Tweet
I recently went in to the dermatologist because of 2 suspicious moles which were sent in for biopsy. This week one of them came back with changing cells...it's in a pre-cancer stage thankfully, but had I ignored it, eventually I'd be screwed. I'm going back to the doc. to have some other moles sent in for biopsy and for a closer examination of all of the others.
Sun exposure and tanning beds are the main causes of skin cancer so we simply should not do it. If you're going to have a tan, please go in regularly to be checked by the doctor! Early detection is important and it can save your life. If the doctor finds anything suspicious, he will take a small sample and send it off for biopsy.
Here are some links and info. that I hope you'll take the time to read through.
What You Need To Know About™ Skin Cancer
Too much here to copy and paste...just click on the link.
Take Action Against Skin Cancer
Take Action Against Skin Cancer
by Arthur R. Rhodes, MD, MPH
Director, Pigmented Lesion Clinic and Skin Cancer Screening
What is skin cancer?
Who is at greatest risk?
What is Epithelial skin cancer ?
What are the signs and symptoms of a developing skin cancer ?
What are some common misconceptions ?
What happens during an examination for skin cancer?
What can I do to save my life?
More information on Melanoma (skin cancer)
The copyright of the following information is owned by Arthur R. Rhodes. If the material is reproduced, it must be reproduced in its entirety. Obtain the permission of Dr. Rhodes to reproduce segments of this material.
What Is Skin Cancer?
Skin cancer is not one disease.
The most common type of skin cancer is epithelial skin cancer, which includes basal cell cancer and squamous cell cancer. Epithelial skin cancer is rarely deadly and usually appears as a persistent pink bump, a sore that does not heal, a scaling red patch, or a warty growth.
The less common but more serious form of skin cancer is melanoma. Melanoma is a potentially deadly cancer that develops as an unusual mole, a new mole, or a mole that changes.
Epithelial skin cancers and melanoma are curable if removed at an early stage of development. More than half of all melanomas are discovered by patients. You can help in early detection. The following information will help you to take personal responsibility for early detection of melanoma and epithelial skin cancer.
Who Has the Greatest Risk for Developing Skin Cancer?
Melanoma occurs mostly in white adults. However, anyone can develop melanoma, regardless of gender, race, or age. Melanoma is extremely rare before puberty and tends to increase with age. Your melanoma risk is markedly increased if you have one or more of the following:
Prominent moles
Five moles at least 5 millimeters in size (7 to 10-fold risk), 12 moles at least 5 millimeters in size (54-fold risk), or 20 moles at least 2 millimeters in size (7 to 14-fold risk).
Dysplastic moles (atypical moles)
Moles 5 millimeters in size or larger that have uneven or dark coloration or fried egg appearance, and often uneven or fuzzy borders (7 to 27-fold risk).
A congenital mole
A mole that was present at birth (2 to 21-fold risk).
Lentigo maligna
A single, irregular, large "varnish stain" spot on sun-damaged skin (10-fold risk).
Personal history of melanoma
This factor represents a 9-fold risk.
Family history of melanoma in a parent, sibling, or child
This factor represents an 8-fold risk.
The above traits do not guarantee that you will develop melanoma but justify your seeking medical advice.
Your melanoma risk is slightly to moderately increased if you have one or more of the following:
suppression of the immune system, due to disease or medication (4-fold risk)
tendency to freckle following sun exposure (2- to 4-fold risk)
tendency to burn and relative inability to tan in the sun (2- to 3-fold risk)
red or blond hair, and blue or green eyes (2-fold risk)
excessive sun exposure (2-fold risk)
What is Epithelial Skin Cancer?
