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| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Image = Mole (body part).jpg |
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| Caption = Melanocytic naevus |
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| DiseasesDB = 8333 |
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| ICD10 = {{ICD10|D|22||d|10}} |
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| ICD9 = {{ICD9|216}} |
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| 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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| {{SI}}
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| '''Editors-In-Chief:''' Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]
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| __NOTOC__ | | __NOTOC__ |
| {{EJ}}
| | '''For patient information, click [[Melanocytic nevus (patient information)|here]]''' |
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| ==Overview==
| | {{Melanocytic nevus}} |
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| A '''mole''', technically known as a melanocytic naevus, is a small, dark spot on human [[skin]]. According to the American Academy of Dermatology, the majority of moles appear during the first two decades of a person’s life while about one in every 100 babies are born with moles. Acquired moles are a form of [[benign]] [[neoplasm]], while [[congenital]] moles are considered a minor [[malformation]], or [[hamartoma]]. A mole can be either subdermal (composed of [[melanin]]), or a pigmented growth on the [[skin]], formed mostly of a type of [[cell (biology)|cell]] known as [[melanocytes]]. 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 [[naevi]].
| | {{CMG}}; {{AE}} {{Qurrat}} [[User:Mcs|Martin I. Newman, M.D., F.A.C.S.]] [mailto:Newmanm@ccf.org]; [[User:Mcs|Michel C. Samson, M.D., FRCSC, FACS]] [mailto:samsonm1@ccf.org]; {{Faizan}} {{RAK}} |
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| ==History==
| | {{SK}} Pigmented nevus, benign nevi, melanocytic nevus, moles, dysplastic nevus, dysplastic atypical nevus, atypical nevus, acquired melanocytic nevus. |
| At one time in the 1950s and 60s, (and, to lesser extent, currently) a 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 and singer Madonna. Madonna's facial mole -- below her right nostril -- has been surgically removed. Almost everyone with light skin has at least one or two moles somewhere on their bodies while large numbers can be concentrated on the back, [[chest]], and arms. Darker skin shades, however, tend to have fewer moles. Some folklore about moles includes the notion that picking at a mole can cause it to become [[cancerous]] or grow back larger. While chronic picking or irritation (by clothing) of a mole can be detrimental in many ways, it has not been associated with a higher incidence of [[skin cancer|cancer]].<ref>P. Kaskel, P. Kind, S. Sander, R.U. Peter, G. Krahn (2000) Trauma and melanoma formation: a true association? British Journal of Dermatology 143 (4), 749-753</ref> But while a mole may sometimes be removed by its bearer and may not grow back larger, the resulting [[scar]] can be larger. When a mole is bothersome, physicians usually recommend that it be examined by a [[dermatologist]] to see if it should be removed. The dermatologist or plastic [[surgeon]] can perform the procedure with an eye toward preventing a larger [[scar]].
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| ==Cause== | | ==[[Melanocytic nevus overview|Overview]]== |
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| ===Sunlight=== | | ==[[Melanocytic nevus historical perspective|Historical Perspective]]== |
| Some scientists suspect that overexposure to [[ultraviolet]] light, including excessive sunlight, may play a role in the formation of acquired moles.<ref>Arne van Schanke, Gemma M.C.A.L. van Venrooij, Marjan J. Jongsma, H. Alexander Banus, Leon H.F. Mullenders, Henk J. van Kranen and Frank R. de Gruijl. Induction of Nevi and Skin Tumors in Ink4a/ArfXpa Knockout Mice by Neonatial, Intermittent, or Chronic UVB Exposures. Cancer Res 2006; 66 (5), 2608-15.</ref> However, more [[research]] is needed in this area.
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| ===Genes=== | | ==[[Melanocytic nevus classification|Classification]]== |
| [[Genes]] can also have an influence on a person’s moles. | |
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| '''[[Dysplastic nevus|Dysplastic nevi]]''' or atypical mole syndrome is a [[hereditary]] condition which causes the 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>Burkhart, C.G MPH, MD. Dysplastic nevus declassified; even the NIH recommends elimination of confusing terminology. SKINmed: Dermatology for the Clinician 2(1):12-13, 2003.</ref>
| | ==[[Melanocytic nevus pathophysiology|Pathophysiology]]== |
| A slight majority of melanomas do ''not'' form in an existing mole, but rather create a new [[growth]] on the skin. Nevertheless, those with more dysplastic nevi are at a higher risk of this type of melanoma occurrence.<ref>D.J. Pope, T. Sorahan, J.R. Marsden, P.M. Ball, R.P. Grimley and I.M. Peck. Benign pigmented nevi in children. Arch of Dermatology 2006;142:1599-1604</ref><ref>D.E. Goldgar, L.A. Cannon-Albright, L.J. Meyer, M.W. Pipekorn, J.J. Zone, M.H. Skolnick. Inheritance of Nevus Number and Size in Melanoma and Dysplastic Nevus Syndrome Kindreds. Journal of the National Cancer Institute 1991 83(23):1726-1733</ref> Such persons need to be checked regularly for any changes in their moles and to note any new ones.
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| ==Appearance== | | ==[[Melanocytic nevus causes|Causes]]== |
| According to the [[American Academy of Dermatology]], the most common types of moles are [[skin tags]], raised moles and flat moles.
