Atypical moles can be distinguished visually by clinical features of size greater than 6 mm in diameter, color variegation, indistinct borders, and textured surface. All patients who have atypical moles should be counselled about sun avoidance, screening of family members, and regular skin checks at least once per year. Total body photography and dermoscopy can aid in regular skin monitoring for changes in atypical moles and the emergence of new lesions. The presence of multiple atypical moles increases the risk of melanoma. The greatest risk of melanoma is in patients who have more than 50 atypical moles and two or more family members with melanoma (familial atypical mole and melanoma syndrome). Atypical moles should be removed when they have features suggestive of malignant transformation. Elliptical excision is the preferred removal technique. Removing all atypical moles is neither necessary nor cost effective.