Moles Removal

Most moles appear on the surface during childhood and adolescence. Moles will grow as the child (or teen) grows. Some moles will darken, and others will lighten. These changes are expected and seldom a sign of melanoma, the most severe skin cancer. Here are three facts that can help you find melanoma soon and get treatment. If you see a mole or other spot that is growing, itching, bleeding, or changing in any way, at once, make an appointment to see a dermatologist. Most moles do not require treatment. A dermatologist will remove a mole that: is bothersome (rubs against clothing, etc.), unattractive to a patient, and suspicious (could be skin cancer). After a mole is removed, the skin will heal. If the mole grows back, at once, make another appointment to see your dermatologist. The recurrence of a mole could be a sign of melanoma, the most severe type of skin cancer.

What is Moles Removal?


Moles are common. Every adult has a few of them. Adults who have light skin have more moles. They may have 10 to 40 moles on their skin. This is normal. Most moles appear on the surface during childhood and adolescence. Moles will grow as the child (or teen) grows.

Some moles will darken, and others will lighten. These changes are expected and seldom a sign of melanoma, the most severe skin cancer. For adults, new moles and alterations to existing moles can signify melanoma. Melanoma is highly treatable if diagnosed early. Here are three facts that can help you find melanoma soon and get treatment:

  • Changing to a mole or a new mole is often the first sign of melanoma.
  • You can find melanoma early by checking your skin.
  • If you see a mole or other spot that’s growing, itching, bleeding, or changing, immediately make an appointment to see a dermatologist.

Signs and Symptoms of Moles


People often want to know how to tell a mole from a melanoma. Here is a general rule. A mole on your body usually has these traits. It’s One color – Often brown, but a mole can be tan, black, red, pink, blue, skin-toned, or colorless, round, flat, or slightly raised and unchanged from month to month. Although moles have a distinct look, they may not look alike.

Even in the same person, moles can differ in size, shape, or color. Moles can have hair. Some moles will change slowly over time, even disappearing. It’s also important to know that moles can appear anywhere on the skin. They can develop on your scalp, between your fingers and toes, soles and palms, and even under your nails. The most severe skin cancer differs from moles in that it tends to show one or more of the following traits:

  • A = Asymmetry. One half is unlike the other.
  • B = Border. An irregular, scalloped, or poorly defined border.
  • C = Color. It varies from one area to another; it has tan, brown, or black; it is sometimes white, red, or blue.
  • D = Diameter. When diagnosed, melanoma is usually greater than 6mm (the size of a pencil eraser), but it can be smaller.
  • E = Evolving. A mole or skin lesion looks different from the rest or changes in size, shape, or color.​

Who Gets Mole(s) and What Are the Types of Skin Moles?

Every adult has a few moles. Most adults have a type of mole called a common mole, which is harmless. There are other types of moles. Below you’ll see varieties of moles that can increase a person’s risk of getting melanoma, the most severe type of skin cancer.

Melanoma can grow in an atypical mole. Anyone with atypical moles, such as this patient, should watch their moles for change. If you discover any of these moles on your skin, you should have a dermatologist give you skin exams.

Common acquired melanocytic nevi.

The prevalence of melanocytic nevi is related to age, race, and perhaps genetic and environmental factors. There is a period of exceptionally rapid development of nevi at puberty. A few nevi are present in early childhood, but their number increases, reaching a peak during the third decade of life; after that, nevi tend to disappear with increasing age53-55.

A study in Scotland noted that females had an average of three nevi and males two nevi in the first decade of life. Reflecting the progressive decline after that, women had a mean of six nevi and men four nevi in the seventh decade of life. For the peak age interval of 20 to 29 years,
women and men had mean nevus counts of 33 and 22.


Melanocytic nevi are well-circumscribed, round to oval lesions, generally measuring from 2 to 6 mm in diameter. They appear orderly and symmetric overall. Although many nevi display slight asymmetry, the borders are usually regular and well defined.
The junctional nevus is a macular lesion with slight accentuation of skin markings visible with side-lighting. The dermoscopic features of a junctional nevus include a uniform pigment network thinning out towards the periphery. Junctional nevi are also characterized by a uniform, medium to dark brown color).

Compound nevi show variable degrees of elevation and, in general, somewhat lighter shades of brown than junctional nevi. Dermoscopically, they are characterized by a rounded architecture with multiple rounds to ovoid globules, sometimes forming a cobblestone pattern).

