Mole or Melanoma: When to Worry?

What Is a Mole?

A mole or nevus is a black or brown spot present in the skin. It is usually round, has a uniform color with smooth edges, and often measures less than 6 mm in diameter. They are often acquired during childhood or adolescence. Most of them will never cause a problem. If new moles arise with age or there is a change in it, there is always a risk of becoming a melanoma. Melanoma is a grave disease that mostly arises from an innocent-looking mole. If a mole is present on the body, here is how one can know if it is just a mole or melanoma.

What Is Melanoma?

Melanoma is a severe type of cancer that occurs in melanocytes (cells that produce melanin). It occurs not only in the skin but also in the eyes and, rarely, inside the body, like in the nose or throat.

What Can Increase the Risk of Getting Melanoma?

The factors that can increase the risk of getting melanoma:

• Exposure to UV radiation.

• Fair skin.

• Women.

• People under the age of 40.

• Light color eye.

• Freckle or sunburn.

• Blond or red hair.

• Family history of skin cancer.

• Unusual mole.

Where Does the Mole Appear?

Mole can occur anywhere in the body, irrespective of whether the area is exposed to the sun. Normally, moles are uniformly colored, like tan, brown, or black, with a distinct border that separates them from the surrounding skin. Moles can start forming from childhood until the age of 40. They can change their appearance over time, and sometimes, they may also disappear.

Do Moles Have Different Appearances?

Yes, moles have a variety of shapes, and a recurring pattern in a patient constitutes 'signature' lesions. They are usually oval or round and size can range from smaller than 6 millimeters in diameter to the size of a pencil eraser. But melanoma usually is asymmetrical in shape and uneven around the edges.

Common mole signatures include:

• Brown or pink type.

• Fried-egg.

• Eclipse.

• Inverse pattern.

• Targetoid or cockade.

• Shrapnel or ladybug pattern.

• Perifollicular hypo or hyperpigmentation pattern.

• Cheetah phenotype, etc.

What Is ABCDE of Melanoma?

• A - Asymmetry - One-half of the mole is different from the other.

• B - Border - Irregular borders.

• C - Color - Has a variety of shades.

• D - Diameter - Larger than 6 mm.

• E - Evolving - Changing size, shape, color, and border with time.

When to Worry About a Mole?

All the symmetric changes occurring in a mole, such as an increase in size with age, a uniform darkening after sun exposure or after a chronic trauma, etc., are not signs of malignancy. However, if there is bleeding, ulceration, or an increase in number after 50 years of age, it is a red flag for malignancy.

Who Should Be Tested?

Patients with the following increased risk factors should be screened annually or bi-annually.

1. Moles with an irregular shape and which increase in number.

2. Familial atypical multiple mole melanoma syndromes.

3. A large congenital nevus.

4. Persons with fair skin and blond or red hair.

5. A family history of melanoma.

6. A previous history of melanoma or other skin cancer.

7. Low immunity (immunosuppressants, human Immunodeficiency virus, etc.).

8. Advanced age.

9. Male sex.

10. Exposure to sun rays and UV (ultraviolet) rays.

11. Xeroderma pigmentosum.

What Does Having a Risk Factor Indicate?

It is significant to know that anyone can get melanoma. Not all persons who have multiple risk factors will have the disease. It is also possible that melanoma may arise in people with few or no risk factors.

Can Melanoma Be Found at an Early Stage?

Yes, it can be detected at an early stage. If it is done, the success rate of the treatment is very high (99 to 100 %).

How to Do a Skin Self-Examination?

Eyes and a full-length mirror are all that is required.

1. Every month, thoroughly examine all body areas, including the scalp, palms, back of the thighs, etc.

2. Check for the appearance of new moles and the size, shape, color, and texture of the existing ones.

3. Clicking pictures of the involved area will be an added tool for comparing the progress.

4. Never inspect using a magnifying lens, as it may intensify the ruggedness of the borders. The more magnified a mole is, the more attenuated and uneven its edges appear to be, which can cause a lot of anxiety.

What Happens at the General Practitioner Appointment?

The general practitioner (GP) asks for details regarding the health, family medical history, medical conditions, and symptoms. The GP should be informed about the mole, freckle, or other area of the skin that has shown changes. GP should be told about anyone in the family who suffered from skin cancer before. GP observes the affected area.

Can a Common Mole Turn into Melanoma?

A common mole can rarely turn into melanoma, a serious type of skin cancer. Although common moles are not considered cancerous, individuals with small and large moles exhibit an increased risk for melanoma.

Certain changes can be observed when the mole turns to melanoma. These changes include:

• The change in the color of the mole.

• The mole may become small or large.

• Changes in shape, texture, and height of the mole occur.

• The skin on the surface of the mole becomes dry or scaly.

• The mole appears hard and lumpy.

• Itching may be observed on the mole.

• Oozing or bleeding of the mole may occur.

What Are the Differences Between a Common Mole, a Dysplastic Nevus, and a Melanoma?

A common mole, a dysplastic mole, and melanoma differ in size, shape, color, and surface texture.

What Factors Increase the Risk of Melanoma?

Anyone may be affected by melanoma, but some factors may increase the risk of melanoma. These include:

• Those with dysplastic nevus.

• Those with small moles or many large moles.

• Those with fair skin, blue or gray eyes, red or blond hair, or with many freckles.

• Sunlight is a source of ultraviolet (UV) radiation, which may damage the skin and result in melanoma or any other skin cancer.

• History of melanoma may lead to other types of melanomas.

• Family history may be responsible for the development of melanoma.

• A weakened immune system is responsible for causing melanoma.

When to Approach a Physician for a Mole?

In patients with a family history or a history of melanoma, if one finds any mole that does not fit into the signature lesion category, a mole having an irregular border to a naked eye is sore or bleeds, it is always better to get examined by a dermatologist using a dermatoscope.

What Are the Tests to Be Done?

• Serial dermatoscopy.

• Digital epiluminescence microscopy (DELM).

• Biopsy.

• Chest X-ray.

• Reflex transmission imaging (RTI).

• CT scan (computed tomography).

• MRI scan (magnetic resonance imaging).

• PET scan (positron emission tomography).

Should One Get All the Moles Removed?

Doctors do not always remove all the moles, as most are harmless. Removing a few or all of them does not decrease the risk of melanoma. It is also possible for melanoma to develop de novo (from the beginning).

What Preventive Measures Should Be Taken to Avoid Melanoma?

Certain risk factors, like age, gender, family history, etc., cannot be prevented. However, the following precautions can be taken.

• Limit exposure to UV rays, including tanning beds and solar lamps.

• Use sunscreen creams with high SPF (sun protection factor).

• Always seek shade.

• Keep an eye on abnormal moles.

• Avoid weakening the immune system (with drug abuse, multiple sex partners, etc.).

Conclusion:

The mole that appears after the age of 50 years should be consulted with the doctor because it has a high chance of developing melanoma, which can spread to other parts of the body and cause life-threatening complications.