A mole - can a change be dangerous?

Usually it is someone else who notices. Your partner at the beach, your hairdresser while washing your hair, someone at the pool: "listen, has that mole on your back always looked like that?".

And from that moment the thought keeps coming back. Did it? Didn't it? Is it darker than last year, or does it only seem that way now?

It is a good question and it is worth asking it all the way through — at the doctor's. Because with moles the point is not for you to make the diagnosis yourself. The point is for you to notice at all that something has changed.

Where moles come from

A mole is the everyday name for a pigmented nevus. Every one of us has them on our skin.

It forms where an excess of dark pigment — melanin — is deposited in the skin. It is produced by the skin's pigment cells, the melanocytes. When melanin forms a cluster, we see it through the skin as a mole.

The mere fact that a nevus exists does not mean anything bad. Only its features determine whether a dermatologist will consider it benign or suspicious.

Congenital and acquired — two different worlds

Pigmented nevi are divided into congenital and acquired.

Congenital ones have existed since birth. The small ones are common — about 1–2% of newborns have them and observation is usually enough. What is rare are large and giant nevi: single, uniform in color and with a papular surface, often covered with hair — and it is these that need to be looked after by a specialist.

Acquired ones are not present right after birth. They develop later in life and can be benign (typical) or atypical (dysplastic). And it is precisely this division that matters.

A benign nevus versus an atypical nevus

These two types look like each other's opposites. The table below shows how they differ.

• Shape — regular, symmetrical · asymmetrical.
• Border — even · uneven.
• Pigment — evenly distributed · areas of differing colors.
• Size — — · larger.
• Appearance over time — stable · changing.
• Additionally — — · may bleed, may protrude above the skin surface.
• Cancer risk — very small · may be the basis for the development of malignant tumors.
• What to do — regular observation, and a specialist consultation if needed · an urgent visit to a dermatologist.

Benign nevi mostly appear in childhood, and their number increases during puberty and early adulthood — under the influence of hormonal changes. This is normal.

With atypical nevi there is one more thing worth knowing: a scratched mole may heal poorly. If that happens, do not wait for it to "go away on its own".

⚠️ When not to put off the visit

This is the most important part of this text.

See a dermatologist as soon as possible if the mole:

• is asymmetrical
• has an uneven border
• has several colors within a single nevus
• has a diameter exceeding 6 mm
• is changing — growing, darkening, changing shape
• bleeds
• has been scratched and is healing poorly
• worries you for any other reason

The last point is not filler. Worry is reason enough. A visit takes a dozen or so minutes, while putting it off can take years.

There is also a type of melanoma that escapes this list. It can be symmetrical, evenly coloured, with a regular border and smaller than 6 mm, and yet it is dangerous, because it grows quickly into the depth. It is recognised by three other features: it is raised above the skin, firm to the touch and gets bigger over weeks, not years. A nodule that has appeared recently and is clearly growing is a reason to see a doctor regardless of whether it fits ABCDE.

ABCDE — five letters worth remembering

It is impossible to tell melanoma from an ordinary mole with the naked eye. A certain diagnosis can only be obtained after a histopathological examination — that is, after examining the specimen under a microscope.

There are, however, several features that can help in differentiating them. They are easy to remember, because their English names form the acronym ABCDE:

• A — asymmetry · asymmetry of the lesion's shape.
• B — border · irregular border of the lesion.
• C — color · several colors within a single nevus.
• D — diameter · a lesion diameter exceeding 6 mm, roughly the size of the eraser on the end of a pencil.
• E — evolution · the evolution, the dynamics of the lesion.

It is important to understand properly what ABCDE is for. It is not a test that lets you determine on your own whether you have melanoma. It is a list suggesting what should catch your attention and prompt you to book an appointment. The diagnosis is made by a doctor — and the final answer comes from the histopathological examination.

To ABCDE it is worth adding one more observation, simpler than all the letters put together: the ugly duckling. One person's moles are usually similar to each other — more or less the same shade, the same character. If one of them clearly stands out from the rest, that is the one that deserves a look, even when on its own it meets none of the criteria on the list.

What a mole examination looks like

No drama and no pain.

