Moles are very common small dark graying or brown lesions on the skin. Often the term nevus (single mole) or nevi (many moles) is used instead of moles. Moles appear brownish because of the presence of pigmented cells. Individuals with dark skin or complexion generally develop moles that are darker than people with fair skin. In the majority of cases, moles first appear during childhood. The number of moles an individual has does vary from 5-30. With advancing age, some of the moles may spontaneously disappear or fade. The majority of moles are benign and harmless. It is the rare mole that develops into a cancer. Nevertheless, all individuals who have moles should monitor them as this is one way of detecting the dreaded melanoma.
The majority of moles are dark brown or gray in color but moles can be of many shapes, size and colors. Some moles may be blue, red, tan or even pink. In addition, the texture of a mole can vary from wrinkled, rough or smooth. While most moles are flat, some may even be raised. In rare cases, moles may even have hair growth. The mole shape can vary from round to oval. The size of a mole is also variable. Most moles are less than 5 mm in diameter or the size of a tip of a pencil. However, some moles can be large especially those that occur in newborns. These moles may cover the entire limb, back or the face.
Moles can occur almost anywhere on the body. However, the most common sites are the face, underarm, under the nails, scalp, chest and between the web spaces of fingers and toes. Most people have 5-30 moles which develop before the third decade of life. While in most cases moles remain unchanged in size or color, some may disappear with advancing age or fade with time. During teenage growth and pregnancy, moles tend to be become larger and darker primarily because of the influence of hormones.
Melanoma is a rare type of skin cancer that develops from the pigmented cells, called melanocytes. Melanoma is a dangerous cancer because unlike other skin cancers, it tends to invade the adjacent tissues and spreads to other parts of the body (eg brain, eyes, liver) very quickly. The earlier melanoma is identified, the better the prognosis. There are several types of melanoma and they usually occur on parts of the body exposed to the sun. Melanomas can also develop from moles in rare cases. In rare cases melanoma may develop in the eye, underneath the nail and in the intestine. In men, melanoma is most frequently observed on the neck, back and head area, whereas in women, it is often found on the legs or back. Melanomas tend to be most common in Caucasians and in people with fair skin. In African Americans, melanoma may occur under the nails or the sole of the foot.
Everyone who has a mole should be educated on how to monitor a mole. When a stable mole develops the below features, one should be suspicious about development of a melanoma. The following ABCDE mnemonic is used to assess moles for cancer:
Moles are usually treated by a skin doctor (dermatologist). However, stable moles may be followed by a general practitioner.
Moles develop when the pigmented cells in the skin, the melanocytes, form into a group or a cluster. Because melanocytes produce the pigment melanin, most moles are dark in color.
The chief complication of moles is development of a melanoma.
Some people with moles have a slightly higher risk of developing a melanoma from a mole. These factors include: – Having a large mole since birth. Moles acquired at birth are referred to as congenital nevi. In general, large moles have a slightly higher risk of becoming cancerous compared to smaller moles. – Having an unusually shaped mole. Also known as dysplastic moles these moles run in families and often have irregular borders that are light in color. Dysplastic nevi can occur on any part of the body but tend to be more common in areas of skin that is exposed to sun. However, some dysplastic nevi can also occur in non-sun exposed areas like the back and blow the waist line. The majority of dysplastic nevi do not turn into a cancer but in individuals with more than 5 dysplastic nevi, the risk of melanoma is high. The more dysplastic nevi an individual has, the greater the risk for melanoma. – Individuals with more than 50 moles have a higher risk of melanoma than those who have less than 20 moles. – Individuals with a family history of melanoma.
When there is a change in your mole, the healthcare provider cannot tell if it is a cancer or a melanoma by just looking at it. However, before proceeding to a biopsy the healthcare provider will do a thorough check of your skin. The biopsy is done in the office and is relatively painless; the tissue obtained is then looked underneath a microscope to look for cancer cells.
The majority of moles need no treatment except observation. Your healthcare provider will only perform a biopsy if he or she suspects that there may be a cancer. Moles may also be removed if they are in an area of your body where they are causing problems. For example a mole on the face may repeatedly bleed during shaving or a mole in the groin area may be prone to friction from clothes. Removal of a mole requires a small surgical procedure done in the doctor’s office. Over the years, many different techniques have been developed to remove moles and the type of technique depends on where the mole is located on the body, the size and doctor experience.
Hair on moles may also reflect poor cosmesis. In such cases, the hair may be plucked with tweezers, removed with a depilatory agent or a laser. Anytime you irritate a mole, you have to observe it to ensure it does not change into something more sinister or becomes infected.
There is no way of preventing moles because most are acquired at or after birth. However, one must observe the mole to ensure that it does not turn into a melanoma. Become familiar with your mole and regularly examine it for changes. Take a picture so that you can compare it later on. Use a mirror to look at your back and closely examine the web spaces between your fingers and toes. If you have numerous moles (> 30), see a skin doctor once every 12-24 months to have a thorough check up.
There are several things you can do to protect the moles and your skin.