Dermal nevi are usually more elevated and show lighter shades of brown or even skin-colored
tones compared with compound nevi. The dermoscopic features of an intradermal nevus predominantly consist of focal globules or globular-like structures. In addition, there may be pale to whitish structureless areas and delicate linear or comma vessels

An essential aspect of melanocytic nevi is their relationship to melanoma. A significant proportion of melanoma patients report the prior presence of a longstanding melanocytic nevus at the site of melanoma development.

Histologic studies also have documented that approximately one-third of melanomas are associated with nevus remnants (but this figure is probably lower nowadays because of the increased incidence
of lentigo maligna melanoma which rarely demonstrates an associated nevus). An increased number of melanocytic nevi correlates with increased melanoma risk. The differential diagnosis of melanocytic nevi includes the entire gamut of pigmented and skin-colored lesions.

Dermatofibromas are usually differentiated from nevi by their very firm consistency, “dimpling” with lateral compression, preference for the lower extremities, and central white patch by dermoscopy. Raised nevi, potentially confused with seborrheic keratoses, are less likely to have a verrucoid surface, and pseudo-horn cysts and dermoscopy can assist in the distinction.

Typical melanocytic nevi are distinguishable from atypical nevi and melanoma by more diminutive size, overall symmetry and orderly appearance, homogeneous coloration, and regular, well-defined borders.

Neurofibromas and fibroepithelial polyps may be indistinguishable from skin-colored or slightly pigmented, pedunculated dermal nevi. Furthermore, red, blue, gray, and black colors are not usually seen in common acquired nevi and should alert one to a potentially atypical lesion.

Moles Removal

Indications for removing melanocytic nevi are as follows:

  • (1) a changing lesion
  • (2)atypical clinical appearance suspicious for melanoma
  • (3) repeated irritation
  • (4) cosmetic concerns. Beyond these indications, there is no reason to remove nevi on a
    routine basis

Melanocytic nevi of genital and flexural skin

Melanocytic nevi in genital sites, especially the vulva, are thought to have rather distinctive histopathologic features than most nevi from non-genital. However, similar nevi may occur in other locations such as the scrotum, perineum, umbilicus, or axilla.

These nevi are often more giant (mean 5.9 mm, range of about 2–24 mm) than non.-genital ordinary nevi, usually have pretty regular borders, and often have a complex mahogany color, i.e., an admixture of tan, brown and red. These nevi appear uncommon, perhaps accounting for <10% of nevi removed, but selection factors could bias data. In general, premenopausal women (ages 14 to 40) present with this type of vulvar lesion60.

The differential diagnosis includes primarily melanoma, Spitz nevus, and nevi associated with genital LS (see above). Vulvar melanoma tends to occur in older women (average age ~65 years).

Melanocytic nevus of acral skin

Acral nevi are usually macular or only slightly elevated. They may display uniform brown or dark brown color but often have linear striations. The characteristic dermoscopic features of benign melanocytic nevi of the palms and soles are due to the unique anatomy of acral skin.

The palms and soles consist of parallel ridges (mountains) and furrows (valleys). The intraepidermal eccrine ducts pass through the ridges. In benign melanocytic nevi, the nests of nevus cells are situated around the furrows. The three major dermoscopic patterns seen in benign melanocytic nevi are the parallel furrow, the lattice-like (see Fig. P4), and the fibrillar pattern.

Atypical Moles (dysplastic)


This type of mole can look like melanoma. It is not melanoma. , But you have a higher risk of getting melanoma if you have: four or more atypical moles already had melanoma and a first-degree relative (parent, brother, sister, or child) who had melanoma. Your dermatologist may call an atypical mole a dysplastic (dis-plastic) nevus. Nevus is the medical term for a mole. When your dermatologist is talking about two or more moles, you may hear the word “nevi.”

Atypical moles (or nevi) are often: Larger than an eraser on the end of a pencil, have an odd shape (not round), and show more than one color — mixes of tan, brown, red, and pink. Atypical moles can appear anywhere on the body. They often appear on the trunk. You can also get them on your scalp, head, or neck. Atypical moles rarely appear on their faces.

Some people who have many atypical moles have a medical condition called familial atypical multiple mole melanoma (FAMMM) syndrome. People with FAMMM syndrome have many moles — more than fifty, some atypical moles, and a blood relative who has (or had) melanoma.

Blue nevus and its variants

Blue Nevus

Common blue nevi are well-circumscribed, dome-shaped bumps that are blue, blue-gray, or blue-black. They are usually 0.5 to 1.0 cm in diameter, rarely more significant. The lesions may occur anywhere, but about 50% are found on the dorsal aspect of the hands and feet, with the face and scalp being other common sites. Blue nevi have been described in the vagina, cervix, prostate, spermatic cord, and lymph nodes. Over time, hypopigmentation can appear centrally within the common blue nevi.

