Dermatological Treatments
Moles (Nevi)
Information on Moles
Moles are refered to cells of dermal origin and are the most benign skin tumor. Benign tumors call all skin tumors or lesions that do not have malignancy. This means they do not create a health problem. Almost all people, men and women, have moles either acquired from birth or in the course of their lives. New moles may occur until the age of 40, and there are some moles that disappear with age.

Moles may appear at any point in the body in various shapes and sizes and, under the influence of certain factors, may constitute a danger to the health of the individual as they can degenerate into malignant lesions, migrate elsewhere if neglected or and bleed.

The dermatologist and plastic surgeon are the only doctors who can assess whether a mole is benign or can cause a problem. After examining each case individually, they can decide whether the mole has to be removed or simply follow up.
 
The Basic Types of Moles
Moles are distinguished in the following types:
  • Relative melanocytic mole or nevus: The mole is present at birth or acquired during the first year of life. Relative melanocytic moles are divided into 3 classes according to their size:
small (<1.5 cm)
middle (1.5-20 cm)
large (> 20 cm)
Large moles tend to be associated with systemic ailments, especially those of the central nervous system. The clinical diagnosis of average and large moles is not difficult because of their size and history, as they are present at birth. Their feature is their cylindrical or mosaic form. Average moles may also be reticulated, mixed in cylindrical and mosaic form but also show diffuse pigmentation. The reticular form is more common in leg moles. Cochlear cysts, hirsutism and small brown spots within the mesh are dermatological criteria that often appear in these moles.
  • Acquired melanocytic mole or nevus: Commonly acquired melanocytic moles are particularly frequent skin tumors composed of melanocytes. They are distinguished in ligands, choriotic or mixed in correspondence with the localization of melanocyte nodes. They can be located in any position of the body. Acquired melanocytic moles have a clear genetic background associated with specific phenotypes (caucasian, light skin, blonde or red hair), and the final number is determined by environmental factors, particularly sun exposure in childhood. The use of sun protection and clothing reduces the rate of new moles and affects their final number.
  • Spitz mole or nevus: It is a benign, domed, hairless little nodule of pink or light brown color. The feature of this mole is that it grows rapidly within a few months. It is common in children and its distribution mainly concerns the head and neck.
  • Becker's mole or nevus: Becker's mole is a skin disorder that primarily affects men and begins as a sliver of irregular shape on the arm or upper torso, while gradually growing and possibly having dense and thick hairs on the surface.
  • Ota-Ito mole or nevus: It is a dark dot of skin that may have a blue or a dark brown color. It is common in Asian populations and may be present at birth, but not inherited. Its distribution mainly concerns the area around the eyes of the upper jaw. If it appears on the shoulders, it is called Ito's mole.
  • Comedo nevus: It is the manifestation of an abnormality of the hair follicle, resulting in the appearance of many comedones arranged in a line. Appearing in childhood or adulthood, they are localized on the face or multiple in the neck, torso and arms.
  • Sebaceous mole: It is an abnormal yellow or orange hairless plaque surrounded by many small specimens. The most frequent location of this mole is the scalp. The mole appears at birth, it grows in size during childhood, like sebaceous glands, but then falls back to adolescence where it again grows to reach its maximum size. Because its future migration to skin cancer is very risky, it is advisable to prevent prone spikes until the third decade of life of the individual.

Are Moles Dangerous?
According to the ABCDE international dermatological rule, moles are suspected when presenting:
  • A → Asymmetry: If the parts of the mole, if separated by line, are symmetrical, then the mole is considered normal. If it is asymmetric, further consideration should be given.
  • B → Limits: Smooth boundaries of the mole are benign. If the limits are irregular, then further consideration should be given.
  • C → Color: If the mole shows a multicolour or a change in colour, then there is a possibility of malignancy. If the mole is not stable, then further examination should be performed.
  • D → Diameter: Generally speaking, the small diameter of the mole indicates being benign, while the malignant moles are larger. The only certainty is that if the mole has a diameter of more than 6 millimeters, it needs further examination.
  • E → Evolution: The benign moles remain stable in colour and size over time. Any change suggests a risk and needs further examination.
Beyond the above, it is worrying if the mole develops bleeding, peeling, itching, pain or crusting. In such a case, the person should contact the specialist dermatologist directly.