Epithelial skin cancer (basal cell cancer and squamous cell cancer) is mostly caused by excessive exposure to sun or artificial sources of ultraviolet radiation, mostly in white adults. Epithelial skin cancer risk is increased several-fold if you have one or more of the following:
personal history of epithelial skin cancer
family history of epithelial skin cancer in a parent, sibling, or child
actinic keratoses -- that is, red, rough, scaling patches on sun-exposed skin
tendency to freckle following sun exposure
excessive exposure to sun or sun lamps
tendency to burn and relative inability to tan in the sun
red or blond hair, and blue or green eyes
Not all epithelial skin cancers are caused by excessive sun exposure. Other predisposing factors for developing epithelial skin cancer include the following:
x-ray (radiation) therapy to skin or internal organs, usually for treatment of disease
scar related to heat burn, chemical burn, and scarring skin diseases
chronic ulcer or chronic draining sinus
immune suppression from disease or medication, such as organ transplantation
Signs and Symptoms of a Developing Skin Cancer
The following signs and symptoms may indicate a developing skin cancer:
mole or freckle that has changed or is changing in some way for more than 2 weeks -- for example, becoming darker or lighter, larger, more raised, or changing shape or outline
new mole or freckle that you are sure wasn't there before
mole or freckle that is continually tender, itching, or scaling for no apparent reason
unexplained sore that oozes, bleeds, scabs, and has not healed after 4 weeks
persistent pink or red bump, lump, or warty growth
mole or freckle that is prominent or unusual in some way
single scaling pink or red patch that has not responded to treatment with ointments or salves
These signs and symptoms do not guarantee that you have a skin cancer, but justify your seeking medical advice.
Common Misconceptions
Some people avoid or delay seeking medical advice because their information is misleading or false. The following are some of the more common misconceptions about skin cancer:
Misconception: Melanoma is always deadly.
Some people believe that melanoma is not treatable. Not true! Melanoma is curable if detected and treated in an early stage of development. Currently, 94 percent of people whose melanoma shows no sign of spread at the time of diagnosis are without signs of cancer five years later. Timely detection and surgical excision of melanoma usually result in cure.
Misconception: Don't touch a mole that is changing, because you will cause cancer to spread.
This myth started 50 years ago, when patients delayed seeking medical advice until melanomas were large, oozing, and painful. Neglected tumors have a greater chance of spreading to vital internal organs. Once the cancer cells of melanoma are removed, these cells can no longer do harm. If the cancer cells of a melanoma have not spread elsewhere before surgical removal, then cure is probable.
Misconception: All skin cancers are the same.
Melanoma is the least common but potentially most deadly of the main types of skin cancer. The more common epithelial skin cancers, basal cell cancer and squamous cell cancer are curable at least 98 percent of the time. Epithelial skin cancers cause local destruction of tissue but rarely spread to vital internal organs. Some squamous cell cancers can spread to lymph nodes and vital internal organs, particularly when developing in scarring skin disease and skin sites exposed to x-ray (radiation) therapy and in patients whose immune system is suppressed by medication or disease. When diagnosed early, epithelial skin cancer is usually able to be treated with less complicated therapy and with a minimum of destruction of involved tissues.
Misconception: Only whites develop melanoma and epithelial skin cancer.
While nonwhites rarely develop melanoma and epithelial skin cancer, the same warning signs and symptoms apply. Melanoma can appear anywhere on the skin of nonwhites, but in about half the cases, melanoma appears on the palms of the hands, soles of the feet, nail beds, or mucous membranes (inner eyelids, nose, mouth, anus, and genitalia), usually as a new or changing black spot a sometimes a pink or red patch. Epithelial skin cancer rarely occurs in nonwhites unless there has been exposure to x-ray (radiation) therapy that has been used to treat disease; a chronic ulcer related to burn or scarring disease; a chronic draining sinus; or excessive exposure to natural sunlight or artificial sources of ultraviolet radiation.
What happens during an examination for skin cancer?
A physician will usually offer to examine your entire skin surface. In addition to areas exposed to the sun, melanoma and epithelial skin cancer can occur on skin sites not commonly exposed to the sun, such as palms, soles, hairy scalp, genitalia, anal area, between toes and fingers, and nailbeds.
What can I do to save my life?
