Nevi - Moles

Nevi, commonly known as moles, are the clinical manifestation of benign proliferation of cells that are normally found on our skin.
Dr. Amalia Tsiatoura
DERMATOLOGIST - VENEREOLOGIST
As Dr. Amalia Tsiatoura explains, "some moles are present from birth (congenital), while others develop in the first decades of life (acquired). The number and type of moles depend on genetic - hereditary factors, while exposure to the sun can affect their appearance, which explains why their incidence is increased in parts of the body exposed to sunlight".
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Nevi - Moles

Types of Removal

A nevus should be removed if it is suspected to change into malignancy or because it is in a location that is frequently injured and causes problems in everyday life, or because it causes aesthetic problems for the patient. The appropriate way of removing a nevus should be decided after discussion with the dermatologist. In general, the ways of removing moles are as follows:

  • Laser nevus removal

The laser method of removing a mole is only suitable if it is absolutely certain that it is a benign lesion (nevus without risk of outbreeding, papillomas, papules, seborrhoeic warts, etc.). The method of removing a mole by laser is only suitable if it is absolutely certain that it is a benign lesion (nevus without risk of outbreeding, papillomas, papules, seborrhoeic warts, etc.). We always aim to removing a lesion without causing scars.

  • Shave Excision

A simple and quick way of removing a mole, where the protruding part of the mole is cut with a blade under xylocaine local anesthesia. Hemostasis and additional removal of any residual part can be achieved by CO2 laser or diathermy.

  • Surgical removal of a mole

When the nevus is flat or when malignancy is suspected, preventive surgical excision of the nevus as well as the borders around it by a Plastic Surgeon is recommended so that the fragment can be sent for biopsy.

The scar that will remain after the removal of the nevus depends on its size, the way it was removed and the healing capacity of the body.

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Nevi - Moles

What are the types of nevi?

Nevi - skin moles - are extremely common, and there is no adult human being without a mole on their skin. Some people even develop them in quite large numbers.

Individuals with moles should consult their dermatologist. Many seek their removal for both aesthetic and medical reasons.

Monitoring them is of great importance as they are sometimes the substrate on which malignant melanoma, the most aggressive malignant skin tumor, develops.

Melanocytes in nevi become cancerous mainly due to the effect of solar radiation which causes mutations and damage to the DNA of the cells resulting in uncontrolled proliferation.

Nevus - Congenital Melanocytic

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.

Nevus – Acquired Melanocytic

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.

Blue Nevus

A blue nevus is an acquired, benign cyan or greyish-black lesion or nodule that usually occurs in childhood or late adolescence. This type of nevus needs close monitoring as in some cases it can lead to malignant melanoma of the skin.

Spitz Nevus

A Spitz nevus is a benign, dome-shaped, hairless small nodule of a pink or light brown colour. The characteristic feature of this nevus is that it grows and enlarges rapidly within a few months. It is common in children and its location is mainly on the head and neck.

Spilocytic nevus

A spilocytic nevus is a melanchromatic spot that has numerous smaller dark brown spots or papules on it. This nevus can lead to melanoma in 5% and therefore close monitoring and nevus removal is required.

Becker's nevus

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.

Nevus of Ota and Ito

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.

Epidermal Nevus

Epidermal nevus occurs from birth or within the first decade of life and may increase in size dring adolescence. Epidermal nevus is skin-coloured and is most commonly found on the upper part of the body. It has no malignant potential.

Comedo Nevus

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.

Nevus Sebaceous

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.

Vascular Nevus / Birthmark

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.

Port-Wine Stain

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.

Mongolian Spot

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.
Nevi - Moles

Check-up

The dermatologist is responsible to decide whether a nevus is benign or suspicious, taking into account the following criteria:
A

Αsymmetry

B

Border

C

Color

D

Diameter

E

Evolution/Elevation

Nevi - Moles

Skin cancer - Melanoma

A less common, but extremely aggressive type of skin cancer is melanoma. Melanoma is caused by melanin cells, the cells that produce melanin, the pigment that gives the skin its characteristic color. In advanced stages, melanoma can cause metastases and can even be fatal.

The person should be informed and consult a dermatologist, in case a new nevus (mole) with an irregular shape appears or in case he/she notices that an existing nevus has altered (based on the aforementioned criteria). Characteristics of the alteration can be a change in size, shape or colour, as well as ulceration or bleeding of the mole. The most common sites of occurrence are mainly the back, arms, legs or face, as well as the genitals. In men it occurs mainly on the trunk, while in women it occurs on the lower limbs.

As a type of skin cancer, it has the lowest incidence rate, but is responsible for 80% of skin cancer deaths.
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Age

Apart from adults, it can occur on the skin of young people, unlike other forms of cancer

Alteration

Changes in size, shape, colour and/or bleeding are warning signs

Immediate Action

A visit to a dermatology specialist is recommended in case of appearance of a new nevi or alteration of an existing nevi
Nevi - Moles

FAQ

Who should have regular nevus screening?

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.

What should I look out for if I develop a mole on my face?

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.

What should I look out for if I develop a nevus on the genitals?

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.

Can removing a mole (nevus) lead to cancer?

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.

Why should I choose Cosmetic Derma Medicine for the monitoring and removal of my moles?

Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group in the field of Dermatology and Plastic Surgery, with 14 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.
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