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| == Melanocytic nevus == | | {{Short description|A type of skin lesion commonly known as a mole}} |
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| A '''melanocytic nevus''' (also known as '''nevocytic nevus''', '''nevus-cell nevus''' and commonly as a '''mole''')<ref name="Andrews">{{cite book|author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology|publisher=Saunders Elsevier|location= |year=2006| pages= |isbn=0-7216-2921-0|oclc= |doi= |display-authors=etal}}</ref><ref name="Dorlands">{{cite book|last1=Albert|first1=Daniel|title=Dorland's illustrated medical dictionary.|date=2012|publisher=Saunders/Elsevier|location=Philadelphia, PA|isbn=978-1-4160-6257-8|page=1173|edition=32nd}}</ref> is a type of [[melanocytic tumor]] that contains [[nevus cell]]s.<ref name="Dorlands"/> Some sources equate the term mole with "melanocytic nevus",<ref name="Dorlands"/> but there are also sources that equate the term mole with any [[nevus]] form.<ref>{{cite web|url=https://www.mayoclinic.org/diseases-conditions/moles/symptoms-causes/syc-20375200|title=Moles|website=[[Mayo Clinic]]|accessdate=2019-09-16}}</ref> | | A '''melanocytic nevus''' is a type of [[skin]] lesion that is commonly referred to as a [[mole]]. These lesions are typically benign and are composed of [[nevus cells]], which are a type of [[melanocyte]]. Melanocytic nevi can appear anywhere on the [[body]] and vary in color, size, and shape. |
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| The majority of moles appear during the first two decades of a person's life, with about one in every 100 babies being born with moles.<ref name="aad.org">{{cite web|url=http://www.aad.org/public/publications/pamphlets/common_moles.html|title=Moles|accessdate=2008-08-02|publisher=[[American Academy of Dermatology]]|deadurl=yes|archiveurl=https://web.archive.org/web/20080805123024/http://www.aad.org/public/publications/pamphlets/common_moles.html|archivedate=2008-08-05|df=}}</ref> Acquired moles are a form of [[Benign tumor|benign neoplasm]], while [[congenital]] moles, or congenital nevi, are considered a minor [[malformation]] or [[hamartoma]] and may be at a higher risk for melanoma.<ref name="aad.org" /> A mole can be either subdermal (under the skin) or a pigmented growth on the [[skin]], formed mostly of a type of [[cell (biology)|cell]] known as a [[melanocyte]]. The high concentration of the body's pigmenting agent, [[melanin]], is responsible for their dark [[color]]. Moles are a member of the family of [[skin lesions]] known as [[nevi]] and can occur in all mammalian species especially humans, dogs, and horses.<ref>{{Cite journal|date=2017-04-04|title=Melanocytic Nevi: Background, Pathophysiology, Epidemiology|url=http://emedicine.medscape.com/article/1058445-overview}}</ref>
| | ==Classification== |
| | Melanocytic nevi are classified based on their location within the layers of the [[skin]] and their appearance. The main types include: |
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| ==Signs and symptoms==
| | * '''Junctional nevi''': These are located at the junction of the [[epidermis]] and [[dermis]]. They are usually flat and uniformly pigmented. |
| According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles. [[Benignity|Benign]] moles are usually brown, tan, pink or black (especially on dark-colored skin). They are circular or oval and are usually small (commonly between 1–3 mm), though some can be larger than the size of a typical pencil eraser (>5 mm). Some moles produce dark, coarse [[hair]]. Common mole hair removal procedures include plucking, cosmetic waxing, [[electrology|electrolysis]], [[Threading (epilation)|threading]] and cauterization.