Delay in seeking help is responsible for the majority of skin cancer deaths. Denial of a problem is your greatest enemy, second only to ignorance of the meaning of the usual signs and symptoms that could indicate a developing cancer. If you have questions about skin cancer and its warning signs, or if you have any of the signs or symptoms or risk factors listed above, take action by consulting your dermatologist or general physician.
Mole Biopsy & Removal
Most people have moles in various numbers and locations. Moles are genetically determined in many cases and can thus be considered inherited to a certain extent. Reasons for removing a mole include suspicion of malignancy, irritation or a cosmetically unacceptable appearance. Medical insurance usually covers the removal in the first two situations.
......If a mole is changing or otherwise suspicious for malignancy, a biopsy should be performed. A biopsy is the removal of any size piece of tissue, large or small, and the analysis of the cells in a specially stained specimen under a microscope.
......There are many ways to biopsy a mole, each varying in cost and scar formation. The author is specially trained in all the existing forms of mole removal. The author's philosophy on mole removal is that, for initial testing, the removal of large pieces of margin (normal) tissue around moles, thereby leaving large scars, is NOT helpful. The extra normal tissue in a large excisional specimen makes it more difficult for the average laboratory to examine a mole thoroughly. FOR INITIAL EXAMINATION or biopsy, the author takes a tiny triangulate (inverted pryamidal) biopsy of small moles. Moles that protrude may delicately be sampled tangentially, i.e., removed to the level of the skin, which is then lightly sanded to match the surrounding body contours. Though the biopsy will be small, it will usually encompass a good portion (60-90%) of the mole cells making the growth. If the biopsy is read "benign," then no further work is necessary. If the biopsy indi-cates any potential for trouble in the future, then the patient will be advised of the options and a final decision made for or against a margin excision to remove any remaining mole.
......If the author must perform a margin excision on the face, ex-tremely fine (7-0) surface stitches and absorbable deep stitches are used so as to not leave "tracks." If the mole is on the body, the author usually uses subcuticular (below surface) stitches that never pass through the surface of the skin in order to avoid tracks.
......Is it dangerous to leave any part of a "bad mole" behind? Isn't it always better to sample moles with a margin excision to avoid spilling potentially malignant cells into the bloodstream? The answers are, fortunately, NO! British and American Dermatologists have battled over these questions for years; detailed studies of large and small melanoma biopsies have now been done that resoundingly favor the American view that small specimens are not dangerous. These studies have shown that melanoma sampled by small biopsies does not spread cells into the bloodstream to any greater degree than melanoma sampled by taking large-margin excisions. Melanoma is derived from cells similar to those of a mole. Melanoma is one of the deadliest forms of skin cancer. If melanoma is not spread from small samples, neither should small sampling a mole spread any possible abnormal cells.
......If a benign-looking, protruding mole needs to be removed due to irritation or to enhance cosmetic appearance, a technique called tangential incisional biopsy may be performed. This procedure consists of "shaving" the mole with a sharp scalpel parallel to the surface of the skin, followed by a light sanding. This biopsy removes the raised portion of the mole, leaving some mole cells in the skin. Less than 10% of the time, these remaining mole cells will regrow the mole; sometimes such regrowth will be even darker than the original mole prior to the biopsy. A tangential-incisional-biopsy wound generally heals within two to three weeks as a flat scar approximately the same size as the original mole. Initially, the scar can be pink, darker or lighter than the surrounding skin. This color tends to blend in with time so that cosmetic results are usually excellent, with a barely perceptible scar. Darkening of the site is minimized if the patient avoids sun exposure or uses at least a number 15 sunscreen on the area for several weeks after the biopsy. It is important to provide good wound care to the area for the best cosmetic result. See Wound Care.
......The healing tendency following tangential biopsies is unpredictable, depending greatly on the individual patient. Rarely, a raised or depressed scar may develop in spite of good biopsy technique and meticulous care. The best thing to do for cosmetic purposes, if one does not know one's healing tendency from previous wounds or surgery, is to have only one mole removed first to see how it heals before having multiple moles removed. Raised scars are more common on the trunk near the breastbone, so one must weigh the risk versus possible benefits there. If a raised scar does form, local steroid injections and firm deep massage are usually effective treatment.
