Moles – Skin Cancer
What are moles (nevus)?
Nevus (also known as moles) represent the clinical presentation of benign concentration melanocytes in the skin. Moles are present in all patients and most people have on their skin 50-100 moles. Moles appear in the first decades of life and are usually small brown to black lesions that are either flat or raised and have a round or oval shape. Moles are most commonly found in the exposed areas of the skin. Moles that are present during birth or shortly after are called congenital nevus
When should moles (nevus) be removed?
Usually there are two main reasons that a patient can have hir/hers moles removed at a dermatologist. First being a medical reason, i.e a moles is suspicious and has a high risk of possibility that it might covert to a skin malignancy- Dermatologist are the only specialist doctors that can determine if a mole is at a high risk to convert in a malignancy. The second most common reason, moles are removes is for cosmetic purposes e.g if a mole catches in a patients chain or bra, or there is a mole is in the face area and the patient does not consider it cosmetically acceptable its cosmetic appearance. Based on the reason a mole is removed, size, location, cosmetic area etc, Dr Sakka after examination will decide the type of surgical techniques that is more appropriate e.g. removal with the use of laser ή shave excision, punch excision, skin grafting etc.
Mole (Nevus. What are the different types?
There are many different types of moles and diagnosing each type is important as specific types are more at high risk in developing skin cancer and should be either monitored on regular basis or need to be removed for prevention.
Α. Congenital Nevus (Moles)
Congenital Nevus are moles that are present during birth or develop in the first year of life. Congenital Nevus appears about one in every 100 childbirths. Large congenital nevus are considered to be at a higher risk to develop into a melanoma (deadly type of skin cancer) they should be regularly examined and evaluated. Congenital nevus are classically classified according to size, i.e small sized (<1.5 cm), medium sized (1.5-19.9cm) and gigantic size (> 20 cm). The larger the size of a congenital nevus the higher the risk is develop into skin cancer (melanoma).
Β. Acquired Nevus ( Moles)
Acquired moles are moles that develop during the first decades of life. Medically they are classified into compound, junctional and intradermal nevus. Acquired nevus may flat or raised and can have a round or oval shave. Their colour can vary and can be light to dark brown or black.
C.Dysplastic Nevus or Clark’s Nevus
Dysplastic Nevus are moles that usually develop during the first decades of life (i.e acquired nevus)and display atypical features that are found in melanoma patients (i.e skin cancer). Dysplastic have a higher risk to develop into skin melanoma (melanoma is a malignant, deadly type skin cancer) hence it is important to be monitored. Typical dysplastic nevus are larger than 5 mm in diameter, might be raised, have irregular borders, non-homogenous colour and be surrounded by erythematous (red) border. Some dysplastic nevus may originate from acquired nevus or might develop de novo.
D. Other type of nevus moles. There are many other types of nevus and are mentioned by name.
- Halo Nevus
- Blue Nevus
- Becker Nevus
- Spitz Nevus
- Nevus of Ota – Nevus of Ito
- Nevus Comedonicus
- Nevus Sebaceous
Which patients are considered to be at high risk to develop skin cancer and should be regularly checked?
High risk patients should be examined regularly for prevention and also in order skin cancer to be ‘caught’ early. High risk patients are considered to be:
- Patients that have a fair skin colour (Phototype 1 and Phototype 2 classified by Fitzpatrick) have a fair hair colour(red or blond) and fair eye colour(green or blue)
- Patients that have more than 50-100 nevus
- Patients that have a family history of skin cancer or melanoma
- Patients that have a personal history of skin cancer or melanoma
- Patients that have nevus present at childhood (e.g lange congenital melanocytic nevus)
- Patients that have dysplastic mole syndrome. With this syndrome it refers to patients that have a large number of dysplastic (atypical) nevus on their skin surface.Atypical Nevus refers to nevus that are larger in size compared to common nevus, they do not have homogenous colour and have irregular borders. Dysplastic nevus tend to develop early in life and evolve during puberty. Dysplastic Nevus have a higher risk to develop into malignancy (6%) and the risk increases if there is a positive family history of dysplastic mole syndrome (15%). Hence it is essential dysplastic nevus to be monitored by a Dermatologist on regular intervals.
Moles (Nevus). How are diagnosed?
It is crucial, early diagnosis of dysplastic nevus to be established so that are monitored in order to prevent possible evolution into a melanoma (deadly type of skin cancer). There are many ways a Dermatologist can establish a diagnosis of a moles and below are methods used by Dr Sakka.
Α. Moles – Dermatoscope
For early diagnosis of a melanoma Dr Sakka uses a dermatoscope. A dermatoscope is a special instrument that is applied on the skin surface and on moles that a specialist trained Dermatologist can see morphological changes that are not visible with a ‘naked’ eye. With the use of a dermatoscope, early stage skin cancer can be detected.
Mole mapping is a method of recording dermatoscopic pictures of all the moles that a patient’s might have. Mole mapping uses digital photography, analysis and storage of the dermatoscopic pictures in a computer with the use of a specific software.
As digital dermatoscopic pictures are stored and can be used at any given time to check if each moles is changing in any matter and are evolving. Even small changes in moles can be easily detected as can be compared to digital dermatoscopic pictures. Early stages of skin cancer can be ‘caught early and be treated.
Mole mapping in high risk patients should be performed once a year. Patient that are considered high risk patients are and should have mole mapping performed are:
- Patients with a history of skin cancer
- Or patients that have a first degree relative with skin cancer
- Or patients that have multiple dysplastic moles or dysplastic mole syndrome
C. Mole –Biopsy
In cases that lesions removed by Dr Sakka share atypical features or if there is possibility of a malignancy, samples are sent for biopsy. Samples that are sent for biopsy are evaluated by pathologist and establish diagnosis at a cellular level.