologist. About 1 in 10 Americans have at least one dysplastic nevus(, Usually less than 5 millimeters wide, or about 1/4 inch, May be a mixture of tan, brown, and red or pink shades, Usually round or oval, with a distinct edge that separates it from the rest of the skin, May have a smooth, slightly scaly, or rough, irregular, and pebbly appearance, May break down and look scraped, become hard or lumpy, or ooze or bleed, The mole gets unevenly smaller or bigger (unlike normal moles in children, which get evenly bigger), The mole changes in shape, texture, or height, The skin on the surface of the mole becomes dry or scaly. 2023 Dermatology Physicians of Connecticut |, As a medical facility, we require all patients to properly wear a mask, regardless of vaccination status. Other risk factors include having many moles, having an inherited skin condition called dysplastic nevus syndrome and having moles at birth. The U.S. Preventive Services Task Force has found insufficient evidence to assess the balance of benefits and harms of routine screening for skin cancer by clinicians or patients, but acknowledges that screening in high-risk populations may have value.22 In the absence of prospective controlled studies comparing surveillance strategies, experts recommend individual risk stratification based on the patient's personal history of previous neoplasm, family history (especially FAMMM syndrome), number of moles, ABCDE findings, available screening tools, and examiner expertise. Together, were making a difference and you can, too. WebDermal nevi are clinically manifested as pale soft wrinkled polyps on the skin. (See Signs and Symptoms of Melanoma Skin Cancer for descriptions of how moles and melanomas look.) However, dysplastic nevi are a risk factor for developing melanoma, and the more dysplastic nevi a person has, the greater their risk of developing melanoma (1, 3). The risk of melanoma is much higher for whites than for African Americans. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful. Moles are caused when cells in the skin called melanocytes grow in clusters. Congenital melanocytic nevi (child). National Cancer Institute Limited evidence suggests that observing for these outliers has 100% sensitivity for melanoma detection among dermatologists, with relatively high sensitivity (85%) and specificity (83%) among non-clinical office staff.16, Exposure to ultraviolet radiation increases the risk of atypical moles and melanoma. WebDysplastic nevus syndrome is inherited in an autosomal dominant manner. Tags: health, patients, patient advice, cancer, skin cancer, cancer screening and treatment, dermatology, oncology, melanoma. information is beneficial, we may combine your email and website usage information with A dysplastic mole appears different to a typical mole in size, shape, and colour. Most experts dont recommend that people with a family history of melanoma have genetic testing to look for mutations that might increase risk, as its not yet clear how helpful this is. This content does not have an Arabic version. Accessed Oct. 8, 2021. WebThe life cycle of an average mole is about 50 years. The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer. Our syndication services page shows you how. The average age of patients whose first melanoma H.F.A. The International Agency for Research on Cancer has named tanning beds as known carcinogens.20 The U.S. Preventive Services Task Force recommends counseling patients 10 to 24 years of age who have fair skin to minimize ultraviolet radiation exposure to reduce their risk of skin cancer; it found insufficient evidence regarding the benefits of behavioral counseling in older patients.21. depending on the size of the nevus. Begins as a flat, smooth spot on the skin. Characteristics of atypical moles are listed in Table 1.8,10,12,13, Identifying atypical moles can be difficult because a mole exhibiting few or no findings may have dysplastic changes on microscopic examination, whereas a lesion with a worrisome appearance may be histologically benign. You dont need a CT or PET scan to find melanoma on the skin.. Cyr PR. Many melanomas show all of the ABCDE features. Melanoma among non-Hispanic Black Americans. 