Dermoscopically, a blue nevus is characterized by homogeneous blue-gray to blue-black pigmentation. Usually, blue nevi are solitary, but they may be multiple or agminated or may arise with a nevus spilus or plaque blue nevus. Concentric, target-like lesions (target blue nevus) have also been described.

Cellular blue nevi are blue to blue-gray or black nodules or plaques, generally 1 to 3 cm in diameter but sometimes larger. Their surface is often smooth but sometimes irregular. The most common sites are the buttocks, sacrococcygeal area, and scalp, followed by the face and feet.

Congenital cellular blue nevi, some with satellite lesions, have been reported, as have benign or malignant cellular blue nevi arising within congenital melanocytic nevi. The ratio of common blue nevus to cellular nevus is at least 5: 1.

The differential diagnosis of a typical blue nevus includes traumatic tattoo, combined nevus, vascular lesions including venous lake and angiokeratoma, sclerosing hemangioma, primary and metastatic melanoma, and atypical nevus, pigmented spindle cell nevus, dermatofibroma, papular pigmented basal cell carcinoma, and glomus tumor. For cellular blue nevus, especially with satellitosis, malignant blue nevus needs to be considered, and when the lesion is on the face, nevus of Ota.

Blue nevi that are <1 cm in diameter are clinically stable, do not have atypical features, are located in a specific anatomic site do not require removal. On the other hand, I should strongly consider histologic evaluation for lesions that appear de novo, are multinodular or plaque-like, or have changed.

Atypical cellular blue nevi and pigmented epithelioid melanocytomas should be entirely resected to prevent recurrence and their risk for malignant transformation or metastases. The typical cellular blue nevi approach varies, but excision can be considered if the observation is complex (e.g., lesions on the scalp).

Spitz nevus

The prevalence of Spitz nevus in the general population has not been accurately documented. However, among melanocytic lesions that have been surgically excised, approximately 1% exhibit the histologic characteristics of Spitz nevus. In data from Australia, it has been estimated that Spitz nevus accounts for 1.4 cases per 100 000 population, as compared with an annual incidence of 25.4 melanomas per 100 000
population. The vast majority of Spitz nevi are acquired, but up to 7% may be congenital.

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Spitz Nevus

Spitz nevi occur in all age groups but are uncommon beyond 40 to 50 years of age. In the series of Weedon and Little, 36% of the individuals with Spitz nevi were under the age of 10 years, 33% were between the ages of 10 and 20 years, and 31% were older than 20 years of age. There is no gender predilection.

Spitz nevi vary in size from 2 mm to >2 cm, with an average diameter of ~8 mm. Typically, they are well-circumscribed, dome-shaped papules or nodules varying in color from pink to tan to dark brown. Generally, the color is homogeneous, and the margins are well defined. The surface topography may be smooth or, in some instances, verrucous.

Relatively flat, polyploid, and pedunculated morphologies have also been described. Occasional lesions may have erosions and scale-crust, while others may be firm due to sclerosis and resemble dermatofibromas (i.e., desmoplastic). Telangiectasia is a frequent finding.

The clinical differential diagnosis of Spitz nevi is comprehensive. It includes other melanocytic nevi, particularly dermal nevi, hemangiomas, pyogenic granuloma, verrucae, molluscum contagiosum, juvenile, and adult xanthogranulomas, dermatofibroma, mastocytoma, and adnexal tumors.

The fundamental diagnostic problem is the histologic differentiation of Spitz nevus from cutaneous melanoma. The latter distinction is one of the most challenging problems in all pathology. It is subjective, based on the pathologist’s experience and the careful weighing of several clinical and histopathologic parameters.

Because of the frequent diagnostic difficulty in classifying these lesions, histologic evaluation of the entire lesion is highly recommended. Recurrence rates from 7% to 16% have been observed when lesions were incompletely excised. In the authors’ opinion, complete excision with margins free of tumor is recommended for all Spitz nevi.

However, clinicians, including pediatric dermatologists, reserve this recommendation for lesions with atypical features (clinically or histologically) or Spitz nevi in adults. Margins of approximately 1 cm are advised for markedly atypical or histologically ambiguous variants. It is also advisable that patients with atypical lesions have periodic evaluations every 6 to 12 months. Although controversial, sentinel lymph biopsy may be considered on a case-by-case basis for markedly atypical

Lesions with a Breslow depth ≥1 mm. However, there is mounting evidence that sentinel lymph node involvement by Spitz tumors is not necessarily analogous to conventional metastatic melanoma76, as almost all of the cases studied to date have not shown the progression of disease beyond the sentinel lymph nodes. In sum, further research into understanding and predicting the biologic behavior of atypical or ambiguous Spitz tumors is needed.