How Is Diagnosis Done?
At Dermatology & Cosmetics Lab, we believe that timely diagnosis using appropriate methods is the most significant advance in recognizing each problem. In the case of moles we use:
  • Dermatoscopy: It is a diagnostic method of skin diseases. It is mainly used in examination of moles, precancerous and neoplastic lesions, contributing to the early diagnosis of skin cancer. The importance of skin dermoscopy could be compared to the importance of Test-Pap for cervical cancer and the PSA test for prostate cancer. This is a completely painless examination that exploits the benefits of polarized or unpolarized light, as the case may be. It is done with the use of a small lens, the hand-held dermiscope, through which we can distinguish several points of the morphology of the damage examined that are not visible to the naked eye.
  • Viral Mapping: It is the most effective method for detecting skin cancer, especially melanoma, at a very early stage. With special digital imaging equipment and the use of polarized light, it draws up an accurate and detailed "map" of the body with photographs of the patient's moles. Then, using electronic technology, individual images of carefully selected whips are taken and stored for diagnosis by the physician and for future digital comparison. Having the option of revocation, there is the possibility of re-checking images and digital comparisons with new images resulting from a review.
  • Viral suture removal - biopsy: This classical method is used when the mole morphology indicates from the outset that there is a problem and must be removed. After removal, the mole is sent directly to the laboratory for biopsy.

When Should Moles Be Tested?
Normally everyone will have to visit the dermatologist for mapping, as we would go for an annual check up to the gynecologist or the physician. However, there are some cases that require immediate visits to the dermatologist.
  • People with light skin, blue or green eyes and blond or red hair.
  • People who had prolonged sun exposure during their childhood.
  • People who have suffered some sunburn
  • People with a family history of skin cancer
  • People who observe dysplastic cavities on their bodies
  • People who have large, congenital pigmented moles on their bodies.
  • People who have more than 100 moles on their bodies.
  • People suffering from other skin problems, such as psoriasis and vitiligo.
The above cases do not necessarily imply malignancy of the moles. However, it is prudent to be examined by a dermatologist to determine the exact nature of the moles and to suggest their treatment or follow-up.

How Are Moles Treated?
Most dermatologists remove moles, not only in the case of malignancy, but also in the case that the mole affects the person aesthetically or makes everyday life difficult.
At Dermatology & Cosmetics Lab, we use all the modern and classic ways to remove the moles with the best results.
  • Segmental resection: Applied primarily to large-sized moles, it is performed after a biopsy has occurred because the skin defect is large. After the biopsy is done and the removal is decided, the mole is removed after being cut into small pieces and followed by plastic surgery to restore the skin.
  • Shave Excision: It is done in benign moles that show little or no overcoat and do not reach the dermis. First, local anesthesia with xylocaine is applied, and then the dermatologist cuts the mole with a fine blade just on the surface of the skin. The mole, of course, will be sent for biopsy. This technique leaves no marks and the person can immediately return to his everyday life.
  • Surgical removal: This is the method used when malignant or large moles are detected. The surgeon who removes the mole at the same time takes skin tissue from the surrounding area, which is also sent for biopsy to exclude any possibility of malignancy. Surgical removal is performed by local anesthesia, sutures are made at the point of abdomen and tissue removal and may remain a small scar after healing.
  • Cavitation: This method that uses low-intensity electric current to destroy the mole is one of the classic methods of removing small moles and epithelia. Following this method, although it is not necessary to suture the wound, it may take a long time for the wound to return because the area is burning. Therefore, it is recommended to avoid it on skins that tend to scar. 
  • Fractional Laser: One of the most modern methods of mole removal. After dermatoscopy or mapping of mole, Dermatology & Cosmetics Lab's specialised doctors indicate the lasers that are suitable for laser removal. A focused beam of light destroys the mole by sublimation without affecting the surrounding healthy tissue. Sutures are not required and no scars remain. The method is suitable for young, small or flat moles, depending on the case, while all the moles are sent for histological examination.

When Should Moles Be Controlled?
Mapping is currently considered the skin test that resembles to PAP-Test. Dermatologists recommend mapping every year, especially in cases of:
  • People with multiple or dysplastic neoplasms
  • People with a family history and especially with a history of melanoma
  • People with low immune system
It is the most effective method for detecting skin cancer, particularly melanoma, at a very early stage. With special digital imaging equipment and the use of polarized light, it draws up accurate and detailed "map" of the body with photographs of the patient's moles. Then, using electronic technology, individual images of carefully selected whips are taken and stored for diagnosis by the physician and for future digital comparison. Having the option of revocation, there is the possibility of re-checking images and digital comparisons with new images resulting from a review.

Mapping moles is a painless and enjoyable process. Practically, moles are photographed with the help of a special digital dermatoscopic camera, which is called a digital video dermatoscope. The method is absolutely safe from the neonatal period of life to any age and, of course, totally safe for pregnant women. It is an examination that can be done at any time, because it does not require any preparation by the patient. The examination may take from a few minutes to half an hour, which, of course, depends on the extent of the damage to be treated. During that time, moles are not only captured, but also a first diagnosis is made, and the doctor may need to intervene in the immediate removal of a mole.

The philosophy of mapping is based not only on accurately recording the position of moles on the classical anatomical surfaces of the body, but also on frequent and regular monitoring. That is why each patient should often visit the dermatologist for a repetitive examination of the moles after mapping and this should happen at least once a year, depending of course on the incident.
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