In the office the doctor first assesses the lesion with the naked eye. Then they reach for a dermatoscope — a special device that strongly magnifies the image and illuminates the skin with polarized light. Thanks to this the examiner sees what is not visible from the outside, and can draw precise conclusions about the nature of the lesion and decide on further management.

From there, there are two scenarios.

Scenario one: there is no cause for concern. In that case the doctor only recommends a follow-up after a few months, to examine and monitor the lesion. Removal is postponed.

Scenario two: the nevus is potentially dangerous. In that case the doctor proposes removing it.

One sentence on why the dermatoscope is not a gadget. Assessing a lesion with the naked eye detects melanoma in roughly seven cases out of ten; adding a dermatoscope raises that to nine out of ten. That is why asking whether the lesion will be examined with a dermatoscope is a sensible question to put when booking an appointment. It is also worth asking for a photograph of the lesion — at a check-up a few months later, comparing photographs says more than memory does.

Mole removal — why a scalpel and not a laser

With pigmented nevi there is one rule worth knowing before anyone offers you a quick "burning off" of the lesion.

Excision is most often performed with a scalpel, keeping an appropriate margin of healthy skin — after the area of the lesion has first been thoroughly anesthetized locally. This makes the procedure quick and, above all, painless.

But the most important thing happens later. The collected material goes to a pathologist, who examines the specimen under a microscope and issues the final diagnosis.

This is exactly the difference that matters: methods that vaporize tissue leave no material to examine. The lesion disappears — and with it disappears the answer to the question of what it was.

In our clinics we remove nevi and pigmented lesions surgically, with a histopathological examination. We also perform dermatoscopy and dermatological consultations, so the entire path — from examining the lesion to the test result — can be completed in one place.

Other skin lesions, the non-pigmented ones, we also remove using non-surgical methods: cryosurgery, curettage, plasma and the CO₂ laser. The choice of method is always made by the doctor after examining the skin.

A red mole is usually not a mole

It happens that a small red lesion appears on the skin, varied in shape, with a slightly protruding and wrinkled surface. It is sometimes called a red mole, although it has little in common with a pigmented nevus.

Most often it is a cherry hemangioma — a benign lesion that usually becomes more numerous with age. It does not disappear on its own, but it does not require treatment either; it is removed only when it bothers you.

Such lesions can also be removed with a laser or with electrocoagulation, that is, "burning off" tissue with a high-frequency current. These are methods used for hemangiomas — not for pigmented nevi, which require excision and examination.

Rarer types of nevi

Besides the classic dark pigmented nevi, there are also types encountered less often — Spitz nevus, Reed nevus or Sutton nevus. Diagnosing them is up to the dermatologist.

And what if a mole simply bothers you

Not every reason for a visit has to be medical.

Moles like to appear in visible places — on the face, décolletage, neck. For some people this is a cosmetic flaw that genuinely affects self-esteem and relationships with other people. That is reason enough to talk about it.

Aesthetic medicine has its solutions here, starting with excision of the disfiguring lesion. The doctor will advise how to remove a particular mole in the safest and most optimal way — taking into account where it is located and how it looks.

Finally: calmly, but without putting it off

The vast majority of the moles on your skin are benign nevi, and the risk of cancer developing from them is very small. It is worth knowing, though, that most melanomas arise not on an existing mole but on skin that was previously unchanged — which is why a new lesion that was not there before deserves attention in exactly the same way as an old mole that is changing. You do not have to inspect yourself in the mirror with a magnifying glass and count every spot.

But it is worth knowing your own skin well enough to notice when something on it changes. That is all — and that is a lot. The rest is up to the doctor: the dermatoscope, the assessment, and if necessary — excision and a histopathological examination, which gives a certain answer.

Have you noticed a lesion that used to look different? Book a dermatological consultation. The worst scenario is the one where you wait for it to go away on its own.

A worrying mole is best examined under a videodermatoscope — you can have such an assessment done with us as part of a dermatological consultation. Lesions qualified for removal are excised surgically with a histopathological examination — this is the only route that gives diagnostic certainty.

This article was prepared by Anna Grodecka, MD.