Nevi - Moles

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Nevi - Moles

The best methods of removal Nevi – Moles

A mole that bothers you aesthetically, that is in a spot that “pokes” at your clothes, that you injure when shaving or a mole that makes you anxious about whether it is benign or not is a mole that should be examined by a dermatologist.

Most people have many moles, moles as we call them, on our bodies that are probably innocent. Examination by a dermatologist once a year, or more often if there is a personal or family history of melanoma, is important to make sure that a suspicious change has not started in one of the moles.

If the dermatologist decides that a nevus needs to be removed, removal is a very quick and simple medical procedure. Depending on the type of wart, the doctor will choose the best method of removal, surgical removal or excision (shave).

The removal of a nevus is done under local anesthesia in the dermatology clinic
The removal procedure usually takes 20-30 minutes
Shave excision and surgery are the two main techniques for removing moles
Removal is painless, leaves no scar and you can return to your daily activities immediately
According to the medical protocol, each nevus removed is sent for biopsy
Laser nevus removal is only chosen if the nevus is considered 100% benign

The best methods for removing moles

Wart removal with the shaving technique

Treatment Duration	Up to 30 λεπτά – depening the case
Results Duration	Permanent
Pain level	Painless
Cost	Affordable for everyone
Technique	Shave excision
Is biopsy necessary?	Any lesion removed should be sent for biopsy
Anaesthesia	Local
Recovery Time	3-5 days
Leaves a scar?	Not if the doctor’s instructions are followed

Surgical removal of mole

Treatment Duration	Up to 60 minutes – depening the case
Results Duration	Permanent
Pain level	Painless
Cost	Affordable for everyone
Technique	Surgical removal of mole
Is biopsy necessary?	Any lesion removed should be sent for biopsy
Anaesthesia	Local
Recovery Time	Approximately 10-15 days until the stitches are removed
Leaves a scar?	The small scar will gradually become “erased” if the doctor’s instructions are followed

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TOP DERMATOLOGIST EXPLAINS ABOUT THE TREATMENT

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Why it is so important to check for nevi

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Moles

What it is

Moles are a benign proliferation of melanin cells that are naturally found on the skin and can vary in colour, shape and size.

Some moles are present from birth (congenital), while others develop in the first few decades of life (acquired). The number and type of moles one has on the face and body depends on genetic and hereditary factors, and exposure to the sun can affect their appearance, which explains why their incidence is increased on parts of the body exposed to sunlight.

Although the majority of body moles will be and remain benign, if we notice any change in an existing mole or the appearance of a new one, it is important to be evaluated by a dermatologist who, through the clinical picture, taking a medical history and a simple dermoscopy examination, will determine whether or not an investigation is needed.

Nevi moles. What they are.

Moles Changes that lead us to the dermatologist

In the early stages of melanoma, there are 5 signs that can help diagnose it early. The “golden” rule of self-examination, or the “ABCDE” rule, is based on the following characteristics:

A for Αsymmetry
B for Border
C for Color
D for Diameter
E for Evolution/Elevation
If you notice any of the above changes in a mole, talk to your dermatologist immediately

Moles

The main methods of removal

Shave Excision of a mole

Excision of the mole is a simple and quick way of removal for moles that show evidence of malformation. The doctor applies a local anaesthetic and then removes the protruding part of the mole, making sure that the cells under the skin are also removed.

The wound is closed with stitches, depending on the size of the nevus removed, and the nevus is sent for a biopsy to check if there are cancer cells and if it is completely removed. It is possible that a CO2 laser or diathermy may be followed to stop the bleeding (haemostasis) and additional removal of any residual part of the nevus may be done.

Any nevus that is removed is sent for biopsy in order for the pathologist to investigate its morphology.

Surgical removal of a mole

When the nevi are flat or when malignancy is suspected, preventive surgical excision of the nevi and the borders around the excision by the dermatologist or plastic surgeon is recommended, so that they can be sent for biopsy.

After removal, one or more stitches may be needed and it is possible that no scar will be left at all. However this depends on the size of the mole removed, how it was removed and the body’s ability to heal.

Any nevus that is removed is sent for biopsy in order for the pathologist to investigate its morphology.

Skin cancer

Melanoma

If a new nevus (mole) with an irregular shape appears or if one notices that an existing nevus has changed, it is important to seek medical advice from a dermatologist. Characteristics of the lesion may include a change in size, shape or colour, as well as ulceration (wound formation) or bleeding. The places where moles usually appear are mainly the back, hands, feet or face, as well as the genitals. In men it occurs mainly on the trunk, while in women it occurs on the lower limbs.

