What is a Mole?

Table of Contents

• What is a Mole
• Diagnosis of a Mole
  • History
  • Exam
  • Biopsy
• Skin Self Exam
• Types of Skin Moles
  • Mole Classification by Time of Development
  • Mole Classification by Cell Type
  • Mole Classification by Location Within the Skin
• The Vanish Center Mole Removal Procedures
  • Incisionless Mole RemovalTM
  • Precision ShaveTM

What is a Mole

A mole is the common name for a dark spot on the skin referred to as a Nevus (singular) or Nevi (plural). Nevi are comprised of pigmented cells, called Melanocytes, that have grouped together instead of spreading out. Melanocytes are the cells responsible for producing melanin, which is responsible for the pigment (color)of our skin. The more pigment a person has in their skin, the darker their skin is.

Moles can be present at birth or may appear throughout life, typically within the first 40 years of life. The average number of moles for adults is between 10 and 40. Moles can appear from sunlight exposure, hormonal changes during pregnancy, or from age. Most moles appear above the waist on sun exposed skin.

Melanocytes are typically located in epidermis and dermis of the skin. These are the two most superficial levels of the skin, as shown in the image above.

Diagnosis of a Mole

Although most small round pigmented areas of the skin appear to be moles(raised) or freckles(flat), a history, exam, and sometimes a biopsy must always be performed to be sure that they are not some other type of skin pathology. Skin growths such as seborrheic keratosis, warts, and skin cancer may initially appear as moles or freckles.

History

A careful history of the pigmented area will provide significant insight about the diagnosis. Typical history questions include:

How long has the area been present?

Has it changed in size, shape, or color?

Does it itch, burn, or bleed?

Have you ever had skin cancer? Has a family member had skin cancer?

The answers to these and several other questions will help to determine the nature of the area and help to determine the necessary treatment required.

Exam

A thorough clinical examination of a pigmented skin area should be performed, and the following should be documented:

Size – Most moles are 5mm or less in diameter (the width of a pencil eraser).

Shape – Most moles are round and symmetrical.

Border – The border should be regular and even.

Color – The color should be even throughout the area.

Sometimes people use the term “the ABCDE’s of Moles” to remind individuals and health care providers of the essential elements to look for when evaluating a mole. The “ABCDE’s” are the following:

Asymmetry – Is the area asymmetrical?

Border – Are there uneven borders? 

Color – Does the area contains two or more distinct colors?

Diameter – Is the area bigger than a ¼ inch or 6 millimeters in diameter?

Enlargement – Has the area grown in size over time

Some doctors will use a device called a dermatoscope to view the mole under magnification. This helps them gain further insight into the cellular nature of the tissue, and it may provide additional diagnostic clues.

Biopsy

Sometimes the doctor may feel that a biopsy of the pigmented area would be beneficial. This can be performed by either taking an “incisional” or “core biopsy”. This involves removing a portion of the area for evaluation under a microscope by a pathologist. Alternatively an “excisional” biopsy might be recommended in which the entire area is removed for evaluation.  The choice between an incisional and an excisional biopsy will depend on the history, location, and physical characteristics of the area.

Skin Self Exam

From the National Cancer Institute

A self-exam of your skin should be performed monthly to identify any abnormal or changing skin areas. Here is how to perform a self examination of your skin:

After a bath or shower, stand in front of a full-length mirror in a well-lighted room. (Use a hand-held mirror to look at hard-to-see areas.)

1 – Begin with the face and scalp, and then work downward, checking the head, neck, shoulders, back, chest, and so on. Be sure to check the front, back, and sides of the arms and legs. Also, check the groin, the palms, the fingernails, the soles of the feet, the toenails, and the areas between the toes.

2 – Be sure to check the hard-to-see areas of the body, such as the scalp and neck. A friend or relative may be able to help inspect these areas. Use a comb or a blow dryer to help move hair so you can see the scalp and neck better.

3 – Be aware of where your moles are and how they look. By checking your skin regularly, you will become familiar with what your moles look like. Look for any signs of change, particularly a new black mole or a change in outline, shape, size, color (especially a new black area), or feel of an existing mole. Also, note any new, unusual, or “ugly-looking” moles. If your doctor has taken photos of your skin, compare these pictures with the way your skin looks upon self-examination.

4 – Check moles carefully during times of hormone changes, such as adolescence, pregnancy, and menopause. As hormone levels change, moles may change.

5 – It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If you find anything unusual, see your doctor right away. Remember, the earlier a melanoma is found, the better the chance for a cure.

In addition to performing routine skin self-exams, people should have their skin checked regularly by a doctor. A doctor can do a skin exam during regular checkups and well visits. It is important to tell the doctor about any new, changing, or “ugly-looking” moles.