Estimates of the incidence of atypical melanocytic nevi cover a wide range, as would be expected given the lack of consensus regarding definitions. Most estimates are in the 10% range, but estimates as high as 53% have been reported for the US population.

Atypical melanocytic nevi may be single or multiple. There is agreement that these nevi indicate some increase in melanoma risk in both clinical settings. In the general population, atypical nevi may arise in a “sporadic” fashion, i.e., without a history of familial melanoma, versus in the context of a family history of atypical moles and melanoma. More recently, It presented objective evidence that “dysplastic” nevi with moderate to severe atypia histologically represented a risk factor for melanoma development.

Sporadic atypical melanocytic nevi may occur, while persons with a family history of atypical melanocytic nevi and melanoma usually manifest their atypical lesions by the end of the second decade. In contrast to commonly acquired moles that appear in clusters around puberty, atypical melanocytic nevi may appear, even in an eruptive fashion, as late as the sixth decade.

Histologic contiguity of atypical melanocytic nevi to melanomas was frequently observed in several studies on melanoma kindreds, but the development of melanoma in association with an individual atypical
a melanocytic nevus in the sporadic setting seems to be an uncommon event.

Nevi, as described below, can occur anywhere on the cutaneous or mucosal surfaces of Caucasians and the acral and mucosal surfaces of other races. Of note, other authors believe that distinct atypical melanocytic proliferations apart from atypical melanocytic nevi occur on acral and mucosal sites.

Atypical nevi occupy an intermediate position on a continuum with common nevi at one end and cutaneous melanoma at the other end, and, as a result, they overlap with both.

No single feature is diagnostic of atypical melanocytic nevi; instead, a constellation of clinical and dermoscopic findings is required for their recognition. However, the greater the number of clinical abnormalities present, the greater the likelihood that the lesion will prove to be histologically atypical, but there are many exceptions.

The following gross morphologic features are commonly observed in atypical melanocytic nevi:

Asymmetry: atypical melanocytic nevi often lack mirror-image symmetry. More significant asymmetry suggests a greater likelihood of atypicality.

Size: atypical melanocytic nevi may be of any size but generally range from 3 to 15 mm in greatest diameter. There is generally a positive correlation between increasing size and the likelihood of atypia.

Borders: atypical melanocytic nevi often exhibit irregular and ill-defined borders but are not typically the notched or scalloped borders of melanoma.

Coloration: atypical melanocytic nevi often have many colors. They commonly exhibit irregular pigmentation with two or three shades of brown, e.g., tan, brown, and dark brown. They may also have skin-colored, pink, gray, or brown-black areas. Some atypical melanocytic nevi present with relatively uniform coloration and an erythematous appearance.

Atypical melanocytic nevi most frequently involve the trunk and show a striking (though less common) preference for the scalp and doubly covered areas of the body (breasts in women and bathing-trunk area in men). Their numbers may range from one or two to hundreds.

When multiple large lesions are present, their prominence is noteworthy, and while there may be variability, patients often have a “signature” nevus, clinically and histologically. Localized patterns such as linear tracts, clusters, or figurate arrays may also be seen in patients with numerous nevi.

The overwhelming majority of atypical melanocytic nevi are clinically stable. However, there is definite evidence that some lesions eventuate in cutaneous melanoma. Progressive abnormalities in DNA content, cytogenetic alterations, and increased expression of melanocyte-associated antigens by immunohistochemistry have been correlated with progressive degrees of histologic atypia.

Although these latter findings suggest a progression of atypical melanocytic nevi toward melanoma, atypical melanocytic nevi are not inevitable precursors to melanoma. Their presence can be viewed as a phenotypic marker of “skin at risk.”

The differential diagnosis of pigmented lesions approximately 4 to 15 mm in size includes both melanocytic and keratinocyte lesions. Among melanocytic proliferations, common acquired nevi, small congenital nevi, and cutaneous melanoma are the principal diagnostic considerations.

The atypical melanocytic nevus is characterized by haphazard, irregular coloration, including hues of pink, tan, brown, and even black, and irregularity in shape (features it shares with melanoma). The other nevic lesions either show symmetry and uniformity of coloration or, when irregularly colored, show orderly gradations or patterns of pigmentation.

As within any area of medicine, the physician is first obliged not to harm. Such an approach is particularly pertinent to patients with atypical melanocytic nevi to avoid overly aggressive procedures, surgery, and follow-up. Common sense should prevail at all times, and consideration should be given to whether the intervention will potentially reduce mortality from melanoma.