| | * '''Compound nevi''': These have both junctional and dermal components, often appearing as slightly raised lesions. |
| | * '''Intradermal nevi''': These are located entirely within the [[dermis]] and are typically raised and flesh-colored. |
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| ==Aging== | | ==Appearance== |
| Moles tend to appear during early childhood and during the first 30 years of life. They may change slowly, becoming raised, changing color or gradually fading.<ref>{{cite web|url=http://www.webmd.com/skin-problems-and-treatments/guide/moles-freckles-skin-tags|title=Moles, Freckles, Skin Tags: Types, Causes, Treatments|work=WebMD}}</ref> Most people have between 30 and 40 moles, but some have as many as 600.<ref>{{cite web|url=https://www.bbc.co.uk/news/health-11813378|title=Skin moles link to delayed ageing|work=BBC News}}</ref>
| | Melanocytic nevi can vary widely in appearance. They may be: |
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| The number of moles a person has was found to have a correlation with [[telomere]] length.<ref>{{cite journal |vauthors=Bataille V, Kato BS, Falchi M, etal |title=Nevus size and number are associated with telomere length and represent potential markers of a decreased senescence in vivo |journal=Cancer Epidemiology, Biomarkers & Prevention |volume=16 |issue=7 |pages=1499–1502 |date=July 2007 |pmid=17627017 |doi=10.1158/1055-9965.EPI-07-0152}}</ref> However, the relation between telomeres and [[Senescence|aging]] remains uncertain.<ref>{{cite journal |vauthors=Gomes NM, Ryder OA, Houck ML, etal |title=Comparative biology of mammalian telomeres: hypotheses on ancestral states and the roles of telomeres in longevity determination |journal=Aging Cell |volume=10 |issue=5 |pages=761–768 |date=October 2011 |pmid=21518243 |pmc=3387546 |doi=10.1111/j.1474-9726.2011.00718.x}}</ref>
| | * '''Flat or raised''' |
| | * '''Round or oval''' |
| | * '''Uniformly colored or variegated''' |
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| ==Complications==
| | The color of a melanocytic nevus can range from pink to dark brown, depending on the amount of [[melanin]] present. |
| Experts, such as the American Academy of Dermatology, say that the vast majority of moles are [[benign]].<ref name="aad.org" /> Nonetheless, the U.S. [[National Cancer Institute]] estimated that 62,480 new cases of [[melanoma]] and 8,420 related deaths would appear in the United States in the year 2008.<ref>{{cite web|url=http://www.nci.nih.gov/cancertopics/types/melanoma |title=Melanoma Home Page|accessdate=2008-05-18|publisher=[[National Cancer Institute]]}}</ref>
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| Data on the chances of transformation from melanocytic nevi to [[melanoma]] is controversial, but it appears that about 10% of malignant melanomas have a precursor lesion, of which about 10% are melanocytic nevi. Therefore, it appears that malignant melanoma quite seldomly (1% of cases) has a melanocytic nevi as a precursor.<ref>{{cite journal |author=Fernandes NC |title=The risk of cutaneous melanoma in melanocytic nevi |journal=Anais Brasileiros De Dermatologia |volume=88 |issue=2 |pages=314–315 |year=2013 |pmid=23739702 |pmc=3750908 |doi=10.1590/S0365-05962013000200030}}</ref>
| | ==Development== |
| | Melanocytic nevi often develop during [[childhood]] and [[adolescence]], with the number of nevi typically peaking in the third decade of life. They may change in appearance over time, sometimes becoming more raised or changing in color. |
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| ==Cause== | | ==Pathophysiology== |
| | The development of melanocytic nevi is influenced by genetic factors and [[sun exposure]]. Nevus cells are derived from [[neural crest]] cells and are similar to [[melanocytes]], the cells responsible for producing [[melanin]]. |
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| The cause is not clearly understood, but is thought to be caused by a defect in embryologic development. This is in the first twelve weeks of pregnancy. The defect is thought to cause a proliferation of melanocytes. This means melanocytes, the cells in the body in charge of normal skin color, are being produced at an extremely fast rate, thus causing the melanocytes to form in clusters instead of spread out, causing abnormal skin pigmentation in some areas of the body.
| | ==Potential for Malignancy== |
| | While most melanocytic nevi are benign, some may develop into [[melanoma]], a type of [[skin cancer]]. Features that may suggest malignancy include: |
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| ===Genetics===
| | * Asymmetry |
| [[Genes]] can have an influence on a person's moles.
