MOLES AND MELANOMAS
Moles (nevi) are tan or brown, raised or flat areas of the skin which have an increased number of melanocytes. Melanocytes are the cells in our body which make pigment and account for skin color.
Some moles are present at birth (congenital nevi), while others come up later in life (acquired nevi). The sun can stimulate the body to make more moles. Sunburns are not the only thing that triggers more moles. Chronic sun exposure can do it too.
Malignant melanoma is a type of skin cancer that can be deadly if it spreads throughout the body. The incidence of melanoma in theUnited Statesis growing faster than any other cancer. Melanoma usually grows near the surface of the skin for a period of time, and then begins to grow deeper into the skin. Once it grows deeper into the skin, the risk of spread to other organs greatly increases. Therefore, early detection and removal of a malignant melanoma can result in a complete cure; removal after the tumor has spread may not be effective.
Melanoma can often be suspected by its appearance. The ABCDE’s of melanoma are:
Asymmetry: Asymmetry means if you draw a line through the mole, the two halves do not match in color, size, shape, or surface texture. Asymmetry can be a result of rapid enlargement of a mole, the development of a raised area on a previously flat lesion, scaling, ulceration, bleeding or scabbing within the mole.
Border: The border of a melanoma often blends into the normal skin and does not sharply delineate the mole from normal skin.
Color: Different colors within a mole, or the development of dark black, blue, or red areas in a preexisting mole.
Diameter: Size greater than 0.6cm (1/4 of an inch, or the size of a pencil eraser). This is only a guideline, and many normal moles may be this large or even a bit larger.
Evolving: Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting
Melanomas should be considered when a mole suddenly appears or changes. Itching, burning, or pain in a pigmented lesion should cause suspicion, but most patients with early melanoma have no skin discomfort whatsoever. The appearance of a mole remains the most reliable method for identifying a malignant melanoma. Suspicious-looking moles may be removed for microscopic examination.
Melanoma can occur anywhere on the skin, including areas that are difficult for self-examination. Many melanomas are first noticed by other family members.Occasionally, melanomas appear as rapidly growing, blue-black, dome-shaped bumps within a previous mole or previous area of normal skin
Dysplastic moles are moles that fit the ABCDE rules of melanoma, but are not melanomas when examined under the microscope. They may indicate an increased risk of melanoma in that person. If there is a family history of melanoma, most experts agree that the person is at an increased risk for developing a melanoma. Experts still do not agree on what dysplastic moles mean in patients without a personal or family history of melanoma. Dysplastic moles are usually larger than common moles and have different colors within it with irregular borders. The appearance can be very similar to a melanoma. Biopsies of dysplastic moles may show abnormalities which are different from a regular mole.
Everyone can prevent death from melanoma by doing two simple things. First, avoid the sun and protect your skin when it is exposed to the sun. People who live near the equator, people who have intermittent exposures to large amounts of sun, and people who have had sunburns in childhood or adolescence have an increased risk for melanoma. Sun sense and sun protection are key to preventing melanoma.
Secondly, moles should be looked at regularly. Melanomas can be diagnosed early by self-examinations at home, looking for the ABCDE’s of melanoma. It is impossible to memorize the way every single mole looks, but if you look at your child’s moles once a month, you should notice changes. On the other hand, don’t check more than once a month or you might not notice a change. It’s like watching hair grow: when you see your child every day, you don’t notice his/her hair growing longer, but if your child returns from being away at camp for a month, you’ll notice the longer hair.
CONGENITAL PIGMENTED MOLES – (CONGENITAL MELANOCYTIC NEVI)
WHAT IS A CONGENITAL MOLE?
“Congenital Nevus” refers to a common brown birthmark that has an increased number of melanocytes, the cells that give skin color. The size of the nevus may vary from a small 1 inch mark to a giant birthmark covering half of the body or more. The size and location of the mole will determine the risk of it developing a melanoma and determine if surgical removal is possible.
HOW COMMON ARE CONGENITAL MOLES?
Small congenital pigmented moles (brown birthmarks) are present in 1 percent of all newborn babies. Giant congenital moles (larger than 8 inches) are rare, found in fewer than one in 20,000 newborn infants.
WHY ARE THEY SPECIAL?
Congenital moles have a risk of growing a melanoma, a dangerous and potentially deadly form of skin cancer. Small and medium sized congenital moles have a low chance of developing a melanoma. Experts agree that they have a low risk, but do not agree on how low that risk is. In general, small and medium sized congenital moles rarely develop a melanoma. If one does develop, it is usually after puberty. The decision of whether to surgically remove a mole depends on appearance of the mole, its location, and ease of removal. Depending on these factors, we may recommend removal in infancy, early childhood, puberty or continued observation of the mole. If your doctor suspects a melanoma, a skin biopsy is necessary.
It is important to inspect congenital moles on a regular basis at home. Some moles may need to be regularly followed by a dermatologist. Photographs may be helpful for your dermatologist to follow certain moles. TREATMENT
Treatment of congenital moles depends on appearance, size, and location of the mole; estimated risk for melanoma; and expected cosmetic outcome from removal.
GIANT CONGENITAL NEVI: A SPECIAL SCENARIO
Babies with giant congenital moles (greater than 7.5cm) have a high risk of developing melanomas. We estimate that up to 10% of children with giant moles may develop melanoma over a lifetime. Many of these melanomas will occur during the first ten years of life, so it is important that these giant moles be followed closely by a dermatologist. Sometimes, the dermatologist will recommend removal. We generally recommend early consultation with a pediatric plastic surgeon. There are different kinds of procedures that allow these large areas of skin to be removed and closure of the wound after the mole is removed. The options include skin grafting, artificial skin substitutes and tissue expanders.