Mikkilineni and Weinstock1 gave an excellent review of the usefulness of mole self-counting by patients. It would seem that this is especially useful when done by individuals in their second to fourth decades of life. However, the risk for melanoma of any patient must be considered within the context of the patient's genetic heritage, which offers an entry point into the patient's kindred for preventive cancer care.
From this inheritance perspective, the total-body mole count can have multiple interpretations of cancer risks depending on different histories of cancer in kindreds. After establishing that the patient (proband) has an abnormally high total-body mole count, the next steps in the kindred investigation include obtaining medical histories of (1) the presence or absence of atypical nevi in the proband, including previously removed moles; (2) the occurrence of any melanoma in the proband, including intraocular melanoma; (3) the occurrences of the 3 cutaneous phenotypes (atypical nevi, abnormally high mole counts, and melanomas) in first- and second-degree relatives; and (4) the presence of other primary systemic cancer phenotypes in the kindred. Depending on the collected data, a small pedigree may need investigation beyond second-degree relatives. It is imperative that the presence or absence of pertinent phenotypes be documented (by medical records and pathology and/or autopsy reports). Any cancer occurrence should be recorded with a specific cancer diagnosis and the pedigree position, sex, and age of the patient at recognition of the cancer.