| | * Border irregularity |
| | | * Color variation |
| '''[[Dysplastic nevus syndrome]]''' is a largely [[hereditary]] condition which causes a person to have a large quantity of moles (often 100 or more) with some larger than normal or atypical. This often leads to a higher [[risk]] of [[melanoma]], a serious [[skin cancer]].<ref>{{cite journal|author=Burkhart CG|title=Dysplastic nevus declassified: even the NIH recommends elimination of confusing terminology|journal=Skinmed|volume=2|issue=1|pages=12–13| year=2003|pmid=14673319|doi=10.1111/j.1540-9740.2003.01724.x|url=http://www.lejacq.com/articleDetail.cfm?pid=SKINmed_2;1:12}}</ref> Dysplastic nevi are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles. Having more than 50 ordinary moles increases the risk of developing melanoma.<ref name="ncimelanoma">{{cite web|url=http://www.nci.nih.gov/cancertopics/wyntk/melanoma/page7|title=What You Need To Know About Melanoma - Melanoma: Who's at Risk?|accessdate=2008-05-18|publisher=[[National Cancer Institute]]}}</ref>
| | * Diameter greater than 6 mm |
| | | * Evolving shape or color |
| In the overall population, a slight [[majority]] of melanomas do ''not'' form in an existing mole, but rather create a new [[tumour|growth]] on the skin. Somewhat surprisingly, this also applies to those with dysplastic nevi. They are at a higher risk of melanoma occurring not only where there is an existing mole, but also where there are none.<ref>{{cite journal|vauthors=Pope DJ, Sorahan T, Marsden JR, Ball PM, Grimley RP, Peck IM |title=Benign pigmented nevi in children. Prevalence and associated factors: the West Midlands, United Kingdom Mole Study|journal=Arch Dermatol|volume=128|issue=9|pages=1201–1206|year= 1992|pmid=1519934|doi=10.1001/archderm.128.9.1201|url= }}</ref><ref>{{cite journal|vauthors=Goldgar DE, Cannon-Albright LA, Meyer LJ, Piepkorn MW, Zone JJ, Skolnick MH |title=Inheritance of nevus number and size in melanoma and dysplastic nevus syndrome kindreds|journal=J. Natl. Cancer Inst.|volume=83|issue=23|pages=1726–1733|year=1991|pmid=1770551|doi=10.1093/jnci/83.23.1726|url=http://jnci.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=1770551}}</ref> Such [[person]]s need to be checked regularly for any changes in their moles and to note any new ones.
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| ===Sunlight===
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| [[Ultraviolet]] light from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Some scientists [[hypothesis|hypothesize]] that overexposure to UV, including excessive [[sunlight]], may play a role in the formation of acquired moles.<ref>{{cite journal |vauthors=van Schanke A, van Venrooij GM, Jongsma MJ, etal |title=Induction of nevi and skin tumors in Ink4a/Arf Xpa knockout mice by neonatal, intermittent, or chronic UVB exposures|journal=Cancer Res. |volume=66|issue=5|pages=2608–2615|year=2006|pmid=16510579|doi=10.1158/0008-5472.CAN-05-2476|url= http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=16510579}}</ref> However, more [[research]] is needed to determine the complex interaction between genetic makeup and overall exposure to ultraviolet light. Some strong indications that this is so (but falling short of proof), are:
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| *The relative lack of moles on the [[buttocks]] of people with dysplastic nevi.
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| *[[Freckle]]s (spots of melanin on the skin, and distinct from moles) are known to be influenced by sunlight.
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| Studies have found that sunburns and too much time in the sun can increase the risk factors for melanoma. This is ''in addition to'' those who have dysplastic nevi being at higher risk of this [[cancer]] (the uncertainty is in regard to acquiring ''benign'' moles). To prevent and reduce the risk of melanoma caused by UV radiation, the [[American Academy of Dermatology]] and the [[National Cancer Institute]] recommends staying out of the sun between 10 a.m. and 4 p.m. standard time (or whenever one's [[shadow]] is shorter than one's height). The National Cancer Institute also recommends wearing long sleeves and trousers, hats with a wide brim, sunscreens, and sunglasses that have UV-deflecting lenses.<ref name="ncimelanoma"/>
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| ===Hormones===
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| Hormonal changes during [[pregnancy]] and [[Diabetes|diabetics]] (i.e. [[insulin]]) are often contributing to mole formation.
