Also known as beauty marks, or nevi, moles are brown and black spots skin lesions that vary in shape, color and texture. They can either be raised from the skin’s surface, or they can be flat. In most cases they are benign and quite common across adults. However they should be examined closely, especially if they change over time, bleed or itch. Surgical excisions or laser treatments are the two main methods used for mole removal.
WHAT CAUSES MOLES?
Moles are caused by melanocytes which are a specialized type of cell that produces melanin. Melanin is the pigment that gives our skins its color. Typically, they spread evenly across the skin. However they will sometimes grow as a cluster.
Two factors that precipitate this dynamic include:
- Sun exposure
- Hormonal changes (e.g. puberty, pregnancy, menopause and taking hormone medication)
TYPES OF MOLES
Moles can vary in form according to shape, color, and texture.
Regular and Irregular Moles
Regular shaped moles include circles and ovals. They are symmetrical. Irregular shaped moles are asymmetrical, where one side appears different from the other side.
Brown, Black, Red and Flesh Colored Moles
Brown and red moles are common in light skin types. Black moles are common in darker skin types. Flesh colored moles are common in individuals of African descent.
Although most moles are benign, exposing these different color types to excessive levels of UV rays can trigger DNA processes within the skin that lead to skin cancer. However red moles have the highest risk factor.
Raised and Flat Moles
Depending on where the melanocyte clusters exist relative to the skin layers, moles can be raised or flat.
Moles are basically lesions (abnormal tissue formations). Because they are caused by a clustering of melanocytes, they are scientifically referred to as melanocytic nevi. The term nevi is plural, while the term nevus is singular. There are many variations of the melanocytic nevus. These classificationsinclude:
The junctional nevus is located at the border junction of the epithelial skin surface and the dermal layer underneath. This mole type is brown or black and flat in texture
The intradermal nevus is based solely in the dermis. These moles are usually flesh colored and raised.
The compound nevus is raised with a brown or black color. It is often referred to as a beauty mark. The melanocytic clustering originates at the epithelial and dermal juncture as well as the dermis. So in a way, it is a hybrid of a junctional and intradermal nevus.
The dysplatic nevus is basically a compound nevus. However its cells are abnormally developed along with their overall architectural configuration. This mole is usually larger than average. And it can be flat or raised. The border and color tends to be irregular, resembling cases of melanoma. If they occur frequently in number, they need to be examined.
The color of the blue nevus results from the fact that the melanocytes responsible for it lie deep within the dermis. These cells are shaped as spindles. Instead of being clustered, they are scattered.
The spitz nevus is a type of intradermal nevus. This mole is red and raised.
This is a mole type that is present at birth and occurs in about 1 out of a 100 babies. This nevus carries a very high risk of developing into melanoma.
As the name suggests, this nevus is acquired during later stages in life, as opposed to being present at birth. The melanocytes causing this nevus can be junctional, compound or intradermal.
Giant Pigmented Nevus
The giant pigmented nevus is a fairly large pigmented area with somewhat prolific hair growth. Melanoma occurs in 10-15% of cases.
According to the University of Maryland Medical Center, most occurrences of moles are benign. However they do need to be examined more closely to see if they are cancerous.
The ABCDE criteria are used to roughly analyze various characteristics of moles.
A stands for asymmetry. Typical moles are symmetrical, where both sides are identical. In asymmetrical moles, the shape is irregular.
B stands for border. It is important to look for fuzzy or smudged borders as possible warning signs.
C stands for color. Benign moles are uniform in color. Color irregularities should be examined by a physician.
D stands for diameter. Moles larger than the size of a pencil eraser, or approximately 7mm should warrant further investigation.
E stands for evolution or elevation. Look for irregularities in elevation, where one part of the mole is more raised than another. Also it is important to note any changes in how the mole evolves, or changes in appearance over time.
MOLE REMOVAL IN LOS ANGELES
There are three common techniques for eliminating nevi:
Surgical Mole Removal
Moles can be removed by either cutting them off at the base or by excising the skin around the mole. The choice of techniques will depend on the elevation of the mole from the skin’s surface. Making cuts below the mole does not often require sutures. However cutting around the mole does require sutures after the procedure. Cutting the mole and suturing leaves a line of a scar while cutting without suturing would leave a wider scar. After removal, moles should be submitted for histological analysis to determine their specific nature as well as the absence or presence of cancer cells.
In cryongenic procedures, liquid nitrogen is used to freeze the mole to destroy the abnormal tissue. This fluid can be applied topically. In cases where the melanocyte cluster is deeply imbedded within the skin, needles or probes are used to administer the nitrogen. There is an increased chance of loss of color (pigment) with cryotherapy.
Mole Removal By Laser
Specific laser wavelengths are absorbed by the pigment of the mole. Then this energy works to destroy the abnormal tissue. The laser also seals off blood vessels which prevents bleeding after the procedure.
Moles can be removed for cosmetic or health reasons. Although most moles are harmless and quite common, it is important to notice any changes or irregularities in their shape, color or texture so that malignant growths can be removed during early onset. Laser removal is done for moles that are benign. A mole that is suspected to have cancerous characteristics should be removed surgically and submitted for pathologic analysis.
Dr Umar uses the spectra Q switch ND:YAG at his office in Los Angeles to remove benign moles. The advantage of treatment of mole by laser instead of surgery is mainly because of less scarring and a cosmetically more appealing result.