......Again, all moles that are removed, even benign-looking ones, should be sent to pathology for microscopic examination. This examination helps to tell doctors whether the mole is harmless or whether the patient should have more bordering tissue removed. Sometimes moles that are textbook examples of benign or "good" moles turn out to be serious melanoma, discovered incidentally (by chance or by accident). This is because 10% of melanomas may not fit dermatologists' classic rules for malignancy. Since early detection and removal is the best way to cure melanoma, the patient can participate actively in his/her own care by self-examination. Signs of concern include a mole's recent change in appearance, size, shape or color, irregularity in color, loss of a uniform border, asymmetry (inequality on either side of a line drawn down the middle), bleeding or the notching of a border. Moles with any of these signs should be brought at once to the attention of a dermatologist for close examination.
Moles
Moles
Written by Prof James Ferguson, consultant dermatologist
What is a mole?
A mole (or melanocytic naevus) is an abnormal collection of pigment cells present within the skin. These cells are known as melanocytes. Moles are extremely common. Most people are born with a few moles and develop others during their lives.
Keep an eye on your moles. Go and see the doctor if they begin to itch, increase in size or change colour.
What causes moles?
Most moles are simply the result of a harmless proliferation of the pigment cells within the deeper layer of the skin. A few of these moles, called congenital melanonaevi, are usually present at birth. But most develop spontaneously or are caused by exposure to sunlight and tend to appear on those areas of the skin that catch the most sunlight. Most of these moles appear during the first 20 years of life, although they may continue to develop into the 30s and 40s. However, the majority disappear with age.
Why are moles a concern?
The main worry with moles is that a small number may go on to develop a condition called malignant melanoma. This form of skin cancer, which can be fatal, is best spotted early and treated with surgical excision (ie it is cut out of the skin).
Who is at risk?
The presence of moles will not cause you serious problems. But large numbers, more than 25, are an indication of susceptibility to melanoma. So you should take great care about exposure to sunlight. If there is a family history of malignant melanoma, you should be particularly vigilant about changing moles.
What are the symptoms of malignancy?
The mole is itchy and painful.
Increased size or an increasingly irregular appearance, especially at the edges.
A change in colour, particularly if the mole gets darker or becomes mottled.
Spontaneously bleeding.
Satellite pigmented lesions.
How is malignancy diagnosed?
Although most changes in the size, shape and colour of moles are due to a benign, non-cancerous increase in number of pigment cells, any mole that looks unusual should be examined. Your doctor will probably request information on recent changes to the mole along with a family history to assess your risk.
If only mild changes are found, your doctor will usually only need to take a clinical photograph of it. The mole's appearance may be reviewed in a later appointment. But if your doctor is concerned, an excision biopsy will be arranged, if necessary following a consultation with a plastic surgeon or a dermatologist.
Good advice
Avoid unnecessary exposure to sunlight, particularly during the two hours on either side of midday when the sun’s rays are strongest, and avoid getting sunburn.
Keep covered up in sunlight and apply sunscreen on exposed skin.
Examine your moles regularly and get someone to check those you cannot see.
Other types of moles include dysplastic, blue and halo naevi.
Dysplastic naevus syndrome
Some large moles have an irregular outline and an indistinct border. These carry an increased risk of malignancy and tend to occur in families who have a history of malignant melanoma. Patients with such moles need to have them examined regularly and compared with clinical photographs.
Halo naevi
Occasionally the skin surrounding a small mole becomes lighter and the central mole becomes pale. Most halo naevi are benign. But some people may have an increased risk of developing the skin disorder, vitiligo. Patients with malignant melanoma may, very rarely, develop halo naevi.
Blue naevus
This deep-seated mole appears blue. It is very common in some West Indian infants but is only rarely of any significance.
Juvenile melanoma (Spitz naevus)
In this condition, the pigment cells form a benign tumour, which is usually a pink-brown colour. Although similar to melanoma, the outlook following treatment is good.