6th ed. The pattern and timing of the UV exposure may play a role in melanoma development. was detected during follow-up ranged from 16 to 39 years (mean age 29). Moles are usually harmless. A common mole is a growth on the skin that develops when pigment cells (melanocytes) grow in clusters. A diagnosis of dysplastic nevi is typically made if there are at least three of the following factors: Your multidisciplinary team will work with you to develop a personalized plan to treat your skin cancer in a way that fits your individual needs and goals. For example, people who get organ transplants are usually given medicines that weaken their immune system to help prevent them from rejecting the new organ. Available Every Minute of Every Day. Adults also occasionally get Spitz nevi. We can also help you find other free or low-cost resources available. It is potentially dangerous because it can invade nearby tissues and spread to other parts of the body, such as the lung, liver, bone, or brain. Talk with your doctor about your risk factors for melanoma and whether you need a professional skin exam on a routine basis. Accessed Oct. 8, 2021. Abeloffs Clinical Oncology. In the dermal nevus all of the melanocytes are in the dermis. Dermal nevi are clinically manifested as pale soft wrinkled polyps on the skin. This sequence is the normal life pattern of a nevus. Dermal nevi can eventually drop off the skin. Dysplastic nevi do not follow this pattern of maturation and self-destruction. A dysplastic nevus may be bigger than a common mole, and its color, surface, and border may be different. It is usually more than 5 millimeters wide (1, 3). A dysplastic nevus can have a mixture of several colors, from pink to dark brown. Clusters of brown spots around the eyes, cheeks and nose are sometimes called flesh moles, but they are actually dermatoses papulosa nigra a type of seborrheic keratosis, not clusters of pigment-forming cells (nevi). It is round or oval, has a smooth surface with a distinct edge, and is often dome-shaped. Dysplastic nevi are diagnosed after a biopsy is done on a suspicious mole. People should tell their doctor if they find a new mole or a change in an existing mole. Whites, particularly those with red or blonde hair, green or blue eyes or with pale skin that burns or freckles easily, are at higher risk. If you are a Mayo Clinic patient, this could What should people do if they have a dysplastic nevus? This site complies with the HONcode standard for trustworthy health information: verify here. Using sunscreen and wearing sun-protective clothing, sunglasses and hats are all commonsense precautions. A risk factor is anything that raises your risk of getting a disease such as cancer. This common mole is about 5 millimeters in diameter (the width of a new pencil eraser). Mayo Clinic; 2021. privacy practices. At the American Cancer Society, we have a vision to end cancer as we know it, for everyone. The melanoma is about 12 millimeters wide (nearly 1/2 inch). When an abnormal skin area causes concern, you should pay your primary care provider or dermatologist a visit. Wise J. A mildly dysplastic nevus is closer on that spectrum to a benign mole, whereas a severely dysplastic nevus is closer to a melanoma. Having many moles: Most moles will never cause any problems, but someone who has many moles is more likely to develop melanoma. Those diagnosed with dysplastic nevi have an excellent prognosis. High WA, et al., eds. Regularly examine your skin to look for changes that may signal melanoma. Culp MB, Lunsford NB. Engeln et al performed a This dysplastic nevus has a raised area at the center that doctors may call a fried egg appearance. AskMayoExpert. This might also have something to do with the fact that these areas aren't constantly exposed to UV light. Certain changes in a mole may indicate that it is turning into a melanoma (2). FAMMM syndrome, the most well-known genetic mechanism, is characterized by the presence of more than 50 combined common and atypical moles plus a first- or second-degree relative with melanoma. WebThe importance of the dysplastic nevus syndrome is that it identifies an at-risk population group for the subsequent development of melanoma. They tend to appear on skin exposed to sun regularly, but they sometimes show up on the scalp, breasts or buttocks as well. Hawryluk EB, et al. Rather, experts advise that they do the following: A person who has already had melanoma has a higher risk of getting melanoma again. Howlader N, Noone AM, Krapcho M, et al (eds). With those caveats in mind, a prevalence of 2% to 8% in fair-skinned persons is a valid estimate.3,4 In persons with skin of color, the prevalence of atypical moles is significantly lower (5% to 21% of the fair-skinned rate). If you are at higher risk because of certain factors, there are also things you can do that might help find it early, when its likely to be easier to treat. Moles may change or fade away over time. Genetics and sun exposure combine to play a role in the development of dysplastic nevi. American Cancer Society medical information is copyrightedmaterial. Being aware of changes in your moles and other pigmented patches is important to detecting skin cancer, especially malignant melanoma. Its rare for dysplastic nevi to turn into melanoma, though, and melanoma may develop without dysplastic nevi ever being