Silva JH et al. the protocol followed by the Dermoscopy Clinic of the Skin Oncology Department of Hospital AC Camargo, risk patients are reevaluated 3 months after the first visit, with a third evaluation 6 months after the last one, followed by annual tracking. In a survey including risk patients who underwent their first examination between March 2003 and November 2007, a total of 255 patients were observed, 53 of whom presented with AMS. 14,307 lesions were followed- up and 355 showed changes over time (2.5%). Of these, 10 lesions were diagnosed as cutaneous melanoma, all pre- senting a thickness under 1 mm, including 5 in situ melanomas. The main risk factors associated with malignant transformation were personal history of melanoma (OR 11.3) and AMS (OR 5.1) (unpublished data). Any suspicious lesion and/or significant change should be considered for biopsy, preferably by excision with conservative surgical margins (2 mm) providing adequate samples for histopathological evaluation.3,8 Non-surgical alternatives such as topical 5-fluorouracil, systemic isotre- tinoin, topical tretinoin with or without hydrocortisone, topical imiquimod and laser ablation are not effective or safe for the removal of suspicious lesions and are not recommended.8,52. Education of patients with dysplastic nevi or AMS in self-examination of the skin is relatively simple and inexpensive, and some studies have suggested increased detection of thin melanomas or greater survival in patients who performed self-examination in comparison with those who did not.18 Slade et al.3 recommend self-examination of the skin every 2 to 3 months. Given the increased prevalence of uveal melanoma in patients with AMS, some authors recommend routine annual assessment by an ophthalmol- ogist.53,54 Ultraviolet light is known to be ‘‘nevogenic’’ and appears to contribute to the emergence of dysplastic nevi.3,55 Furthermore, UV radiation acts as an initiator and promoter in the process of malignant transformation of melanocytes.3 It was demonstrated that patients with hereditary AMS have reduced abilities to repair DNA damage induced by ultraviolet light.56,57 Therefore, the patient should avoid exposure to sunlight or artificial ultraviolet light (such as tanning beds) and use physical protection in the prevention of sunburn.3,18 Although it has not been documented that the use of sunscreen prevents the emergence of dysplastic nevi or decreases the risk of developing melanoma, it has been shown that a sunscreen with a Sun Protection Factor of at least 15 reduces the incidence of actinic keratoses and decreases the development of melanocytic nevi.3,18 The patient must be advised not to use sunscreen in order to prolong exposure, which may in fact increase the risk of developing melanoma.3,19 Prospective studies show that the risk of melanoma in families of patients with AMS is considerable.32 In addition, many patients initially considered as having sporadic AMS actually belong to families with AMS.3 Therefore, it is recommended that first-degree relatives of AMS patients be examined by a dermatologist for the presence of dysplastic nevi, AMS or melanoma. Because carriers of AMS and FAMMM evidence an association between melanoma and other internal malig- nancies (pancreatic neoplasia, central nervous system tumors, breast cancer)3, evaluation by a specialist is there- fore recommended in the case of suspected symptoms in these patients. 498 CLINICS 2011;66(3):493-499 Currently, there is no scientific basis for performing genetic testing in AMS patients except in research proto- cols.18,58,59 CONCLUSION AMS demonstrably increases the risk of developing melanoma, a malignant neoplasm for which incidence have increased significantly in recent decades and for which early diagnosis is of great importance in the prognosis of the disease.4,59 The identification of patients with AMS, the main clinical risk factor, allows them to be included in short and long term monitoring programs, aimed at early detection of suspicious lesions and the consequent reduc- tion in mortality associated with advanced melanoma.42 In addition, a prevention program could contribute to increased awareness and changes in risk behavior, mini- mizing the environmental risk not only for patients but also for their families. 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