Moles – Park City Dermatologist

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By Dr. Steven Kern, M.D.

Park City, Utah 84098

Physician, Dermatology

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Moles are the familiar and normal tumors on the skin most people. They can come at any time and at any age. Most occur during one’s adult’s life they come in large numbers as a shower of lesions. It is thought that they tend to disappear spontaneously after a period of many years.

Moles consist of nevus cells, a cell thought to be related to both the nervous system and to the pigment –forming cells of the body. This latter relationship explains why a mole can become a melanoma, a very dangerous skin cancer. Perhaps not more than one mole in a million ever changes to cancer so there should be no such necessity to have moles removed to prevent cancer. Many melanomas arise without any relationship to moles.

The mole is strictly a tumor of the skin. The nevus cells are bunched together under the skin surface and sometimes, if there are many, they raise the surface of the skin producing the usual dome shaped configuration of a mole. The color of a mole varies from skin color, from light yellow to shades of brown or even bluish-black. They may be smooth or rough, and may be surrounded by redness, or even absence of pigment.

Generally, moles may be left untreated. Unsightly moles may be removed. It is always wise to have the doctor ask for microscopic examination of one or more of the most troublesome moles that are removed.

The average young adult will have about 40 moles. A mole may be dangerous if it changes in color, size or consistency, surface characteristic, of becomes itchy, painful or bloody. If new moles develop close to an old one, and particularly if there is swelling of the nearby lymph glands, the mole may be dangerous. Again, the mole that is fleshy, elevated, and hairy can usually go ignored except for cosmetic reasons. Moles should be removed if the person continually strikes or injures them. Similarly, tumors situated where the clothing rubs or cuts them, or where the razor cuts them should be removed. Some doctors advice removing all moles on the genitals, palms, and soles as well as in blue-black areas in the mouth.

There are many other types of nevus cell tumors. One of these is the so-called giant nevus, or bathing trunk nevus, a brownish tumor that covers a large part of the body. These are important tumors; they show at birth, and they demand medical attention.

Another type of nevus is called the halo nevus. This tumor is surrounded by an area of decreased color and it too should be observed by a physician and probably should be removed.

The blue is a dome shaped blue tumor which is usually innocent, but which again should be observed by a physician from time to time. Some of the other unusual types of nevi that should be mentioned for completeness include the spindle-celled nevus, the pseudomelanomatous nevus, the balloon-cell nevus, and the nevus with globular melanin.

About 9% of people have nevi on the bottom of their feet and 6% have them on the palm of the hand. These may be removed safely, just as all moles can be safely removed.

Closely related to moles are freckles (ephelides), liver spots (senile lentigines), and while these lesions look alike to the eye, they show different changes microscopically. Neither one is serious, nor should both be ignored unless they show signs of change. It is possible to treat them for cosmetic reasons if desired.

The ordinary nevus should so that a good cosmetic result occurs. Complete excisions of these with subsequent suturing is not only unnecessary, but often produces an undesirable result. We attempt to produce the least amount of scar possible, no matter what area is involved.

It is almost always necessary to have follow-up visits after mole removal because we must check to see that the scar is smooth (a keloid will occasionally form, and this type of big scar is usually preventable if caught early). We also check to see if some pigment is reoccurring in the scar. If it does, this brown color can usually be destroyed with just the brief use of the electric needle.

Hairs and moles will not always be destroyed by the surgery because the hair root often goes deeper than the mole itself. If the hairs do come back after surgery, and if they are annoying they can be destroyed by a procedure called epilation of electrolysis.