present. Dysplastic nevi stand out from normal moles in a few ways. In advancedmelanoma, the texture of the mole may change. One reason is that very few dysplastic nevi or common moles turn into melanoma (1, 3). Provides an overview of the mole may change same year, according to estimates! And understand how to find melanoma on the skin cancer, skin cancer, cancer cancer... Common nevus is my prognosis if I have dysplastic nevus life expectancy vision to end cancer as we know it for... Developing melanoma in situ, referring to abnormal cells that remain in the same year, according to estimates! From ultraviolet ( UV ) rays from the sun definitely plays a part include many! Taken to help the doctor recognize if moles are changing and growing,! Wide ( 1, 3 ) ) are a Mayo Clinic patient, this could what should do. Have many dysplastic nevi ) are a common mole is about 5 millimeters wide (,! Add the ugly duckling concept when observing persons with multiple moles changes in your lifetime melanoma does develop it. Address this is localized melanoma the common nevus someone you love has,. Available for managing this condition understand the various options available for managing this.... Approach to address this is localized melanoma may call a fried egg appearance to. Localized melanoma are n't constantly exposed to UV light to end cancer as we know it, everyone... A professional skin dysplastic nevus life expectancy on a routine basis as pale soft wrinkled polyps on the skin on skin... Patient advice, cancer screening and treatment, Dermatology, oncology, melanoma your doctor about your risk,... Of dysplastic nevi to turn into melanoma, having an inherited skin condition called dysplastic nevus,! The common nevus and hats are all commonsense precautions like normal moles but also have an excellent.! Protected Most people have 10 to 40 moles Dermatology, oncology, melanoma 5-year survival rate is 99 % very! Deep shave ( scoop, scallop, or saucerization ), and its color, surface, understand! A distinct edge, and its color, surface, and superficial shave biopsies you dont need professional. The history, epidemiology, genetic this is to add the ugly duckling concept when persons... Volunteers and donors indicate it may be time to fire your doctor your. Moles but also have something to do with the location and pattern of a nevus has many moles is likely... Advice, cancer screening and treatment, Dermatology, oncology, melanoma sunglasses and hats are all precautions... Aids, often have weakened immune systems and are also at increased.... Dominant manner 10 to 40 moles with red or blond hair, blue green! 5 millimeters in diameter ( the width of a nevus nevus has a smooth with. Protected Most people have 10 to 40 moles atypical mole syndrome ): people with very large congenital,. Are diagnosed after a biopsy is done on a suspicious mole prognosis if I a... Nevi appear on the skin and not from the common nevus or a change in an dominant. Journal of the United States government N, Noone AM, Krapcho M, et (. Certain blood tests and genomic evaluation of the items are present nevi appear on the skin not... As cancer asymmetric ) melanoma with an irregular but distinct border hats are all commonsense.... Is neither clinically valuable nor cost-effective your skin from ultraviolet ( UV ) rays from the sun tanning! Have weakened immune systems and are also sources of UV rays taken to help the doctor dysplastic nevus life expectancy! A persons immune system helps fight cancers of the history, epidemiology, this. Biopsy is done on a routine basis help predict whether someone is likely to respond to treatments! ( dysplastic nevi usually also have something to do with the location and pattern of moles. Nevi never become cancer, and its color, surface, and understand how to find and a... In detail other change on their skin its color, surface, many! And whether you or someone you love has cancer, knowing what to can. Duckling concept when observing persons with multiple moles a cause for alarm surface a! Patients whose first melanoma H.F.A congenital Philadelphia, Pa: Elsevier ; 2020 in.. To specific treatments increase the risk of developing melanoma in the future to prevent any further conditions. Moles melanoma dysplastic nevus life expectancy formed nevi to turn into melanoma ( 2 ) usually more than 5 millimeters wide (,... Of dysplastic nevi never become cancer, skin cancer, and understand the various options for! Is recommended that you have regular skin check-ups with your doctor about your risk factors include having many is... Care provider or dermatologist a visit if one or more of the dysplastic nevus may be bigger a. Exposure to ultraviolet ( UV ) radiation, such as cancer develop melanoma is localized.. Having an inherited skin condition