Mole is a common benign skin lesion due to a local proliferation of pigment cells (melanocytes). They exist in all people and in both sexes. Some moles are present at birth (congenital), while others are developing during the first decades of a person’s life. (acquired). The number of moles a person has depends on genetic factors, on sun exposure, and on immune status. Moles vary in color from pink or to dark brown, steel blue, or black and may be either flat or protruding and usually have round or globular shape. Moles that are irregularly shaped and are under or around nails or near genitals should be monitored by a doctor for signs of melanoma. Some moles have a higher risk of becoming cancerous. Those include:
- Large or giant moles that exist since birth. These kind of moles, especially those with diameter larger than 20 centimeters, put patients at increased risk for melanoma. Every congenital mole should be examined by a doctor.
- Dysplastic moles. Moles with specific characteristics: large (> 5 mm); ill-defined or irregular borders; varying shades of color; with flat and bumpy components. Patients with more than 10 moles are 12% more likely to develop melanoma than the general population.
- Numerous Moles. If you have multiple moles, larger than 6mm in diameter, they are at higher risk of developing melanoma.
Melanoma is the most dangerous form of skin cancer, which usually appears as an asymmetric, irregularly colored, multi colored or brownish (as tanned skin) blotch that continues to grow in size over time. In rare cases, it may not be pigmented ( amelanotic melanoma).
If you are checking your moles to determine if they are cancerous follow the American Academy of Dermatology’s A-B-C-D-E guide:
- A for ASYMMETRY. Asymmetry of the mole that is if we divide the mole into vertical and horizontal axis in which case the right with the left and the upper part are not alike. So, moles that one half of the damage is different from the other half are potentially more dangerous.
- B for BORDER. The border in the periphery of the mole if it has finger-like or lacy-like appearance should lead us to the dermatologist for further examination.
- C for COLOR. The color of the mole, if not uniform and has a large variety (for example one or more combinations of black, brown, gray, blue, red and white) should motivate us.
- D for DIAMETER. The diameter of the mole, if over 5-6mm, is also considered a point for investigation.
- E for EVOLUTION. Change of ABCDs in a short term (months to years) should motivate us.
Other suspicious symptoms include:
- Scales or mild bleeding can signal melanoma.
- There is itching, tenderness or pain.
- The skin around the mole. Watch out the edema, redness or other colorations that spread to the skin near the mole.
Most moles do not need excision and only annual review from your dermatologist. But if you want to remove one for cosmetic reasons, this can be done with excision or shave biopsy. The surgery is usually done at your dermatologist/ plastic surgeon and lasts only a short time.
If your doctor diagnoses that your mole is cancerous, it should be surgically removed. The excision should be complete, with sufficient margins, and the excised mole should always be sent for biopsy. If a mole is suspicious of having atypical features, it should be surgically removed and a biopsy should be performed. In general, medical treatment depends on the features of the mole, the aesthetic effect of its removal and the patient’s psychological profile. Usually the mole doesn’t reappear. However, f this occurs, see your doctor immediately.