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| ==Diagnosis==
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| [[File:Pie chart of incidence and malignancy of pigmented skin lesions.png|thumb|280px|Various [[differential diagnosis|differential diagnoses]] of pigmented skin lesions, including nevi, showing the relative [[incidence (epidemiology)|incidence]] of biopsied lesions, and their malignancy potential.]]
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| Clinical diagnosis can be made with the naked eye using the [[ABCD guideline]] or by using [[dermatoscopy]]. An [[Moletest|online-screening test]] is also available to help screen out benign moles.
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| <gallery>
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| File:Dermatoscope1.JPG|A [[dermatoscope]].
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| File:Dermatoscope.jpg|A modern polarized [[dermatoscope]].
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| </gallery>
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| ===Classification===
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| Melanocytic nevi can mainly be classified by depth, being congenital versus acquired, and/or specific specific [[dermatoscopy]] or [[histopathology]] patterns:
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| [[File:Micrograph of an intradermal melanocytic nevus.jpg|thumb|Micrograph of an intradermal melanocytic nevus]]
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| ;Depth:
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| *'''[[Junctional nevus]]''': the nevus cells are located along the junction of the [[epidermis]] and the underlying [[dermis]]. A junctional nevus may be colored and slightly raised.<ref>{{cite web |title=NCI Definition of Cancer Terms |url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/junctional-nevus |website=www.cancer.gov |publisher=National Cancer Institute |accessdate=5 December 2018}}</ref> | |
| ::*'''[[Intramucosal nevus]]''': junctional nevus of the mucosa of the mouth or genital areas. In the mouth, they are found most frequently on the hard palate. They are typically light brown and dome-shaped.<ref>{{cite web|title=Oral Nevi|url=https://emedicine.medscape.com/article/1079272-overview|website=MedScape|accessdate=23 January 2018}}</ref>
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| *'''[[Compound nevus]]''': A type of mole formed by groups of nevus cells found in the epidermis and dermis.<ref>{{cite web |title=NCI Definition of Cancer Terms |url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/compound-nevus |website=www.cancer.gov |publisher=National Cancer Institute |accessdate=5 December 2018}}</ref> | |
| *'''Intradermal nevus''': A classic mole or [[birthmark]]. It typically appears as an elevated, dome-shaped bump on the surface of the skin.<ref>{{cite web |title=What is an intradermal nevus? |url=https://www.healthline.com/health/intradermal-nevus |website=www.healthline.com |publisher=Health Line |accessdate=5 December 2018}}</ref> | |
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| ;Congenital versus acquired:
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| *'''[[Congenital nevus]]''': Small to large nevus present at or near time of birth. Small ones have low potential for forming [[melanomas]], however the risk increases with size, as in the giant pigmented nevus.{{Citation needed|date=June 2016}}
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| *'''Acquired nevus''': Any melanocytic nevus that is not a congenital nevus or not present at birth or near birth.
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| ;Specific [[dermatoscopy]] or [[histopathology]] patterns:
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| {|class="wikitable"
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| ! Type !! Characteristics !! Photo-<br>graphy || [[Histopathology|Histo-<br>pathology]]
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| | '''[[Dysplastic nevus]]''' (nevus of Clark) || Usually a compound nevus with cellular and architectural [[dysplasia]]. Like typical moles, dysplastic nevi can be flat or raised. While they vary in size, dysplastic nevi are typically larger than normal moles and tend to have irregular borders and irregular coloration. Hence, they resemble [[melanoma]], appear worrisome, and are often removed to clarify the diagnosis. Dysplastic nevi are markers of risk when they are numerous, such as in people with [[dysplastic nevus syndrome]]. According to the National Cancer Institute (NIH), doctors believe that, when part of a series or syndrome of multiple moles, dysplastic nevi are more likely than ordinary moles to develop into the most virulent type of skin cancer called melanoma.<ref>{{cite web|title=Familial atypical multiple mole melanoma syndrome|url=https://rarediseases.info.nih.gov/diseases/9281/familial-atypical-multiple-mole-melanoma-syndrome|website=Genetic and Rare Diseases Information Center (GARD)|publisher=NIH|accessdate=23 January 2018}}</ref>
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| | [[File:Dysplastic nevi (2) - crop.jpg|100px|left]]
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| In this case, the central portion is a complex papule, and the periphery is macular, irregular, indistinct and slightly pink.