Common misconceptions
It is not true that moles on the soles of the feet or hairy moles are more likely to become malignant (cancerous).
Sun exposure and tanning beds are the main causes of skin cancer so we simply should not do it. If you're going to have a tan, please go in regularly to be checked by the doctor! Early detection is important and it can save your life. If the doctor finds anything suspicious, he will take a small sample and send it off for biopsy.
Here are some links and info. that I hope you'll take the time to read through.
What You Need To Know About™ Skin Cancer
Too much here to copy and paste...just click on the link.
Take Action Against Skin Cancer
Take Action Against Skin Cancer
by Arthur R. Rhodes, MD, MPH
Director, Pigmented Lesion Clinic and Skin Cancer Screening
What is skin cancer?
Who is at greatest risk?
What is Epithelial skin cancer ?
What are the signs and symptoms of a developing skin cancer ?
What are some common misconceptions ?
What happens during an examination for skin cancer?
What can I do to save my life?
More information on Melanoma (skin cancer)
The copyright of the following information is owned by Arthur R. Rhodes. If the material is reproduced, it must be reproduced in its entirety. Obtain the permission of Dr. Rhodes to reproduce segments of this material.
What Is Skin Cancer?
Skin cancer is not one disease.
The most common type of skin cancer is epithelial skin cancer, which includes basal cell cancer and squamous cell cancer. Epithelial skin cancer is rarely deadly and usually appears as a persistent pink bump, a sore that does not heal, a scaling red patch, or a warty growth.
The less common but more serious form of skin cancer is melanoma. Melanoma is a potentially deadly cancer that develops as an unusual mole, a new mole, or a mole that changes.
Epithelial skin cancers and melanoma are curable if removed at an early stage of development. More than half of all melanomas are discovered by patients. You can help in early detection. The following information will help you to take personal responsibility for early detection of melanoma and epithelial skin cancer.
Who Has the Greatest Risk for Developing Skin Cancer?
Melanoma occurs mostly in white adults. However, anyone can develop melanoma, regardless of gender, race, or age. Melanoma is extremely rare before puberty and tends to increase with age. Your melanoma risk is markedly increased if you have one or more of the following:
Prominent moles
Five moles at least 5 millimeters in size (7 to 10-fold risk), 12 moles at least 5 millimeters in size (54-fold risk), or 20 moles at least 2 millimeters in size (7 to 14-fold risk).
Dysplastic moles (atypical moles)
Moles 5 millimeters in size or larger that have uneven or dark coloration or fried egg appearance, and often uneven or fuzzy borders (7 to 27-fold risk).
A congenital mole
A mole that was present at birth (2 to 21-fold risk).
Lentigo maligna
A single, irregular, large "varnish stain" spot on sun-damaged skin (10-fold risk).
Personal history of melanoma
This factor represents a 9-fold risk.
Family history of melanoma in a parent, sibling, or child
This factor represents an 8-fold risk.
The above traits do not guarantee that you will develop melanoma but justify your seeking medical advice.
Your melanoma risk is slightly to moderately increased if you have one or more of the following:
suppression of the immune system, due to disease or medication (4-fold risk)
tendency to freckle following sun exposure (2- to 4-fold risk)
tendency to burn and relative inability to tan in the sun (2- to 3-fold risk)
red or blond hair, and blue or green eyes (2-fold risk)
excessive sun exposure (2-fold risk)
What is Epithelial Skin Cancer?