Treatment depends on whether the patient presents with a few nevi or numerous nevi and whether there is a personal history of melanoma and a domestic setting of atypical melanocytic nevi and melanoma. A gradient of melanoma risk has been established for these various subsets of patients.

Melanoma risk is probably continuous and increases with progressive increases in numbers of nevi, clinical atypia of nevi, and personal and familial occurrence of atypical nevi and melanoma.

Regardless of the risk group, any pigmented lesion suspicious of melanoma and any persistently and significantly changing lesion should, in the authors’ opinion, be entirely excised with approximately 2 mm margins for histopathologic examination.

Some authors have advocated “deep” shave excision (cauterization) for superficial lesions as long as the base of the lesion is removed. As opposed to partial punch biopsy, the latter allows for assessment of the overall architecture of the lesion and leads to minor sampling error.

A helpful rule of thumb is following patients with many atypical melanocytic nevi to search for lesions that stand out as different from the patient’s (baseline) nevi; It should carefully examine such lesions. I should keep in mind that new nevi will continue to develop, and nevi may enlarge and change with time, especially in young individuals.

One must use common sense in assessing this normal evolution of nevi and not be overly aggressive in removing such nevi. It is not mandatory to remove clinically atypical nevi to confirm or exclude atypical melanocytic nevi histologically.

An acceptable practice is to follow such patients regularly with a full-body skin examination plus dermoscopy, baseline photography, and digital dermoscopy, as the clinician prefers. The frequency of follow-up examinations is individualized and is based on the previously mentioned risk factors, i.e., numbers and clinical atypia of nevi, lesion stability, and personal and family history of melanoma.

How do dermatologists Tell Whether a Dark Spot is a Mole?

Dermatoscopy of a Mole

A dermatologist’s trained eye can often tell whether a spot is a mole.

How do dermatologists treat Moles?

Most moles do not require treatment. A dermatologist will remove a mole that: is bothersome (rubs against clothing, etc.), unattractive to a patient, and suspicious (could be skin cancer). A dermatologist can usually remove a mole during an office visit.

Most removals require only one office visit. Occasionally, a patient may need to return for a second visit. During 1 or 2 visits, a dermatologist can safely and efficiently remove a mole. A dermatologist will use one of these procedures:

  • Surgical excision: The dermatologist cuts out the entire mole and stitches the skin closed if necessary. Your mole will also be looked at under a microscope by a specially trained doctor. This is done to check for cancer cells. If cancer cells are found, your dermatologist will let you know.
  • Surgical shave: The dermatologist uses a surgical blade to remove the mole. In most cases, a specially trained doctor will examine your mole under a microscope. If cancer cells are found, your dermatologist will let you know.

Never Try to Remove a Mole at Home

While it may seem more convenient to shave off or cut out a mole yourself, there are three excellent reasons a dermatologist should remove it:

  • Skin cancer: If the mole contains skin cancer, some cells can stay in the skin and even spread.
  • Scarring: You can disfigure your skin, causing a scar.
  • Infection: A dermatologist uses sterile equipment to prevent infection.

The Outcome of Moles Treatment

After a mole is removed, the skin will heal. If the mole grows back, immediately make another appointment to see your dermatologist. This could be a sign of melanoma, the most severe type of skin cancer.

The phobia of Moles

Occasionally, a dislike of moles and freckles may manifest in BDD. For dermatologists, these are usually related. Still, there is an underlying cancer phobia for most patients who repeatedly demand mole examinations and excision. This is in response to various stimuli.

They may have had a malignant lesion removed and need constant reassurance. This is a ‘normal.’
Response to disease. There may have been malignancy or, unfortunately, death from melanoma in the family or friends, or concern repeatedly triggered by media or commercial pressure. These patients present regularly and acutely to screening clinics or primary physicians. They may demand the removal of some of their moles or even attempt multiple self-surgery.

Mole phobia, by proxy, is not uncommon in parents who worry about their children and their moles to such an extent that normal play activities are curtailed because of the sun, and family holidays are
also compromised.

Screening programs per se are not shown consistently to increase cancer anxiety nor attract a disproportionate number of phobic patients. However, the vulnerable attendees
are the young, low education and social class, and high doctor dissatisfaction.

The management of these patients is complex because they usually present with an instant demand to be seen, and a consultation is a form of crisis management. It is preferable to organize regular reassuring appointments, gradually extending the period between visits to a reasonable interval.

Nor is it reasonable to regularly take off normal naevi to ‘reassure’ the patient, who will see this as a form of definitive therapy. Many of these patients are seen in private clinics where their fears are reinforced by repeated, expensive operations.

Moles Removal Results (before & after)


Dark Spots Laser Removal Results (before and after)

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