Moles (nevi) and Melanomas

When should you be concerned about a “freckle” or pigmented spot or mole?

See a physician experienced in diagnosing skin cancer if any of the following apply to you:

1. There has been a change inthe feel or appearance of any growth or spot
2. You have a mole or spot that is dark or contains multiple colors
3. You have a mole that fails on any of the A thru D criteria below
4. You have a new mole, one that was not there before

Touch, pain, itching:

Often when something has gone wrong with the skin, there is some change that you can notice. An area may feel rough or scaly. You may notice redness or some other color change. A mole may change color, size, shape or all of the foregoing.

ABCD

A-B-C-D. These letters represent the first letter of four words that will help you have an idea of what constitutes a suspicious mole. Spots or moles (also known as nevi) that are Asymmetrical or have an irregular Border, or are dark in Color or have more than one color, or are ¼ inch (6mm) or more in Diameter, are suspicious moles or spots.  If a growth fails on one or more of these criteria, you should have an experienced physician evaluate the area.

The problem I see so often is that pictures in brochures often depict large and rather ugly lesions and so patients are tempted to think that what they have doesn’t look so bad and therefore their mole must be okay. Big mistake. The brochures aren’t intended to turn people into diagnosticians, but patients are often lulled into attempting a self-diagnosis.

Here is a better way to approach the situation: If you have a non-healing or odd feeling area on your skin or an area that is rough or fails on any of the A through D criteria, please have it checked. Notice that everything said or, not and. You may only have one warning, such as itching.

Benign

There are many different kinds of nevi (moles) and they may change over time. Some are benign and are not known to be harmful. Sometimes a really “bad” looking mole turns out to be not so bad. And sometimes an unimpressive mole turns out to be a very bad, advanced stage of melanoma. So, how do you know? You don’t know. You have to have your moles evaluated by an experienced physician.

Atypical Moles (a.k.a. Dysplastic Nevi)

Nevi (moles) can become abnormal in which case they are called atypical nevi or dysplastic nevi. Some people have a lot of abnormal nevi and we call that a dysplastic nevus syndrome. It is the degree of atypia that is important and this is determined with a biopsy. Nevi that show a moderate or severe amount of atypia need to be fully removed following special guidelines. Severe atypia is also known as borderline melanoma.

Melanoma

Moles (nevi) can become cancerous. We call these cancerous moles melanomas. They require serious, prompt attention and can be deadly. Caught early they can be fully cured. There are many different kinds of melanoma, some worse than others. Also the depth of the melanoma at the time of diagnosis is very important. The deeper they have gone the more problematic they can be. The importance of early diagnosis and treatment must be emphasized.

This overview is purposely simple because the message is simple:
Don’t diagnose yourself. Be checked. Be sure. Be safe.

Richard E. Buckley, MD
Pocono Medical Care/Advanced Dermatology