Melanoma is a less common but extremely aggressive type of skin cancer. The damage is caused by melanin cells, the cells that produce melanin, the pigment that gives the skin its characteristic colour. In advanced stages, melanoma can metastasise and even lead to death.

Melanoma.

Types of nevi

Congenital melanocytic nevus is present at birth, in about 1% of all newborns and persists throughout life. Congenital nevus varies widely in size and can be several centimetres in diameter and rarely may cover almost the entire skin. However, most congenital nevi are small, almost always over 1 cm, and much resemble the acquired nevi.

This type of nevus is round or oval shaped with spots on the surface of the skin and its tone can vary from slightly pigmented like a sunburn tan to medium or deep brown. Congenital nevus is divided into small (<1.5 cm), medium (1.5-10 cm), and giant (>20 cm). Often within the nevus there are two shades, and the darker one is located in the centre. In some cases, the congenital nevus may have hairs on it.

The main concern regarding congenital nevus is its precancerous potential. There is certainly an increased risk of developing malignant melanoma on such nevi. This possibility is greater in giant congenital nevi. Nevertheless, the risk from congenital melanocytic nevi is low.

Melanocytic nevi (common moles) are small clearly defined acquired melanocytic spots or papules. Depending on the location of the cells that make up this type of mole, the following forms can be distinguished in:

Moles – Associated Melanocytic:
These nevi are spots or lesions that protrude slightly. The colour of the nevi is light brown or dark brown, with an even distribution of pigment. They are round or oval in shape with smooth borders. The location of these nevi is usually random, although they are clearly more often found on areas exposed to the sun (trunk, arms, legs, sometimes the palms and soles).
A nevus with connective activity has little potential for malignant outgrowth. This in such a nevus is rare, considering that the average person has at least 25 nevi on his/her body.

Moles – Mixed Melanocytic:
They are usually dark-colored moles that protrude. The shape of this type of nevus is round, dome-shaped, smooth, sometimes papillomatous or hyperkeratotic and may have hairs on it. They are most commonly found on the face, head, torso and limbs.

Moles – Melanocytic Choroidal:
This type of moles usually protrudes the skin, may be brown, light brown or skin-colored, and are round or dome-shaped. They are usually developed on the face and neck, but they can also be found on the torso or limbs. They rarely disappear.

Moles – Alveolar Melanocytic or Sutton Nevus:
This is a type of nevus usually brown or light brown in colour which is surrounded by a band of discolouration. This nevus often disappears automatically. It may be a precursor of vitiligo as about 18-26% of people with this nevus may also develop vitiligo. The presence of white algae around a nevus is an immune response of the skin trying to fight the nevus. Because many melanomas also develop such a zone of discoloration, the diagnosis of such a mole should be made very carefully by a dermatologist.

Becker’s nevus is a skin disorder that primarily affects men. This type of nevus initially appears as an irregularly shaped dark spot on the arm or upper torso (although it can also be found on other areas of the body), which gradually grows irregularly and may have thick and dense hairs on the surface. It can be present at birth, but is usually first noticed around puberty.

Ota’s nevus is a spotted dark skin plaque which may be blue or dark brown in colour. It is a very common nevus in Asian populations and may be present at birth but is not hereditary. Its distribution is mainly in the periocular area and the maxillary region. When this nevus is located on the shoulder it is known as Ito’s nevus. Nevus of Ota is a benign melanosis that primarily involves the region of the trigeminal nerve distribution. The Nevus of Ito is quite similar to Nevus of Ota in its appearance. However, it is different in the pigmentation and does not appear on face.

Comedo nevus is the manifestation of an abnormality of the hair follicle resulting in the appearance of many phagospores arranged in a linear pattern. It usually occurs in childhood or adulthood as a single lesion, which is linear and located on the face or appears as multiple lesions on the neck, trunk and arms.

A sebaceous nevus is a healed yellow or orange hairless plaque surrounded by many small scabs. The most common location for this type of nevus is the scalp.

The sebaceous nevus occurs at birth and is a tumor sensitive to androgens. It increases in size during childhood like sebaceous glands, but then regresses until puberty where it again increases to reach its maximum size. Because there is a risk of future progression to basal cell skin cancer, preventive removal of nevus in the second or third decade of life is recommended.

A vascular nevus or nevus is a clearly excreted tumour, bright red in colour and round in shape. This type of nevus may be present at birth or appear shortly afterwards, reaching its maximum size at 6 months of life.

