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Dysplastic or atypical nevi are premalignant proliferations of melanocytes and are both a risk factor and a precursor for the development of melanoma. The ultimate goal of managing patients with dysplastic nevi is the prevention or early detection of malignant melanoma, thereby reducing the incidence of metastatic melanoma. Although metastatic melanoma is relatively uncommon, it is one of the most lethal malignancies and is the cause of more years of lost life than is any cancer except leukemia. Melanocytic lesions are among the most common neoplasms in humans; however, the distinction between benign and malignant lesions is often quite difficult even for the most experienced dermatologist. Primary and secondary prevention strategies should be implemented with populations at large and more specifically in patients with risk factors such as dysplastic nevi that put them at risk for the development of melanoma. Close clinical surveillance of such patients is essential to detect and treat melanoma in its earliest stages when it is most curable. Data support that melanomas detected by clinicians are diagnosed earlier than the lesions recognized by patients themselves. Therefore, recognizing populations at risk, identifying both clinical and histomorphologic features of risky lesions, and recognizing features of melanoma are a cornerstone of early detection.