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| Untroublesome moles are usually circular or oval and not very large.
| | ==[[Melanocytic nevus differential diagnosis|Differentiating Melanocytic Nevus from other Diseases]]== |
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| ===If malignant=== | | ==[[Melanocytic nevus epidemiology and demographics|Epidemiology and Demographics]]== |
| 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>Granter, Scott R. M.D.; McKee, Phillip H. M.D., F.R.C. Path.; Calonje, Eduardo, M.D.; Mihm, Martin C. Jr., M.D.; Busam, Klaus, M.D. 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’. American Journal of Pathology. 25(3):316-323, March 2001.</ref> Conversely, a junctional nevus, which develops at the junction of the dermis and epidermis, is potentially cancerous.<ref>Hall J., Perry, VE Tinea nigrra palmaris: differentiation from malignant melanoma or juncional nevi. Cutis. 1998 Jul;62(1):45-6</ref>
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| A basic reference chart used for consumers to spot suspicious moles is found in the [[mnemonic]], A-B-C-D. The letters stand for '''A'''symmetry, '''B'''order, '''C'''olor and '''D'''iameter. Sometimes, the letter E (for '''E'''volving) 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 than the others and begins to crust over, bleed, [[itch]], or becomes [[inflamed]]. The changes may indicate developing [[melanomas]]. The matter can become clinically complicated because mole removal depends on which types of cancer, if any, comes into suspicion.
| | ==[[Melanocytic nevus risk factors|Risk Factors]]== |
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| ==Complications== | | ==[[Melanocytic nevus screening|Screening]]== |
| Experts say that vast majority of moles are [[benign]]. Nonetheless, the National (U.S.) Cancer Institute reported 59,940 new cases of [[melanoma]] by June, 2007, with 8,110 deaths.<ref>http://www.nci.nih.gov/cancertopics/types/melanoma</ref>
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| ===Prevention=== | | ==[[Melanocytic nevus natural history|Natural History, Complications and Prognosis]]== |
| Sun exposure may drive up the total number of moles and cause them to become darker. Because studies have found that sunburns and too much time in the sun can increase the risk factors for melanoma, the American Academy of Dermatology recommends:
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| * Staying out of the sun between 10 a.m. and 3 p.m. standard time (or whenever your shadow is shorter than your height).
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| * Forgoing tanning booths
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| * Wearing sun block, a hat and sunglasses outdoors
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| ==Mole removal== | | ==Diagnosis== |
| If a mole is highly suspicious of being a melanoma, then it might need to be removed and [[biopsy|biopsied]] (microscopic evaluation by a [[pathologist]]). Other reasons for removal may be cosmetic, or because a raised mole interferes with daily living (e.g. [[shaving]]).
| | [[Melanocytic nevus diagnostic study of choice|Diagnostic Study of Choice]] | [[Melanocytic nevus history and symptoms|History and Symptoms]] | [[Melanocytic nevus physical examination|Physical Examination]] | [[Melanocytic nevus laboratory tests|Laboratory Findings]] |[[Melanocytic nevus electrocardiogram|Electrocardiogram]] | [[Melanocytic nevus x-ray|X-ray]] |[[Melanocytic nevus echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Melanocytic nevus CT scan|CT scan]] | [[Melanocytic nevus MRI|MRI]] | [[Melanocytic nevus other imaging findings|Other Imaging Findings]] | [[Melanocytic nevus other diagnostic studies|Other Diagnostic Studies]] |
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| Moles can be removed by laser, surgery or electrocautery. They leave a red mark on the site which morphs back 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 [[Melanoma#Diagnosis|Melanoma diagnosis]], including e.g. excitional biopsy.
| | ==Treatment== |
| | [[Melanocytic nevus medical therapy|Medical Therapy]] | [[Melanocytic nevus surgery|Surgery]] | [[Melanocytic nevus primary prevention|Primary Prevention]] | [[Melanocytic nevus secondary prevention|Secondary Prevention]] | [[Melanocytic nevus cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Melanocytic nevus future or investigational therapies|Future or Investigational Therapies]] |
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| If the mole is not very deep, scratching it away could be an option as well. It would leave a scab and somewhat of a wound, but it would take most of the mole away, even though there might still be a slightly dark spot on the patch of skin.
| | ==Case Studies== |
| | [[Melanocytic nevus case study one|Case #1]] |
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| ===Laser=== | | ==Related chapters== |
| 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.
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| While laser treatment is commonly offered and may require several appointments, 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.
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| ====Healing====
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| After a laser treatment a scab is formed, which falls off about seven days later, in contrast to surgery, where the fissure has to be stitched with [[suture]]s.
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| ===Surgery===
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| 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 cauterizes the [[amputation|stump]].
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| Because a circle is difficult to close with stitches, the [[incision]] is usually elliptical or eye-shaped.
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| ===Electrocautery===
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| [[Cauterization|Electrocautery]] is also used for removing skin tags and only reaches the outermost level of skin so that scarring is not a problem.
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| ==References==
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| {{reflist|2}}
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| ==External Links==
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| *[http://www.cosmeticsurgery.com/articles/archive/an~221 Examples of moles that illustrate A-B-C-D warnings]
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| *[http://www.nci.nih.gov/cancertopics/wyntk/moles-and-dysplastic-nevi National Cancer Institute Information on Moles]
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| *[http://www.aad.org/public/Publications/pamphlets/Moles.htm Moles in a nutshell from the American Academy of Dermatology]
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| *[http://www.wikisurgery.com/ Moles:Information for patients on Wikisurgery]
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| ==See also==
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| *[[Birthmark]] | | *[[Birthmark]] |
| *[[Freckle]] | | *[[Freckle]] |
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| {{Plastic surgery}}
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