Epithelial skin cancer (basal cell cancer and squamous cell cancer) is mostly caused by excessive exposure to sun or artificial sources of ultraviolet radiation, mostly in white adults. Epithelial skin cancer risk is increased several-fold if you have one or more of the following:
personal history of epithelial skin cancer
family history of epithelial skin cancer in a parent, sibling, or child
actinic keratoses -- that is, red, rough, scaling patches on sun-exposed skin
tendency to freckle following sun exposure
excessive exposure to sun or sun lamps
tendency to burn and relative inability to tan in the sun
red or blond hair, and blue or green eyes
Not all epithelial skin cancers are caused by excessive sun exposure. Other predisposing factors for developing epithelial skin cancer include the following:
x-ray (radiation) therapy to skin or internal organs, usually for treatment of disease
scar related to heat burn, chemical burn, and scarring skin diseases
chronic ulcer or chronic draining sinus
immune suppression from disease or medication, such as organ transplantation
Signs and Symptoms of a Developing Skin Cancer
The following signs and symptoms may indicate a developing skin cancer:
mole or freckle that has changed or is changing in some way for more than 2 weeks -- for example, becoming darker or lighter, larger, more raised, or changing shape or outline
new mole or freckle that you are sure wasn't there before
mole or freckle that is continually tender, itching, or scaling for no apparent reason
unexplained sore that oozes, bleeds, scabs, and has not healed after 4 weeks
persistent pink or red bump, lump, or warty growth
mole or freckle that is prominent or unusual in some way
single scaling pink or red patch that has not responded to treatment with ointments or salves
These signs and symptoms do not guarantee that you have a skin cancer, but justify your seeking medical advice.
Common Misconceptions
Some people avoid or delay seeking medical advice because their information is misleading or false. The following are some of the more common misconceptions about skin cancer:
Misconception: Melanoma is always deadly.
Some people believe that melanoma is not treatable. Not true! Melanoma is curable if detected and treated in an early stage of development. Currently, 94 percent of people whose melanoma shows no sign of spread at the time of diagnosis are without signs of cancer five years later. Timely detection and surgical excision of melanoma usually result in cure.
Misconception: Don't touch a mole that is changing, because you will cause cancer to spread.
This myth started 50 years ago, when patients delayed seeking medical advice until melanomas were large, oozing, and painful. Neglected tumors have a greater chance of spreading to vital internal organs. Once the cancer cells of melanoma are removed, these cells can no longer do harm. If the cancer cells of a melanoma have not spread elsewhere before surgical removal, then cure is probable.
Misconception: All skin cancers are the same.
Melanoma is the least common but potentially most deadly of the main types of skin cancer. The more common epithelial skin cancers, basal cell cancer and squamous cell cancer are curable at least 98 percent of the time. Epithelial skin cancers cause local destruction of tissue but rarely spread to vital internal organs. Some squamous cell cancers can spread to lymph nodes and vital internal organs, particularly when developing in scarring skin disease and skin sites exposed to x-ray (radiation) therapy and in patients whose immune system is suppressed by medication or disease. When diagnosed early, epithelial skin cancer is usually able to be treated with less complicated therapy and with a minimum of destruction of involved tissues.
Misconception: Only whites develop melanoma and epithelial skin cancer.
While nonwhites rarely develop melanoma and epithelial skin cancer, the same warning signs and symptoms apply. Melanoma can appear anywhere on the skin of nonwhites, but in about half the cases, melanoma appears on the palms of the hands, soles of the feet, nail beds, or mucous membranes (inner eyelids, nose, mouth, anus, and genitalia), usually as a new or changing black spot a sometimes a pink or red patch. Epithelial skin cancer rarely occurs in nonwhites unless there has been exposure to x-ray (radiation) therapy that has been used to treat disease; a chronic ulcer related to burn or scarring disease; a chronic draining sinus; or excessive exposure to natural sunlight or artificial sources of ultraviolet radiation.
What happens during an examination for skin cancer?
A physician will usually offer to examine your entire skin surface. In addition to areas exposed to the sun, melanoma and epithelial skin cancer can occur on skin sites not commonly exposed to the sun, such as palms, soles, hairy scalp, genitalia, anal area, between toes and fingers, and nailbeds.
What can I do to save my life?
Delay in seeking help is responsible for the majority of skin cancer deaths. Denial of a problem is your greatest enemy, second only to ignorance of the meaning of the usual signs and symptoms that could indicate a developing cancer. If you have questions about skin cancer and its warning signs, or if you have any of the signs or symptoms or risk factors listed above, take action by consulting your dermatologist or general physician.