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| | [[File:Dysplastic_nevus_-_add_-_high_mag.jpg|180px]] Characteristic [[rete ridge]] bridging, shouldering, and lamellar fibrosis. [[H&E stain]].
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| | '''[[Blue nevus]]''' || It is blue in color as its [[melanocytes]] are very deep in the skin.
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| | [[File:Blue Nevus (crop).jpg|140px]]
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| | [[File:blue nevus - intermed mag.jpg|85px|left]] Characteristic pigmented [[melanocyte]]s between bundles of [[collagen]]. [[H&E stain]].
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| | '''[[Spitz nevus]]''' || A distinct variant of intradermal nevus, usually in a child.
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| | [[File:Spitz nevus.jpg|180px]] They are raised and reddish (non-pigmented).
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| | [[Image:Spitz nevus - intermed mag.jpg|160px|left]] Characteristic vertically arranged nests of cells ("hanging bananas"). [[H&E stain]].
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| | '''[[Giant pigmented nevus]]''' || Large, pigmented, often hairy congenital nevi. They are important because [[melanoma]] may occasionally (10 to 15%) appear in them.{{Citation needed|date=June 2016}}
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| | [[File:Giant melanocytic nevus - photography.jpg|180px]]
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| | [[File:Giant melanocytic nevus - histopathology.jpg|180px]]
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| | '''[[Nevus of Ito]]''' and '''[[nevus of Ota]]''' || Congenital, flat brownish lesions on the face or shoulder.<ref>{{cite web|title=Nevus of Ito|url=https://rarediseases.info.nih.gov/diseases/10830/nevus-of-ito|website=Genetic and Rare Disease Information Center (GARD)|publisher=NIH|accessdate=23 January 2018}}</ref>
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| | [[File:Nevus of Ito.jpg|150px|left]] Nevus of Ito.
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| | '''[[Mongolian spot]]''' || Congenital large, deep, bluish discoloration which generally disappears by puberty. It is named for its association with East Asian ethnic groups but is not limited to them.<ref>{{cite web|title=Mongolian Spot|url=http://www.aocd.org/?page=MongolianSpot|website=AOCD Dermatologic Disease Database|publisher=American Osteopathic College of Dermatology|accessdate=23 January 2018}}</ref>
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| | [[File:Mongolianspotphoto.jpg|150px]]
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| ;Recurrence:
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| *'''[[Recurrent nevus]]''': Any incompletely removed nevus with residual melanocytes left in the surgical wound. It creates a dilemma for the patient and physician, as these scars cannot be distinguished from a melanoma.<ref name="abd">{{cite journal|title=The recurrent nevus phenomenon|journal=Anais Brasileiros de Dermatologia|date=July–August 2017|volume=92|issue=4|pages=531–533|doi=10.1590/abd1806-4841.20176190|pmc=5595602|accessdate=}}</ref> | |
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| ===Differentiation from melanoma===
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| It often requires a dermatologist to fully evaluate moles. For instance, a small blue or bluish-black spot, often called a blue nevus, is usually benign but often mistaken for [[melanoma]].<ref>{{cite journal|vauthors=Granter SR, McKee PH, Calonje E, Mihm MC, Busam K |title=Melanoma associated with blue nevus and melanoma mimicking cellular blue nevus: a clinicopathologic study of 10 cases on the spectrum of so-called 'malignant blue nevus'|journal=Am. J. Surg. Pathol.|volume=25|issue=3|pages= 316–323|date=March 2001|pmid=11224601|doi=10.1097/00000478-200103000-00005|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=25&issue=3&spage=316}}</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>{{cite journal|vauthors=Hall J, Perry VE |title=Tinea nigra palmaris: differentiation from malignant melanoma or junctional nevi|journal=Cutis| volume=62|issue=1|pages=45–46|year=1998|pmid=9675534|doi= |url= }}</ref>
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| A basic reference chart used for [[consumer]]s to spot suspicious moles is found in the [[mnemonic]] A-B-C-D, used by institutions such as the American Academy of Dermatology and the National Cancer Institute. The letters stand for asymmetry, border, color, and diameter.<ref name="aad.org" /> <ref>{{cite web|url=http://www.nci.nih.gov/cancertopics/wyntk/melanoma/page8|title=What You Need To Know About Melanoma - Signs and Symptoms|publisher=[[National Cancer Institute]]|accessdate=2008-05-18}}</ref> Sometimes, the letter E (for elevation or evolving) is added. According to the American Academy of Dermatology, if a mole starts changing in size, color, shape or, especially, if the [[border]] of a mole develops ragged edges or becomes larger than a [[pencil]] [[eraser]], it would be an appropriate time to consult with a physician. Other warning signs include a mole, even if smaller than a pencil eraser, that is different from the others and begins to crust over, bleed, [[itch]], or become [[Inflammation|inflamed]]. The changes may indicate developing [[melanoma]]s. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, come into suspicion.
