EVERYONE HAS MOLES: WHAT YOU NEED TO KNOW
Moles are common features of the landscape of our skin, brown spots and bumps that many of us have had ever since we can remember. But how often do you stop to look at your moles, I mean really look at your moles?
Although they are often overlooked and taken for granted, there are a few things you should know about them.
In this post, I’m going to share a basic overview of our spotted friends, as well as answer some frequently asked questions, including:
How often should I get my moles checked?
Should I be concerned if I get a new mole?
Should moles be removed as a precaution?
What’s the deal with moles with hair?
What is a mole?
Image: Dermnetnz.org
Moles, also known as melanocytic nevi, are benign growths of melanocytes, which are the cells that produce pigment in the skin. Moles typically look brown because of the pigment, or melanin, produced by the melanocytes, although some moles can just look like skin colored bumps.
Some moles are present from birth, called congenital nevi, or can appear later in life (acquired nevi). Nevi that develop during childhood (age 2 -10 years) tend to be darker, larger and stick around longer than moles that develop during the teenage years or adulthood. It’s common for moles to disappear (involute) as we get older.
Although almost everyone has at least one mole, people with fair skin tend to have more nevi (based on genetics).
What causes moles?
We don’t know the exact answer to that question, but it depends on genetics, sun exposure, and the status of your immune system.
We know that people with many, many nevi have other members of their family that also have many, many nevi. We also have found that there are certain types of moles that have a specific genetic mutation, i.e. many congenital nevi have a RAS mutation.
Sun exposure is associated with an increased number of moles, so we know that UV exposure can induce the proliferation of melanocytes. You probably have noticed that you may have more moles in areas that have more exposure to the sun (arms vs. booty).
A sudden increase in the number of nevi can also occur when your immune system is suppressed, either from medication or disease.
How can you tell the difference between a mole and melanoma?
A melanoma is one of the most aggressive types of skin cancer that arises from melanocytes gone bad. Although not every melanoma comes from a mole, some moles can develop melanoma.
There are certain characteristics that can help you visually differentiate moles from melanoma.
Typical benign nevus (Image: Dermnetnz.org)
Moles (nevi) are typically:
Uniform in color (usually brown, but can also be tan, pink, skin-colored, blue, or black)
Round or oval and symmetric (if you cut it in half, both sides look the same)
Unchanged month to month
Can be flat or raised (some can be protuberant). Sometimes moles that are flat can become raised.
It’s important to remember that your moles won’t necessarily look alike and they can be present anywhere on your skin, including your scalp, between your toes, and where the sun don’t shine.
Melanoma typically has:
Asymmetry
Irregular borders
Multiple colors (brown, black, blue, gray — all within the one spot)
A size larger than 6mm
Rapid evolution (changes in size, shape or color within a few weeks or months)
Symptoms like bleeding or itching
The “Ugly Duckling” sign (it looks obviously different from your benign moles)
These characteristics can help you spot a potential melanoma, but the diagnosis of melanoma is based on the results of a biopsy from your dermatologist (what the spot looks like under the microscope).
Ultimately, if you notice that any of your spots look unusual, have changed, or become symptomatic, you should get it checked out by a dermatologist.
How often should I get my skin checked?
Getting your skin and moles checked by a board certified dermatologist is important because finding and diagnosing skin cancer (especially melanoma) earlier has the potential to increase your survival and result in less extensive treatment.
Dermatologists are specially equipped to identify subtle signs of melanoma because of years of training, as well as with the use of a dermatoscope*.
The American Academy of Dermatology recommends that people with the following get a full body skin examination from a board certified dermatologist every year:
Personal history of skin cancer
A family history of skin cancer (especially melanoma in a first degree relative - parent or sibling)
Extensive sun exposure, tanning bed use, or history of blistering sunburn
Many moles (>100)
However, if you don’t fall into any of the above groups but have a spot you are concerned about or are just anxious, it is reasonable to get a skin exam.
Nervous about your skin exam? Check out my video on what to expect during a full body skin check.
You should also get in the habit of looking at your skin about every month. You will have a better sense of what is your normal baseline and be better equipped to spot anything new and unusual. Here’s a video on how to do your own skin check at home.
This is what a mole looks like under dermoscopic examination. This symmetric pigment network is a benign pattern. (Image: Dermnetnz.org)
*What’s a dermatoscope?
I’m glad you asked! A dermatoscope is essentially the stethoscope for the dermatologist. It combines magnification and polarized light to allow us to see structures and details of skin lesions that are not visible to the naked eye. Dermoscopy gives us more information with which to diagnosis lesions.
FREQUENTLY ASKED QUESTIONS
Should moles be removed as a precaution?