Mole Biopsy & Removal
Most people have moles in various numbers and locations. Moles are genetically determined in many cases and can thus be considered inherited to a certain extent. Reasons for removing a mole include suspicion of malignancy, irritation or a cosmetically unacceptable appearance. Medical insurance usually covers the removal in the first two situations.
......If a mole is changing or otherwise suspicious for malignancy, a biopsy should be performed. A biopsy is the removal of any size piece of tissue, large or small, and the analysis of the cells in a specially stained specimen under a microscope.
......There are many ways to biopsy a mole, each varying in cost and scar formation. The author is specially trained in all the existing forms of mole removal. The author's philosophy on mole removal is that, for initial testing, the removal of large pieces of margin (normal) tissue around moles, thereby leaving large scars, is NOT helpful. The extra normal tissue in a large excisional specimen makes it more difficult for the average laboratory to examine a mole thoroughly. FOR INITIAL EXAMINATION or biopsy, the author takes a tiny triangulate (inverted pryamidal) biopsy of small moles. Moles that protrude may delicately be sampled tangentially, i.e., removed to the level of the skin, which is then lightly sanded to match the surrounding body contours. Though the biopsy will be small, it will usually encompass a good portion (60-90%) of the mole cells making the growth. If the biopsy is read "benign," then no further work is necessary. If the biopsy indi-cates any potential for trouble in the future, then the patient will be advised of the options and a final decision made for or against a margin excision to remove any remaining mole.
......If the author must perform a margin excision on the face, ex-tremely fine (7-0) surface stitches and absorbable deep stitches are used so as to not leave "tracks." If the mole is on the body, the author usually uses subcuticular (below surface) stitches that never pass through the surface of the skin in order to avoid tracks.
......Is it dangerous to leave any part of a "bad mole" behind? Isn't it always better to sample moles with a margin excision to avoid spilling potentially malignant cells into the bloodstream? The answers are, fortunately, NO! British and American Dermatologists have battled over these questions for years; detailed studies of large and small melanoma biopsies have now been done that resoundingly favor the American view that small specimens are not dangerous. These studies have shown that melanoma sampled by small biopsies does not spread cells into the bloodstream to any greater degree than melanoma sampled by taking large-margin excisions. Melanoma is derived from cells similar to those of a mole. Melanoma is one of the deadliest forms of skin cancer. If melanoma is not spread from small samples, neither should small sampling a mole spread any possible abnormal cells.
......If a benign-looking, protruding mole needs to be removed due to irritation or to enhance cosmetic appearance, a technique called tangential incisional biopsy may be performed. This procedure consists of "shaving" the mole with a sharp scalpel parallel to the surface of the skin, followed by a light sanding. This biopsy removes the raised portion of the mole, leaving some mole cells in the skin. Less than 10% of the time, these remaining mole cells will regrow the mole; sometimes such regrowth will be even darker than the original mole prior to the biopsy. A tangential-incisional-biopsy wound generally heals within two to three weeks as a flat scar approximately the same size as the original mole. Initially, the scar can be pink, darker or lighter than the surrounding skin. This color tends to blend in with time so that cosmetic results are usually excellent, with a barely perceptible scar. Darkening of the site is minimized if the patient avoids sun exposure or uses at least a number 15 sunscreen on the area for several weeks after the biopsy. It is important to provide good wound care to the area for the best cosmetic result. See Wound Care.
......The healing tendency following tangential biopsies is unpredictable, depending greatly on the individual patient. Rarely, a raised or depressed scar may develop in spite of good biopsy technique and meticulous care. The best thing to do for cosmetic purposes, if one does not know one's healing tendency from previous wounds or surgery, is to have only one mole removed first to see how it heals before having multiple moles removed. Raised scars are more common on the trunk near the breastbone, so one must weigh the risk versus possible benefits there. If a raised scar does form, local steroid injections and firm deep massage are usually effective treatment.
