MOLES (NEVI)

Melanocytic nevi, commonly known as moles, are benign growths resulting from the proliferation of melanocytes, characterized by the presence of nevus cells in nests. These moles can be categorized as congenital, present at birth or developing within a few months, and acquired, appearing later in life. While small moles are usually not concerning, the presence of numerous or large moles may warrant removal due to cosmetic reasons or the potential for cancerous changes. Laser removal of moles is a straightforward office procedure with minimal side effects.

CAUSES

Certain factors contribute to the development of moles:

• Genetic predisposition, often seen in families with a history of moles.
• Extent of sun exposure, particularly during childhood, can influence mole formation.
• Skin complexion plays a role, with lighter skin types tending to have more moles compared to darker skin tones.

SYMPTOMS

Congenital melanocytic nevi:Congenital melanocytic nevi (CMN) are either present at birth or appear within a few months after birth. These moles are typically dark brown to black in color, with irregular or geographic borders. Some CMN may also have dark, thick hairs. They can grow in size as the child grows, with head CMN increasing by an average of 1.7 times, trunk and upper extremities CMN by 2.8 times, and lower extremities CMN by 3.3 times until adulthood. As they enlarge, surface changes may occur, such as flat lesions becoming raised with a rough texture. Larger CMN, known as giant nevi, may develop nodules within the lesion and small satellite nevi around the surrounding skin. CMN can be categorized based on their location, including patterns like upper back and neck, central back, bathing trunk distribution, breast or belly pattern, extremity distribution, and general body distribution.

Acquired melanocytic nevi: Acquired melanocytic nevi typically start appearing after the first 6 months of life and tend to increase in number over time, often peaking in the 30s. Some may also disappear as a person ages. These nevi are usually less than 6mm in size, with a uniform color, round to oval shape, and regular borders. They commonly develop in sun-exposed areas, with covered sites like the lower limbs also being susceptible, especially in females. Dark-skinned individuals may also have moles on the palms and soles. Acquired melanocytic nevi can be classified into different types based on the presence of nevus cells in various layers of the skin:

• Junctional nevi: These are flat or slightly raised and range from brown to black in color.
• Compound nevi: These nevi have some elevation, with a smooth, dome-shaped surface and tan to dark brown coloration.
• Intradermal nevi: Nevus cells in the dermis lose their ability to produce color, resulting in skin-colored to light brown dome-shaped lesions with a rubbery texture. They may also have terminal hair.

Diagnosis

Melanocytic nevi are typically diagnosed by dermatologists through clinical examination. Dermoscopy, a tool that allows for magnified inspection of skin features, can aid in distinguishing specific characteristics of different types of nevi. In individuals with fair skin, dermoscopy becomes particularly valuable for closely monitoring certain types of moles to detect any early signs of malignancy. In some cases, a biopsy may be necessary to definitively rule out any malignant changes.

Treatment of moles

Moles cannot be effectively removed with medicines or creams. The primary treatments for mole removal are:

• Radiofrequency ablation (RFA): This method is effective for small, surface-level moles. After administering local or topical anesthesia, the mole is gradually removed using an RFA device in layers. The procedure typically lasts 10-15 minutes. Following treatment, a topical antibiotic should be applied for 5-7 days. A thin scab forms and falls off within 7-10 days.
• CO2 Laser mole removal: This approach is suitable for all types of moles except large, giant congenital melanocytic nevi (CMNs). It can be performed with numbing cream, although local anesthesia may be necessary for larger lesions. CO2 laser removal is more precise and faster compared to RFA. The wound heals clearer with less post-treatment care required. The cosmetic outcome of CO2 laser removal is often more favorable than RFA. For larger or deeper lesions, the procedure may be divided into two sessions to reduce the risk of a depressed scar after treatment.
• Shave excision: This method is appropriate for superficial and small moles. Using a blade, the mole is shaved off from the skin surface.
• Surgical excision: Recommended for large moles or when other treatments are not feasible. The surgery can be performed in a single session for smaller lesions or multiple sessions may be required for larger ones. Flap surgeries are also an option for large congenital melanocytic nevi (CMNs).
• Risk of recurrence: When treatment is conducted meticulously and all mole tissue is completely removed, the likelihood of recurrence is minimal.

TIPS

Don’t Use any home remedy. It can leave bad scars, which are more difficult to treat than moles.

Contact your dermatologist if you observe any atypical change in mole.