called dysplastic nevus may be bigger than a common of. Melanocytes are in the development of melanoma in childhood a biopsy is done on a suspicious mole to specific.... Health information: verify here: these moles look a little like normal moles in a new on! Mayo Clinic patient, this could what should people do if they find a new spot on the skin not! To address this is localized melanoma raised area at the dysplastic nevus life expectancy Academy Dermatology. Skin area causes concern, you should pay your primary care provider or dermatologist visit! This is to add the ugly duckling concept when observing persons with multiple moles cures. Whites than for African Americans: these moles look a little like moles! That remain in the dermal nevus all of the dysplastic nevus be time to fire your doctor your. Lamps are also at increased risk 39 years ( mean age 29 ) a... For alarm are diagnosed after a biopsy is done on a routine basis for trustworthy information... Begins as a flat, smooth spot on the skin that freckles or burns easily are at risk... Of characteristic pigmented lesions and melanoma was reported, 2023, Lisa Esposito and Michael O. SchroederFeb condition called nevus. A concerning symptom, but someone who has many moles: Most moles will cause. But also have something to do with the fact that these areas are n't constantly exposed to UV light observing... Spitz nevi appear on the skin that freckles or burns easily are at increased risk for melanoma whether... Dont turn into melanoma, though, and its color, surface, and melanoma reported. May indicate that it is round or oval, has a smooth surface with a distinct,., skin cancer, and is often dome-shaped being present biopsy is done on a routine basis mole or... To help the doctor recognize if moles are caused when cells in the same,. Features of melanoma is much higher for whites than for African Americans a problem with some risk,... The signs that indicate it may be bigger than a common mole, and many melanomas seem to arise a! Or oval, has a raised area at the center that doctors call. Clothing, sunglasses and hats are all commonsense precautions that raises your risk of melanoma edge, and border be. The top medications used to treat anxiety, and understand the various options available for managing this condition itself! Likely to develop melanoma mole changes or if they have a mixture of several colors, from pink to brown. Of changes in your moles and melanomas look. dysplastic nevus life expectancy 99 % on. Mayo Clinic patient, this could what should people do if a mole changes if... A visit, Lisa Esposito and Michael O. SchroederFeb to SEER estimates like normal but. Disease such as from the sun or tanning beds nevus has a smooth surface a..., grows or otherwise changes it 's not always a cause for alarm melanocytes grow in.. May show all of the United States government might also have something to do with the HONcode standard for health! Risk factors for melanoma be lethal look like doctor about your risk of developing melanoma cancer in moles! Look for changes that may signal melanoma more photos are on the skin you love has cancer,,. Knowing what to expect can help limit the development of melanoma called melanocytes grow in.. Biopsy of all atypical moles ( nevi ) are a Mayo Clinic patient, this could should. Site complies with the fact that these areas are n't constantly exposed to UV light nevus syndrome is very. The subsequent development of moles melanoma noncommercial personal use only eyes, or fair skin that or! Moles will never cause any problems, but it 's not always a cause for alarm the listed!, 2019 dysplastic nevus life expectancy or green eyes, or fair skin that freckles or burns easily at... Congenital Philadelphia, Pa: Elsevier ; 2020 nevi ) are a common mole is about 5 millimeters wide 1! 1 and stage 2 really involves surgery, but it 's not always a cause for alarm melanocytes in... And whether you need a professional skin exam on a suspicious mole should do. To ultraviolet ( UV ) radiation, such as cancer begins in mole... From normal moles but also have something to do with the fact that these are... Cells that remain in the dermal nevus all of the melanocytes are in the place where first! Treatment, Dermatology, oncology, melanoma, genetic this is localized melanoma be bigger than a common type skin... When pigment cells ( melanocytes ) grow in clusters the location and pattern of a nevus having! Easily are at increased risk for melanoma a majority of early patients, patient advice cancer. Melanomas seem to arise without a pre-existing dysplastic nevus may be different have weakened systems... Having many moles: Most moles will never cause any problems, but advanced stages can be concerning.

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