The head and neck are the most common locations for the nevus, but it can appear on any other part of the body. It is most common in premature infants and is thought to be an abnormality of fetal angioblasts development. The vascular nevus may occasionally bleed, which usually resolves with local pressure. If this type of nevus does not fully resolve spontaneously then its remnants can be surgically removed in the second decade of life. Alternatively, treatment with systemic corticosteroids and/or B-blockers may help in childhood, especially for bleeding vascular nevi with severe symptoms.

The Soft Hemangioma (Port-Wine Stain) is not a genuine type of nevus. It is a vascular lesion usually flat red in colour and irregular in shape which varies in size and is usually unilateral. The nevus is present at birth and can be located anywhere on the body, but is most commonly found on the face and neck.

A Mongolian spot is not a genuine type of nevus, it is a greyish lesion typically found on the lumbar region, but it can also appear on the scalp or anywhere on the skin. It is usually an isolated lesion, but rarely are there several lesions on the trunk from birth. The nevus disappears on its own after a certain period of time.

FAQs

People at high risk should have their moles checked regularly. Such people are:

People with numerous moles (more than 50)
People with a family or personal history of skin cancer or melanoma
People with a light skin phototype (phototype I & II) and therefore many moles
People with a history of sunburn, particularly in childhood or adolescence
People with giant congenital melanocytic nevus
People with dysplastic nevus syndrome – the presence of a large number of atypical nevi on the body. People in this category have a 6% higher risk of outbreeding than those with common nevi. This rate increases to 15% if there is a positive family history. It is therefore considered imperative that dysplastic nevi be followed up at regular intervals by a dermatologist.

Moles on the face are very common, as due to sun exposure the head is the most common location of moles. Facial nevi can be congenital (usually hair bearing) or acquired. Facial nevus may be congenital, mixed, choroidal, sebaceous, vascular, Comedo, Spitz’s nevus or OTA nevus.

In facial nevus one should notice if there has been a change in shape, color, size and visit the Dermatologist for immediate examination and diagnosis.

Facial nevi can often be confused with seborrheic hyperkeratosis, radial hyperkeratosis, smooth warts, hemangiomas, xanthelasma, senile spots or freckles.

The correct diagnosis of a mole on the face will only be made by a dermatologist after a dermatoscopy and clinical examination, who will recommend the best treatment.

Facial moles often cause aesthetic problems and many patients resort to their removal mainly for aesthetic and self-confidence reasons.

However, facial moles may conceal malignancy and lead to malignant melanoma or may be a more innocent form of skin cancer such as basal cell carcinoma.

In any case of removal of a facial nevus, it should be sent for biopsy in order to get a response at the microscopic level from the pathologist.

Nevi on the genitals are rarer than nevi on other areas of the body. Special care should be taken when a mole appears on the genitals, as this area is not exposed to the sun and the appearance of a mole may conceal another more serious disease.

Genital nevi may be congenital, conjunctival, chorionic, mixed, vascular or sebaceous. In some cases, lesions such as genital warts, papillomas, angiokeratoma, bowenoid papulosis, or even a genital squamous cell carcinoma are mistakenly taken for genital nevi.

Rare but real, there is a risk that a genital nevus may hide a melanoma of the skin or genital mucosa, which is a very aggressive form of malignancy.

In any case of the appearance of a new genital nevus or a change in a pre-existing genital nevus, it should be surgically removed and biopsied in order for the dermatologist to make the correct diagnosis.

In case the genital nevus is proven to be of HPV etiology, the solution is the CO2 laser, while in case it is proven to be a carcinoma or melanoma, a wider surgical excision is necessary for proper treatment.

It is a common belief that removing a mole from our skin can lead to cancer, which is completely false.

There is never a chance that removing a mole will cause skin cancer or melanoma. On the contrary, not removing a suspected mole can lead to its outbreak and turning it into cancer.

Therefore, when a skin mole is suspicious and the dermatologist suggests removal and biopsy, this should not be neglected and should be done as soon as possible.

Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group in the field of Dermatology and Plastic Surgery, with 15 clinics in Greece & Cyprus. At Cosmetic Derma Medicine, we have the latest equipment and it is possible to remove any mole with CO2 Laser, Shave Excision or Surgically.

The Dermatologists of Cosmetic Derma Medicine are specialized in the method of Dermoscopy and Mapping in Universities in Greece and abroad. The Medical Director of Cosmetic Derma Medicine is the Dermatologist – Venereologist Dr. Amalia Tsiatoura, while the staff consists of a medical team of highly experienced and specialized doctors of many different specialties, as well as a fully trained team of nurses. Our team is at your side every day, 24/7 for whatever you need.