Moles

What is a mole?

A mole (or melanocytic naevus) is an abnormal collection of pigment cells present within the skin. These cells are known as melanocytes. Moles are extremely common. Most people are born with a few moles and develop others during their lives.

 

Moles can be round, oval, flat, or raised. They can occur singly or in clusters on any part of the body. Most moles are brown, but colors can range from pinkish flesh tones to yellow, dark blue, or black.

Everyone has at least a few moles. They generally appear by the time a person is 20 and resemble freckles at first. A mole's color and shape don't usually change. Changes in hormone levels that occur during puberty and pregnancy can make moles larger and darker. New moles may also appear during this period.

A mole usually lasts about 50 years before beginning to fade. Some moles disappear completely, and some never lighten at all. Some moles develop stalks that raise them above the skin's surface; these moles eventually drop off.

Types of moles

About 1-3% of all babies have one or more moles when they are born. Moles that are present at birth are called congenital nevi.

Other types of moles include:

* Junctional moles, which are usually brown and may be flat or slightly raised.

* Compound moles, which are slightly raised, range in color from tan to dark brown, and involve pigment-producing cells (melanocytes) in both the upper and lower layers of the skin (epidermis and dermis).

* Dermal moles, which range from flesh-color to brown, are elevated, most common on the upper body, and may contain hairs.

* Sebaceous moles, which are produced by over-active oil glands and are yellow and rough-textured.

* Blue moles, which are slightly raised, colored by pigment deep within the skin, and most common on the head, neck, and arms of women.

Dysplastic naevus syndrome

Some large moles have an irregular outline and an indistinct border. These carry an increased risk of malignancy and tend to occur in families who have a history of malignant melanoma. Patients with such moles need to have them examined regularly and compared with clinical photographs.

Halo naevi

Occasionally the skin surrounding a small mole becomes lighter and the central mole becomes pale. Most halo naevi are benign. But some people may have an increased risk of developing the skin disorder, vitiligo. Patients with malignant melanoma may, very rarely, develop halo naevi.

Juvenile melanoma (Spitz naevus)

In this condition, the pigment cells form a benign tumour, which is usually a pink-brown colour. Although similar to melanoma, the outlook following treatment is good.

Most moles are benign, but atypical moles (dysplastic nevi) may develop into malignant melanoma, a potentially fatal form of skin cancer. Atypical moles are usually hereditary. Most are bigger than a pencil eraser, and the shape and pigmentation are irregular.

Congenital nevi are more apt to become cancerous than moles that develop after birth, especially if they are more than eight inches in diameter. Lentigo maligna (melanotic freckle of Hutchinson), most common on the face and after the age of 50, first appears as a flat spot containing two or more shades of tan. It gradually becomes larger and darker. One in three of these moles develop into a form of skin cancer known as lentigo maligna melanoma.

At the consultation we will perform a mole skin check to see if the mole or skin lesion should be sent for testing (histology) to rule out anything suspicious.

The direct consequence of this is little or no scarring!

This surgery is ideal for any raised lesion on the skin - especially the face, due to the superior healing it offers. We are first clinic in the UK, and the only clinic in the South West England, to use this revolutionary new piece of equipment.

Why are moles a concern?

The main worry with moles is that a small number may go on to develop a condition called malignant melanoma. This form of skin cancer, which can be fatal, is best spotted early and treated with surgical excision (ie it is cut out of the skin).

Who is at risk?

The presence of moles will not cause you serious problems. But large numbers, more than 25, are an indication of susceptibility to melanoma. So you should take great care about exposure to sunlight.

If there is a family history of malignant melanoma, you should be particularly vigilant about changing moles.

What are the symptoms of malignancy?

A- Asymmetry: Normal moles or freckles are completely symmetrical. If you were to draw a line through a normal spot, you would have two symmetrical halves. In cases of skin cancer, spots will not look the same on both sides. The mole is itchy and painful.

B- Border: Increased size or an increasingly irregular appearance, especially at the edges.

C- Colour: A change in colour, particularly if the mole gets darker or becomes mottled.

D- Diameter:  Change in size. Spontaneously bleeding.

E- Elevation: Elevation means the mole is raised above the surface and has an uneven surface. Satellite pigmented lesions.

How is malignancy diagnosed?

Although most changes in the size, shape and colour of moles are due to a benign, non-cancerous increase in number of pigment cells, any mole that looks unusual should be examined. Your doctor will probably request information on recent changes to the mole along with a family history to assess your risk.

If only mild changes are found, your doctor will usually only need to take a clinical photograph of it. The mole's appearance may be reviewed in a later appointment. But if your doctor is concerned, an excision biopsy will be arranged, if necessary following a consultation with a plastic surgeon or a dermatologist.

Good advice

Avoid unnecessary exposure to sunlight, particularly during the two hours on either side of midday when the sun’s rays are strongest, and avoid getting sunburn.

Keep covered up in sunlight and apply sunscreen on exposed skin.

Examine your moles regularly and get someone to check those you cannot see.