About Nevus (Moles)

Overview

A nevus, or mole, is an area of benign growth on the skin formed by a cluster of pigmented skin cells. Some moles are present at birth, while others develop later in life. Many moles that develop during adulthood are related to sun exposure and effects on melanin production. Moles can come in a variety of colors, including brown, red, pink, and flesh-colored. Some moles may also have hairs that grow from them. Most moles are benign (noncancerous), but it's still important to keep an eye on them for any changes that could indicate cancer growth. Nevus is the medical term for a mole, and it is very common. Most people have between 10 and 40 moles. There are different types of nevi, some harmless and others more serious. If you notice any changes in the color, size, shape, or height of a mole, or if it starts to itch, bleed, or ooze, it's important to consult with a healthcare provider.

Causes and Risk Factors

The physiologic causes of nevus are not well understood, but it is believed to be a combination of genetic factors and sun damage. Moles are concentrations of pigment-producing cells (melanocytes) in the skin. They tend to appear during childhood and adolescence and can change in size and color over time.

Non-modifiable risk factors for nevus include:

• Age: Moles tend to appear more frequently as you get older.
• Genetic factors: Family history of moles or melanoma can increase the risk.

Modifiable risk factors for nevus are not well established, but may include:

• Sun exposure: Excessive sun exposure, especially during childhood and adolescence, may increase the risk of developing moles.
• Hormonal changes: Moles may appear or change during times of hormonal fluctuations, such as pregnancy.

It's important to note that while these factors may be associated with an increased risk of developing moles, they do not guarantee the development of moles or melanoma. Regular skin examinations and sun protection measures are recommended.

Symptoms

Moles usually have the following characteristics:

• Appearance of small brown, tan, or pink spots on the skin.
• Round and symmetrical shape with a well-defined border.
• Size less than 1/4 inch across.
• Flat or raised texture.
• Uniform color throughout the mole.

Moles that should be evaluated by a healthcare professional include the following characteristics:

• Rapid growth, often to a width of less than 6 millimeters in under 6 months.
• Bleeding and oozing a clear discharge.
• Itching on or around the mole.
• Irregular, variable color.
• Larger than 1 centimeter in width.
• Unclear, poorly defined margins or borders.
• Scaly, rough, or flaky appearance.
• Open wounds or cracks.

It's important to note that some benign nevi can resemble cancerous melanoma tumors. These are known as atypical Spitz tumors (AST) and may exhibit characteristics such as larger size, unclear margins, irregular color, and scaly appearance. ASTs are not definitely benign nor cancerous and should be monitored for additional changes.

If you notice any changes in your moles or have concerns about their appearance, it's best to consult with your doctor for further evaluation.

Diagnosis

To diagnose nevus, the following examinations, tests, and procedures are commonly performed:

• History and Physical Exam: The healthcare provider will take a detailed history regarding the appearance of new moles or changes in existing moles, and factors such as family history and sun exposure. They will visually examine the moles for size and characteristics.
• Dermoscopy: This is a non-invasive procedure that uses a handheld device called a dermatoscope to examine moles closely. It helps the healthcare provider evaluate the mole's structure and identify any abnormal features.
• Biopsy: If a mole appears suspicious or shows signs of melanoma, a biopsy may be performed. During this procedure, a small sample of tissue is removed from the mole and sent to a laboratory for further analysis.

Additional examinations, tests, and procedures may be performed based on initial findings or individual factors. These may include:

• Excisional Biopsy: If the initial biopsy confirms melanoma, an excisional biopsy may be performed to remove the entire mole or a wider area of skin around it. This helps determine if the melanoma has spread beyond the mole.
• Sentinel Lymph Node Biopsy: If there is concern that melanoma has spread to nearby lymph nodes, a sentinel lymph node biopsy may be recommended. This procedure involves injecting a dye near the mole to identify the first lymph node that receives drainage from the area. The identified lymph node is then removed and examined for cancer cells.

It's important to note that these examinations, tests, and procedures are usually conducted by healthcare professionals who specialize in dermatology. They will assess your specific situation and provide appropriate recommendations based on your individual needs.

Treatment Options

The goals of treatment for nevus are to:

• Monitor changes: Regularly monitor the size, color, and shape of moles for any potential changes that could indicate skin cancer. This can be done through self-examination or with the help of a dermatologist.
• Prevent further development: Limit sun exposure to prevent the development of more moles and reduce the risk of changes in existing moles. This includes wearing protective clothing, using sunscreen, and seeking shade when the sun is strongest.
• Removal: Depending on the type and characteristics of the mole, removal may be recommended. The methods of removal include:
  • Shave biopsy: A superficial removal of the mole using a scalpel or razor blade.
  • Excisional biopsy: Surgical removal of the entire mole, especially for cancerous or suspicious moles.
  • Laser treatments: Effective for certain types of moles, laser therapy destroys melanocytes responsible for pigmentation.
  • Dermabrasion: A technique that removes superficial lesions on the face using mechanical exfoliation.
  • Voltaic arc dermabrasion (VAD): A newer method used for skin resurfacing and removing skin lesions.

It is important to consult with a healthcare professional to determine the best treatment approach based on individual circumstances.