Dermatologists typically remove moles for one of two reasons:
They are concerned that the mole may have unusual features and want to make sure it hasn’t developed into something that may harm you, like a melanoma
The mole is bothersome to the patient (for example, an irritated mole at the bra line)
Moles are not inherently dangerous. If a mole appears benign, does not have any concerning features upon examination or isn’t symptomatic to you, many dermatologists don’t recommend removal of moles.
Melanoma doesn’t necessarily develop from moles (only 20-40%), thus mole removal is not an effective prevention strategy. Instead, perform regular self skin checks and get an annual skin examination with a board-certified dermatologist.
How do I get rid of a lot of small moles?
I do get many patients that don’t like their moles for cosmetic reasons. In order to remove a mole completely, it needs to be cut out. Any method of removal, via a shave or punch biopsy or excision, will leave behind a scar.
Removal of moles with laser is not recommended. Any mole that is removed from your body should be examined and diagnosed under the microscope. Sometimes spots that look like moles can actually be melanoma when examined under the microscope.
If you want to get a mole removed for cosmetic reasons, ask yourself this: is a mole or a scar more noticeable? From my experience, scars are more noticeable and catch the eye more than moles, especially on the face, which tend to blend into the landscape of your skin.
For someone with many small moles, I recommend learning to love your spots as part of your own personal landscape. No one has perfect, flawless skin and your moles are part of what makes you unique.
If you are interested in cosmetic removal of a mole, have a chat with your dermatologist about the risks and potential for scarring before you make your decision.
Are moles with hair something to worry about?
Nope! It is extremely common for moles to arise around a hair follicle. It might be unsightly and annoying, but it’s definitely not dangerous.
If you are bothered by the hair and don’t want to be bothered with plucking it out every so often, you can ask your derm about laser hair removal or cosmetic excision. Hair follicles run deep, so a superficial shave removal won’t get rid of the hair follicle.
Image: Dermnetnz.org
Photo by Nathan Dumlao on Unsplash
What is the difference between a freckle and a mole?
Freckles (a.k.a. ephelides) and moles can both look very similar to the naked eye, like small flat brown spots.
Freckles tend to be smaller than moles and are usually tan or light brown and always arise in areas that are exposed to the sun. If not exposed to sunlight and UV radiation, freckles can fade or even disappear.
Ultimately, the distinction between the two is made microscopically. Moles are benign growths of melanocytes, while freckles are just spots with an increase of pigment (melanin), without an increase of melanocytes.
Should I be concerned if I get a new mole?
Not necessarily. It is normal to get new moles even into your thirties. If your new mole looks like the other moles you have, there’s unlikely anything to worry about.
However, if you get a new mole and it doesn’t look like any of your other moles (an ugly duckling), or it has some of the atypical, ABCDE features of melanoma, it’s a good idea to get it examined by a dermatologist.
How can I prevent moles from developing?
Although you can’t prevent every single mole from developing, strict sun avoidance and protection can minimize the number of moles that will arise from sun exposure. The proof of concept is the difference of the number of moles on your arms versus your butt. I’ll bet you a tube of sunscreen that you have way more moles on your arms.
Just a reminder, strict sun avoidance doesn’t just mean putting sunscreen on. Sunscreen is your last layer of protection from the sun.
To truly protect your skin from UV radiation, you should avoid the midday sun, doing outdoor activities in the early morning or late afternoon. If you do go outside, use shade and sun protective clothing in addition to sunscreen to protect your skin.
For more, check out my post, “Sunscreen 101: A Dermatologist’s Guide To Everything You Need To Know”.
Moles are both ubiquitous and unique — they are a part of what makes you you, as much as the color of your eyes or your smile.
Take care of your moles and don’t take them for granted!
References
Bhatt M, Nabatian A, Kriegel D, Khorasani H. Does an increased number of moles correlate to a higher risk of melanoma? Melanoma Manag. 2016 Jun;3(2):85-87.
Gallagher RP, McLean DI. The epidemiology of acquired melanocytic nevi. A brief review. Dermatol Clin. 1995 Jul;13(3):595-603. PMID: 7554507.
Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005 Jan;41(1):28-44.
Garbe C, Büttner P, Weiss J, Soyer HP, Stocker U, Krüger S, Roser M, Weckbecker J, Panizzon R, Bahmer F, et al. Risk factors for developing cutaneous melanoma and criteria for identifying persons at risk: multicenter case-control study of the Central Malignant Melanoma Registry of the German Dermatological Society. J Invest Dermatol. 1994 May;102(5):695-9.
Plasmeijer EI, Nguyen TM, Olsen CM, Janda M, Soyer HP, Green AC. The Natural History of Common Melanocytic Nevi: A Systematic Review of Longitudinal Studies in the General Population. J Invest Dermatol. 2017 Sep;137(9):2017-2018.