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| A recent and novel method of melanoma detection is the "ugly duckling sign"<ref>{{cite web|url=http://www.skincancer.org/the-ugly-duckling-sign.html|title=404 Error - SkinCancerFoundation|publisher=|deadurl=yes|archiveurl=https://archive.is/20090130144704/http://www.skincancer.org/the-ugly-duckling-sign.html|archivedate=2009-01-30|df=}}</ref><ref name="ReferenceA">{{cite journal |vauthors=Mascaro JM, Mascaro JM |title=The dermatologist's position concerning nevi: a vision ranging from 'the ugly duckling' to 'little red riding hood' |journal=Archives of Dermatology |volume=134 |issue=11 |pages=1484–1485 |date=November 1998 |pmid=9828892 |url=http://archderm.jamanetwork.com/article.aspx?volume=134&page=1484 |doi=10.1001/archderm.134.11.1484}}</ref> It is simple, easy to teach, and highly effective in detecting melanoma. Simply, correlation of common characteristics of a person's skin lesion is made. Lesions which greatly deviate from the common characteristics are labeled as an "ugly duckling", and further professional exam is required.{{Citation needed|date=June 2016}} The "little red riding hood sign",<ref name="ReferenceA"/> suggests that individuals with fair skin and light colored hair might have difficult-to-diagnose melanomas.{{Citation needed|date=June 2016}} Extra care and caution should be rendered when examining such individuals as they might have multiple melanomas and severely dysplastic nevi. A dermatoscope must be used to detect "ugly ducklings", as many melanomas in these individuals resemble non-melanomas or are considered to be "wolves in sheep clothing".<ref name="dermnetnz.org">{{cite web|url=http://dermnetnz.org/doctors/dermoscopy-course/introduction.html|title=Dermoscopy. Introduction to dermoscopy. DermNet NZ|publisher=}}</ref> These fair skinned individuals often have lightly pigmented or amelanotic melanomas which will not present easy-to-observe color changes and variation in colors. The borders of these amelanotic melanomas are often indistinct, making visual identification without a [[dermatoscope]] very difficult.
