Moles or Pigmented Nevi


A mole is a non-cancerous skin growth made up of cells (melanocytes or nevus cells) that produce color (pigment). They can appear anywhere on the skin, alone or in groups. Small
in size (less than 5 mm), well-circumscribed lesion with a well-defined border and a single shade of pigment from beige or pink to dark brown. Most or all of the individual patientís moles often are similar to each other with respect to color and size.


Moles are usually present at birth or appear early in life. In time they may grow larger. Although they may never make trouble aside from their unsightliness, some of them may become cancerous, spreading cancerous cells through the bloodstream to other parts of the body.


The life cycle of an average mole is about 50 years. As the years pass, moles usually change slowly, becoming raised and lighter in color. Often, hairs develop on the mole. Some moles will not change at all. Some moles will slowly disappear over time.

 


What causes a mole?
Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. These cells are called melanocytes, and they make the pigment that gives skin its natural color. Moles may darken after exposure to the sun, during the teen years and during pregnancy.


A few of these moles, called congenital melanonaevi, are usually present at birth. But most develop spontaneously or are caused by exposure to sunlight and tend to appear on those areas of the skin that catch the most sunlight. Most of these moles appear during the first 20 years of life, although they may continue to develop into the 30s and 40s. However, the majority disappear with age.

 

Types of moles

  • Congenital Nevi: Moles that appear at birth. Congenital nevi occur in about 1 in 100 people. These moles may be more likely to develop into melanoma than are moles that appear after birth. If the mole is more than 8 inches in diameter, it poses a significant risk of becoming cancerous.


  • Dysplastic Nevi: Moles that are larger than average (larger than a pencil eraser) and irregular in shape. They tend to have uneven color with dark brown centers and lighter, uneven edges. These moles tend to be hereditary, and people with dysplastic nevi may have more than 100 moles. People with dysplastic nevi have a greater chance of developing malignant (cancerous) melanoma. Any changes in the mole should be checked by a dermatologist to detect skin cancer.

  • 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.

  • Blue naevus: This deep-seated mole appears blue. It is very common in some West Indian infants but is only rarely of any significance.


Identifying a malignant mole :

The presence of moles is not a serious concern. but If there is a family history of malignant melanoma, you should be particularly vigilant about changing moles.

  • The mole is itchy and painful.

  • Increased size or an increasingly irregular appearance, especially at the edges.

  • A change in colour, particularly if the mole gets darker or becomes mottled.

  • Spontaneously bleeding.

  • Satellite pigmented lesions.

Treating moles
To treat a mole, first a biopsy (small tissue sample of the mole) is taken by a dermatologist so that thin sections of the tissue can be examined under a microscope. This is a simple procedure. If the dermatologist thinks the mole might be cancerous, cutting through the mole will not cause the cancer to spread. If the mole is found to be cancerous, the dermatologist will remove the entire mole.

 

There are two methods of removal:

  • Shave excision (shaving it off) Moles with an elevated surface typically are removed cosmetically by a process called shave excision. This involves numbing the area around the mole and removing the top portion of it so it is flush with the surrounding skin. A small scar usually results, which is usually cosmetically acceptable. If the mole had hair or was dark in color, these likely would remain. There is a chance that after this procedure the mole could re-grow.



    The mole cells below the cut surface of the removal site can also cause re-pigmentation of the removal site to a shade much darker than that of the removed mole. This re-pigmentation side effect is particularly problematic for patients with olive skin or dark eyes and hair. Mole re-growth and re-pigmentation occur more commonly in young patients and may result in the desire for re-removal.

  • Elliptical excision The cutting method of mole removal may be used for both normal and atypical moles. (Potentially cancerous moles are nearly always removed using this technique.) This procedure is often called elliptical excision because the mole, as well as the surrounding and underlying tissue, is removed in the shape of an ellipse, or oval. The entire mole is removed, both above and below the skin. A small medical blade may be used, or a laser may be chosen to reduce bleeding and allow for quicker healing time. If a blade is used, sutures (stitched) are used to close the incision if it is cut. If a laser is used, sutures will not be needed. After the procedure, a bandage is usually applied.

  • Laser treatment Some moles can also be removed with lasers instead of scalpels. Because lasers seal blood vessels and evaporate the tissues they remove, the need for cutting and sutures is eliminated. This may reduce scarring in some cases. After laser surgery, a scab forms and falls off within 2 weeks. The slight redness that is evident after the scab is gone will disappear in time.

If you see any signs of change in an existing mole, if you have a new mole or if you want a mole to be removed for cosmetic reasons, consult your dermatologist.

Who is an Ideal candidate for mole removal?

In general, the best candidates for mole removal are:

  • Fair skinned

  • Knowledgeable about the procedure

  • In good physical and psychological health

  • Wanting to improve their appearance and/or comfort

  • Realistic in their expectations

  • Not users of marijuana or anabolic steroids

  • Not heavy users of alcohol

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your surgeon if he/she considers you an ideal candidate for this surgery.
 

  • Tell your doctor about any allergies you have (to foods, drugs, environmental elements)

  • Tell your doctor about all medications you are taking (both prescription and non-prescription)

  • Carefully follow any instructions your doctor gives you.


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