......Again, all moles that are removed, even benign-looking ones, should be sent to pathology for microscopic examination. This examination helps to tell doctors whether the mole is harmless or whether the patient should have more bordering tissue removed. Sometimes moles that are textbook examples of benign or "good" moles turn out to be serious melanoma, discovered incidentally (by chance or by accident). This is because 10% of melanomas may not fit dermatologists' classic rules for malignancy. Since early detection and removal is the best way to cure melanoma, the patient can participate actively in his/her own care by self-examination. Signs of concern include a mole's recent change in appearance, size, shape or color, irregularity in color, loss of a uniform border, asymmetry (inequality on either side of a line drawn down the middle), bleeding or the notching of a border. Moles with any of these signs should be brought at once to the attention of a dermatologist for close examination.
Moles
Moles
Written by Prof James Ferguson, consultant dermatologist
What is a mole?
A mole (or melanocytic naevus) is an abnormal collection of pigment cells present within the skin. These cells are known as melanocytes. Moles are extremely common. Most people are born with a few moles and develop others during their lives.
Keep an eye on your moles. Go and see the doctor if they begin to itch, increase in size or change colour.
What causes moles?
Most moles are simply the result of a harmless proliferation of the pigment cells within the deeper layer of the skin. A few of these moles, called congenital melanonaevi, are usually present at birth. But most develop spontaneously or are caused by exposure to sunlight and tend to appear on those areas of the skin that catch the most sunlight. Most of these moles appear during the first 20 years of life, although they may continue to develop into the 30s and 40s. However, the majority disappear with age.
Why are moles a concern?
The main worry with moles is that a small number may go on to develop a condition called malignant melanoma. This form of skin cancer, which can be fatal, is best spotted early and treated with surgical excision (ie it is cut out of the skin).
Who is at risk?
The presence of moles will not cause you serious problems. But large numbers, more than 25, are an indication of susceptibility to melanoma. So you should take great care about exposure to sunlight. If there is a family history of malignant melanoma, you should be particularly vigilant about changing moles.
What are the symptoms of malignancy?
The mole is itchy and painful.
Increased size or an increasingly irregular appearance, especially at the edges.
A change in colour, particularly if the mole gets darker or becomes mottled.
Spontaneously bleeding.
Satellite pigmented lesions.
How is malignancy diagnosed?
Although most changes in the size, shape and colour of moles are due to a benign, non-cancerous increase in number of pigment cells, any mole that looks unusual should be examined. Your doctor will probably request information on recent changes to the mole along with a family history to assess your risk.
If only mild changes are found, your doctor will usually only need to take a clinical photograph of it. The mole's appearance may be reviewed in a later appointment. But if your doctor is concerned, an excision biopsy will be arranged, if necessary following a consultation with a plastic surgeon or a dermatologist.
Good advice
Avoid unnecessary exposure to sunlight, particularly during the two hours on either side of midday when the sun’s rays are strongest, and avoid getting sunburn.
Keep covered up in sunlight and apply sunscreen on exposed skin.
Examine your moles regularly and get someone to check those you cannot see.
Other types of moles include dysplastic, blue and halo naevi.
Dysplastic naevus syndrome
Some large moles have an irregular outline and an indistinct border. These carry an increased risk of malignancy and tend to occur in families who have a history of malignant melanoma. Patients with such moles need to have them examined regularly and compared with clinical photographs.
Halo naevi
Occasionally the skin surrounding a small mole becomes lighter and the central mole becomes pale. Most halo naevi are benign. But some people may have an increased risk of developing the skin disorder, vitiligo. Patients with malignant melanoma may, very rarely, develop halo naevi.
Blue naevus
This deep-seated mole appears blue. It is very common in some West Indian infants but is only rarely of any significance.
Juvenile melanoma (Spitz naevus)
In this condition, the pigment cells form a benign tumour, which is usually a pink-brown colour. Although similar to melanoma, the outlook following treatment is good.
Common misconceptions
It is not true that moles on the soles of the feet or hairy moles are more likely to become malignant (cancerous).
Comment