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| People with a personal or family history of skin cancer or of [[dysplastic nevus syndrome]] (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.<ref>{{Cite web|url=https://www.dermcarestl.com/medical-services/skin-cancer/dysplastic-nevus-atypical-mole.html|title=Atypical Mole/Dyplastic Nevus - Skin Cancers - Medical Dermatology|website=DERMCARE|language=en|access-date=2018-08-13}}</ref>
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| ==Management== | | ==Management== |
| First, a diagnosis must be made. If the lesion is a [[seborrheic keratosis]], then shave excision, electrodesiccation or cryosurgery may be performed, usually leaving very little if any scarring.{{Citation needed|date=June 2016}} If the lesion is suspected to be a [[skin cancer]], a [[skin biopsy]] must be done first, before considering removal. This is unless an excisional biopsy is warranted.{{Citation needed|date=June 2016}} If the lesion is a melanocytic nevus, one has to decide if it is medically indicated or not{{Citation needed|date=June 2016}}
| | Most melanocytic nevi do not require treatment unless they are symptomatic or show signs of malignancy. In such cases, a [[biopsy]] or [[excision]] may be performed to rule out [[melanoma]]. |
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| If a melanocytic nevus is suspected of being a [[melanoma]], it needs to be sampled or removed and sent for microscopic evaluation by a [[pathologist]] by a method called [[skin biopsy]]. One can do a complete excisional [[skin biopsy]] or a punch [[skin biopsy]],{{Citation needed|date=June 2016}} depending on the size and location of the original nevus. Other reasons for removal may be cosmetic, or because a raised mole interferes with daily life (e.g. [[shaving]]). Removal can be by [[excisional biopsy]] or by [[shaving]]. A shaved site leaves a red mark on the site which returns to the patient's usual skin color in about two weeks. However, there might still be a risk of spread of the melanoma, so the methods of [[ABCD guideline|Melanoma diagnosis]], including excisional biopsy, are still recommended even in these instances.{{Citation needed|date=June 2016}} Additionally, moles can be removed by laser, surgery or electrocautery.
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| In properly trained hands, some medical lasers are used to remove flat moles level with the surface of the skin, as well as some raised moles. While laser treatment is commonly offered and may require several appointments,{{Citation needed|date=June 2016}} other dermatologists think lasers are not the best method for removing moles because the laser only [[cauterization|cauterizes]] or, in certain cases, removes very superficial levels of skin. Moles tend to go deeper into the skin than non-invasive lasers can penetrate. After a laser treatment a [[Wound healing#Proliferative phase|scab]] is formed, which falls off about seven days later, in contrast to surgery, where the wound has to be [[surgical suture|sutured]].{{Citation needed|date=June 2016}} A second concern about the laser treatment is that if the lesion is a melanoma, and was misdiagnosed as a benign mole, the procedure might delay diagnosis.{{Citation needed|date=June 2016}} If the mole is incompletely removed by the laser, and the pigmented lesion regrows, it might form a [[recurrent nevus]].{{Citation needed|date=June 2016}}
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| Electrocautery is available as an alternative to laser cautery. Electrocautery is a procedure that uses a light [[electrical current]] to burn moles, [[skin tags]], and [[warts]] off the skin.{{Citation needed|date=June 2016}} Electric currents are set to a level such that they only reach the outermost layers of the skin, thus reducing the problem of scarring. Approximately 1–3 treatments may be needed to completely remove a mole. Typically, a local anesthetic is applied to the treated skin area before beginning the mole removal procedure.<ref>{{cite book|last=Habif|first=Thomas P.|title=Clinical dermatology, a color guide to diagnosis and therapy|publisher=Mosby|year=1985|isbn=0-8016-2233-6|url-access=registration|url=https://archive.org/details/clinicaldermatol0000habi}}{{page needed|date=July 2014}}</ref>
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| For surgery, many dermatologic and plastic surgeons first use a freezing [[solution]], usually [[liquid nitrogen]], on a raised mole and then shave it away with a [[scalpel]]. If the surgeon opts for the shaving method, he or she usually also [[Cauterization|cauterizes]] the [[amputation|stump]].{{Citation needed|date=June 2016}} Because a [[circle]] is difficult to close with stitches, the [[Surgical incision|incision]] is usually [[elliptical]] or eye-shaped. However, freezing should not be done to a nevus suspected to be a melanoma, as the ice crystals can cause pathological changes called "freezing artifacts" which might interfere with the diagnosis of the melanoma.{{Citation needed|date=June 2016}}
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| ===Mole removal risks===
