Mole Dermatology

Concern about moles is one of the most common reasons for visiting a dermatologist.

Moles are pigmented skin growths medically known as nevi. Moles are usually brown but can vary in color (skin colored to pink to light brown to dark brown to blue to black). Moles can be present at birth, but most moles develop during childhood until the age of 20. Some people have many more moles than others—the average person has 10- 40 moles.

Moles are made of cells called melanocytes. Melanocytes are found scattered throughout our skin and are the cells that make our skin become tan by generating a pigment called melanin. A mole is made of many melanocyte cells clustered together. When a mole becomes cancer it is called melanoma.

What is normal for a mole?

Moles can be found anywhere on your skin, including your scalp, nails and genitals. (Moles can grow in areas of skin that are not exposed to the sun.)
Moles can be flat or raised.
Moles often grow slowly and become more dome shaped or raised with age.
Hair in a mole is normal
New moles develop during childhood until the age of 20
Moles darken during times of hormonal change (adolescence, pregnancy, birth control pills)

When should I be concerned about a mole?

When it is an “ugly duckling”. No other mole on your body looks similar. It is different from your other moles.
New mole develops after age 20.
Pain.
Itching or burning.
Bleeding.
Rough, scaly or crusty texture.
“A” asymmetric shape (if you cut it in half and one side is different from the other).
“B” irregular border (scalloped or ill-defined border).
“C” variegated or uneven color.
“D” diameter greater than a pencil eraser (6mm, ¼ inch).
“E” evolving or changing mole.

How is a mole evaluated at the dermatologist?

Moles are looked at by your dermatologist. Your doctor will examine your skin, comparing one mole to the next, looking for the “ugly duckling” or stand-out mole. During your exam, point out any moles that you are concerned about. Your doctor may use an instrument that illuminates and magnifies the mole called a dermatoscope.
If a mole is suspicious, a biopsy will be done. This involves numbing the affected skin and removing a small area to determine under the microscope if the mole is abnormal. Your biopsy may or may not require stitches. Wound care instructions will be provided at the time of your biopsy.

Post Surgical Care Sheet

What happens after a biopsy?

Results are usually available within one – two weeks. You will be contacted by phone or mail.
- Normal moles: No further treatment is needed. If your entire mole was not removed with the biopsy, some color may persist or recur at your biopsy site
- Abnormal moles: This includes a variety of terms including “atypical” or “dysplastic”. These moles are not cancer and may or may not need to be removed completely. Your doctor will recommend treatment based on the specifics of your results. Mole removals will be done in the dermatology office and usually involve stitches. Annual full body skin exams are often recommended for patients with a history of abnormal moles as this diagnosis may increase your risk for melanoma.
- Malignant melanoma: This is the most concerning type of skin cancer. Expect that you will need to have skin surgery to remove the melanoma as well as a margin of normal skin surrounding the melanoma as soon as possible. Most often this surgery will be completed in the dermatology office. In some cases you will be referred for further evaluation of your lymph nodes at the time of your skin cancer removal. If this is the case, you will have your surgery at the hospital. Learn more about Malignant Melanoma.

What should I do at home for prevention?

Monitor your moles by examining your skin carefully, including areas of skin not exposed to the sun, on a monthly basis.
Avoid tanning and do not use UV tanning booths.
Avoid burning.
Use sunscreen: a broad spectrum SPF 15+ sunscreen that has coverage for both UVA and UVB. Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours—more frequently if in water or sweating.
Seek shade, especially at times of peak sun between 10 AM and 4 PM.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Have your primary care doctor examine your moles and provide a skin cancer screening at the time of your annual physical. If moles are concerning they can refer you to the dermatologist for further evaluation.

What if I have a mole that I want removed?

Mole removals are a common procedure performed by dermatologists.
Mole removals can be done for medically necessary reasons
- Your doctor determines it is suspicious for skin cancer
- Your mole is symptomatic (bleeds with shaving, painful from rubbing on clothing…)
Mole removal can also be done for cosmetic/appearance reasons. This is not covered by insurance. You can discuss this option with your doctor at the time of your visit.

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References:

Moles. The Merck Manuals: The Merck Manual for Healthcare Professionals.
Accessed Sept. 13, 2010.
What you need to know about moles and dysplastic nevi. National Cancer Institute.
Accessed Sept. 13, 2010.
Abbasi NR, et al. Early diagnosis of cutaneous melanoma: Revisiting the ABCD criteria. Journal of the American Medical Association. 2004:292;2771.
Moles. American Academy of Dermatology. http://www.aad.org/public/publications/pamphlets/common_moles.html
Accessed Sept. 13, 2010.
Moles. Mayo Clinic. http://www.mayoclinic.com/health/moles/DS00121
Accessed Sept 13, 2010.
Grichnik JM, et al. Benign neoplasias and hyperplasias of melanocytes. In: Wolff K, et al. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2982281
Accessed Sept. 13, 2010.
Prevention guidelines. The Skin Cancer Foundation.
Accessed Sept. 13, 2010.