Any lesions that do not have the typical appearance of a mole, have been changing, become symptomatic, etc., should be evaluated by a doctor. For more up-yo-date information regarding skin cancer and lesion evaluation please visit the following websites:

• https://www.cancer.gov/types/skin/moles-fact-sheet
• https://www.cancer.gov
• https://www.skincancer.org

Types of Skin Moles

Moles can be categorized in many different ways, including when they developed, cellular classification, and the anatomical location in the skin. Below, are some of the more common classifications of moles. Classifications can also be combined to describe all of the characteristics present in a given mole.

Mole Classification by Time of Development

Congenital

Congenital moles, referred to as congenital nevi, are present at birth or develop within the first year of life. They are caused by pigment cells (melanocytes) cells in the epidermis (top layer of skin), the dermis (middle layer of skin), or in both layers. Congenital moles can range in size from “small congenital melanicytic nevi” which are less than 1.5 cm to  “giant congenital melanocytic nevi (GCMN)” which can be larger than 20cm. Treatment of congenital nevi is controversial, as the removal can result in significant scarring, and there is no universally accepted protocol to determine if or when removal will reduce the chance of developing cancer. For more information about congenital nevi visit https://www.nevus.org. For a review of GCMN, visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900335/.

Acquired

Acquired moles are are the most common types of moles. They appear after the first year of life and may appear into adulthood. They typically develop as a result of genetics, skin type, and sun exposure.  Most acquired moles are benign. Still, all moles should be monitored since all moles have a chance of becoming cancerous.

Mole Classification by Cell Type

Typical

A typical mole will not have any of the ABCDE characteristics of atypical moles

Asymmetry – the area will be symmetrical, Border – The boarders will be even, Color – The area will be one solid color, Diameter – It will be less than 6mm in diameter, Enlargement – It will not have undergone changes in size over time.

Atypical

Atypical moles, referred to in medical terms as dysplastic nevi, are moles that exhibit irregular characteristics. They usually have an abnormality in one or more of the ABCDE’s of mole characteristics, such as an irregular boarder, abnormal color, asymmetrical shape, etc. Although dysplastic nevi share a lot of the same signs of cancerous moles, they are not considered cancerous. However, a person with dysplastic nevi has an increased risk for skin cancer. Individuals with multiple dysplastic nevi are at a higher risk of developing skin cancer than those with just one. There are also certain syndromes in which people have a significant number of dysplastic nevi including Atypical Mole Syndrome and Familial Atypical Multiple Mole Melanoma Syndrome (FAMMM).(https://rarediseases.info.nih.gov/diseases/9281/familial-atypical-multiple-mole-melanoma-syndrome)

All of these high-risk individuals should practice rigorous, daily sun protection, perform a monthly skin self-examination from head-to-toe, and be on a regular and consistent schedule of professional skin exams performed by a dermatologist or skin cancer expert.

Halo Nevi

Halo nevi are typically raised moles that have a surrounding ring (halo) of light skin that has lost its pigmentation. The light skin is due to inflammatory cells that infiltrate the area and reduce the amount of pigmentation. The reason for this cellular invasion is unclear. They are typically benign.

Mole Classification by Location Within the Skin

Intradermal Nevi

Intradermal nevi are skin-colored or lightly pigmented moles that may blend in with the adjacent skin. The pigmentation is not as dark as other types of nevi because they are located deeper in the skin – in the dermis. Intradermal nevi are very common, and they typically develop in late childhood or adulthood, and they are typically benign.

Junctional Melanocytic Nevi

Junctional melanocytic nevi are located in the junction between the epidermis and the dermis. Junctional nevi are usually raised and darker in color than intradermal nevi. Junctional nevi develop between childhood and early adulthood, and they are usually benign.

Compound Nevi

Compound nevi show signs of both intradermal and junctional nevi. Their melanocytes are located both in the dermis and in the junction between the epidermis and dermis. These moles usually have a central, raised area surrounded by a flat area They typically have distinct borders and even pigmentation, and they are usually benign.

The Vanish Center Mole Removal Procedures

Incisionless Mole Removal^TM

The Incisionless Mole Removal^TM technique was developed at the Vanish Center and is used for the removal of qualifying moles in cosmetically critical areas. The procedure uses a special radio-frequency device which  is used when to remove the mole without an incision. The radio-frequency device works differently from a laser because the tip of the device remains cold as opposed to a laser which generates a significant amount of heat on the skin. Excessive heat can lead to unnecessary scarring. At the Vanish Center, we feel this technique is superior to laser removal.

Precision Shave^TM

The Precision shave technique developed at the Vanish Center is used when it is decided that a sample of the lesion should be taken, but an excisional biopsy is not necessary. This is a modification of the Incisionless Mole Removal^TM technique with a sample of tissue obtained which is sent to the lab for evaluation. The technique utilizes microsurgical instruments as well as a specialized radio-frequency device to remove the mole. The results are the same or similar to the Incisionless Mole Removal^TM technique. Agian, we feel the specialized radio-frequency device is superior to a laser because the radio-frequency device remains cool on the skin throughout the procedure while a laser may generate a significant amount of heat on the skin. Excess heat on the skin can lead to unnecessary scarring.