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| Mole removal risks mainly depend on the type of mole removal method the patient undergoes. First, mole removal may be followed by some discomfort that can be relieved with [[pain medication]]. Second, there is a risk that a scab will form or that redness will occur. However, such scabs and redness usually heal within one or two weeks.{{Citation needed|date=June 2016}} Third, as in other surgeries, there is also risk of [[infection]] or an anesthetic allergy or even [[nerve damage]]. Lastly, the mole removal may imply an uncomfortable [[scar]] depending on the mole size.<ref>{{cite web|url=http://www.emedicinehealth.com/mole_removal/page3_em.htm|title=Mole Removal|accessdate=2010-05-04}}</ref>
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| ==History==
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| In the 1950s and 60s (and, to lesser extent, currently) a facial mole was known as a "[[beauty mark]]" when it appeared in certain spots on a woman's [[face]]. Examples include [[Marilyn Monroe]], model [[Cindy Crawford]], singer [[Madonna (entertainer)|Madonna]], and the fictional [[Ms. Pac-Man]]. Madonna's facial mole—below her right nostril—has been surgically removed. Some [[folklore]] about moles includes the notion that picking at a mole can cause it to become [[cancerous]] or grow back larger.{{Citation needed|date=June 2016}}
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| ==Society and culture==
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| [[File:Abraham Lincoln head on shoulders photo portrait.jpg|thumb|[[Abraham Lincoln]] famously had a mole on his right cheek]]
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| Throughout [[human history]], individuals who have possessed facial moles have been subject to ridicule and attack based on superstition. Throughout most of history, facial moles were not considered objects of [[beauty]] on lovely faces. Rather most moles were considered hideous growths that appeared mostly on the [[human nose|noses]], [[cheek]]s, and [[chin]]s of [[Witchcraft|witches]], [[frog]]s and other low [[Animal|creatures]].
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| Both [[folklore]] and modern [[popular culture]] use physical traits to denote a character's either [[Good and evil|good]] or [[evil]] tendencies. In contrast to the fine features and smooth skin of its heroes and heroines, characters who possess negative or evil characteristics have also been known to possess more rugged features and skin blemishes, including facial moles.{{Citation needed|date=June 2016}}
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| During the Salem witch trials, warts and other dermatological lesions such as moles, scars, and other blemishes, when found on accused women were considered evidence of a pact with the devil.<ref>{{Cite journal|last=Flotte|first=T. J.|last2=Bell|first2=D. A.|date=1989-12-01|title=Role of skin lesions in the Salem witchcraft trials|journal=The American Journal of Dermatopathology|volume=11|issue=6|pages=582–587|issn=0193-1091|pmid=2690652}}</ref>
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| ===Face mole reading===
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| In traditional Chinese culture, facial moles are respected and they are used in [[moleomancy]], or face mole reading. The moles' meaning varies according to which of the nine "wealth spots" of the face they are located in. Depending on their position and color, a person's facial moles may render their face "lucky" or "unlucky."{{Citation needed|date=June 2016}}
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| Moles that can be easily seen may be considered warnings or reminders, while hidden moles may symbolize good luck and fortune. Furthermore, traditional Chinese culture holds that each facial mole indicates the presence of a corresponding mole on another part of the body. For instance, if a mole is present around the mouth, a corresponding mole should be found in the pubic region.<ref>{{cite web|url=http://www.chinesefortunecalendar.com/FaceMoleReading.htm|title=Chinese Face Reading - Facial Mole and Your Fate|accessdate=2010-05-04}}</ref>
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| ==See also==
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| *[[Mole map (dermatology)|Mole map]]
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| ==References==
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| {{reflist}}
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| ==External links== | | ==Related pages== |
| {{Medical resources
| | * [[Melanoma]] |
| | DiseasesDB = 8333
| | * [[Skin cancer]] |
| | ICD10 = {{ICD10|D|22||d|10}}
| | * [[Dermatology]] |
| | ICD9 = {{ICD9|216}}
| | * [[Nevus]] |
| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = derm
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| | eMedicineTopic = 289
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| | MeshID = D009508
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| }}
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| *{{Commonscatinline}} | |
| *[http://www.cancer.gov/types/skin/moles-fact-sheet Common Moles, Dysplastic Nevi, and Risk of Melanoma] - National Cancer Institute. | |
| {{Skin tumors, nevi and melanomas}}
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| {{DEFAULTSORT:Melanocytic Nevus}}
| | [[Category:Dermatology]] |
| [[Category:Melanocytic nevi and neoplasms]] | | [[Category:Skin conditions]] |
| [[Category:Benign neoplasms]] | |
| {{stub}}
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