Moles

What are moles?

Moles are usually harmless collections of pigmented cells called melanocytes on the skin. They can appear alone or in multiples. Most moles are present on the torso, but they are also commonly found on the face, arms and legs. Moles can also be present in more obscure locations such as the scalp, under the nails, in the armpits and around the genitals. Moles can be cancerous in rare cases.

What are the various types of moles?

Moles vary in colour, shapes and sizes. They can be flesh-coloured, brown, blue or black spots that vary in shape from oval to round. They can be as small as a pinhead or large enough to cover an entire limb. Moles that are larger than 8 inches in diameter and are present at birth are a special problem. They may need to be removed to avoid the risk of cancer. The surface of a mole can be smooth or wrinkled, flat or raised. Moles are likely to change over a lifetime. They may darken with exposure to sun. They also may start out flat and brown in colour and later become slightly raised and lighter in colour. Some may become raised enough that they form a small stalk and are eventually rubbed off. Others may just disappear.

Several types of moles have a higher than average risk of becoming cancerous. They include:

• Congenital moles- Large moles present at birth are called congenital moles or giant hairy moles. These moles may increase the risk of malignant melanoma, a deadly form of skin cancer.
  
• Hereditary moles- These moles are about 1/4 inch (6 mm) and irregular in shape and known as atypical (dysplastic) moles. They usually have dark brown centres and lighter, uneven borders. Dysplastic moles have a greater risk of developing malignant melanoma.

What are the causes?

Moles have no known purpose and it is not known why they develop. Women may develop numerous dark moles during pregnancy.

How to take care of moles?

Most moles are harmless and don't require special care. If a mole is irritating or unattractive, however, one can get it removed. All moles that are removed should be examined under a microscope because doctors can't always tell if moles are pre-cancerous or cancerous just by the way they look on the skin. One should monitor moles for changes in size, shape, colour, texture and sensation that may indicate a problem. To take care of moles, the following can be done:

• Avoid sun exposure, particularly from 10 a.m. to 4 p.m., when ultraviolet rays are most intense. Apply sunscreen with a sun protection factor (SPF) of at least 15 to minimize the risk of skin cancer.
  
• Broad-brimmed hats, long sleeves and other protective clothing also help avoiding sunrays that damage the skin.
  
• An unattractive mole can be covered up with the help of makeup designed to conceal blemishes.
  
• Hair growth on the mole can be clipped close to the skin's surface. Permanent removal of hair on a mole is also possible.
  
• Shaving repeatedly over a mole may cause irritation; therefore one should get it removed by a dermatologist.
  
• Care should be taken while cutting a mole; the area around the mole should be clean. A dermatologist should be consulted if the mole doesn’t heal properly.

The doctor examines the skin from head to toe, including scalp, palms, the soles of feet and the skin between the buttocks. If the doctor suspects that a mole may be cancerous, he may take a sample of the tissue (biopsy) and submit the biopsy for microscopic examination.

What is the treatment?

If a mole is found to be cancerous, the entire mole and a margin of normal tissue around it needs to be removed. Usually a mole that has been removed does not reappear. If it does, a doctor should be consulted immediately. Treatment of most moles usually isn't necessary. For cosmetic reasons, a mole can be removed in several ways:

1. Shave excision: In this method, the area around the mole is numbed and a small blade is used to shave off the mole close to the skin.
   
2. Punch biopsy: The mole is removed with a small incision or punch biopsy technique, which uses a small cookie-cutter-like device.
   
3. Excisional surgery: In this method the mole is cut off along with a surrounding margin of healthy skin.

How can moles be prevented?

The skin should be examined carefully on a regular basis. If there is a family history of melanoma, monthly check up of moles is required. Otherwise the moles should be checked every three months, to detect early skin changes that may signal melanoma, the most serious form of skin cancer. Areas that are not exposed to sunlight should also be checked, including the scalp, armpits, feet (the soles and between the toes), and genitals. Women should also examine the skin underneath the breasts.