Moles & Birthmarks

Moles are growths on the skin that are usually brown or black; they may be located, alone or in groups, anywhere on the body. A birthmark is a colored mark that appears soon after a baby's birth. Although many moles and birthmarks are completely benign and pose no health risk, some people choose to remove them because they consider them unattractive. Regularly using a strong sunscreen, and monitoring birthmarks and moles for changes, is highly recommended.

Types of Moles and Birthmarks

There are many types of moles and birthmarks, including the following:

  • Congenital mole (dark and irregularly shaped)
  • Atypical mole (irregular color and undefined borders)
  • Cafe-au-lait spot (light-brown patch)
  • Mongolian spot (flat, bluish and irregularly shaped)
  • Hemangioma (reddish-purple patch or raised dots)
  • Salmon patch (reddish patch, usually on the upper eyelid)
  • Port-wine stain (dark red and flat)

Most moles and birthmarks are harmless. However, some atypical moles have the potential to be or become malignant. Atypical moles may be asymmetrical, or have irregular borders and uneven coloring; they can be located anywhere on the body, including areas not exposed to the sun.

Diagnosis of Moles and Birthmarks

A thorough physician-performed examination of the skin is necessary to determine whether a mole or birthmark needs immediate treatment or simply to be checked on a recurring basis. When a mole is diagnosed as atypical, it may need immediate treatment. A patient with an atypical mole may have a personal or family history of melanoma, which increases the possibility of malignancy.

A mole should be examined by a physician if it is:

  • Larger than 6 millimeters
  • Itching or bleeding
  • Rapidly changing color, size or shape
  • Multicolored
  • Located in a difficult-to-monitor area (such as the scalp)

Most birthmarks are benign, but some have the potential to become malignant or may indicate systemic disease. A large congenital mole that is present at birth has a greater risk of becoming malignant; this is especially true if the mole covers an area larger than the size of a fist. Café au lait spots can indicate a number of rare systemic diseases, such as Maffucci syndrome or Gaucher disease.

Treatment of Moles and Birthmarks

Depending on its depth, location and color, as well as factors that include the patient's skin type and age, treatment for a benign mole or birthmark includes:

  • Laser or pulsed-light therapy
  • Microdermabrasion
  • Surgical removal

If a mole is irregular and needs to be evaluated further, either the entire mole is removed, or a small tissue sample taken, in order to biopsy it. If only a small section of tissue is taken and it is diagnosed as malignant, the entire mole will be removed, along with a margin of normal skin around it. Cutting into a malignant mole will not cause cancer to spread. If the malignancy is caught early enough, this may be the only treatment needed.

A melanoma that has spread beyond the skin requires more aggressive treatment, which may include:

  • Surgery to remove affected lymph nodes
  • Radiation therapy
  • Chemotherapy
  • Biological therapy to boost the immune system
  • Targeted therapy (attacks vulnerabilities in cancer cells)

Depending on the type and severity of the malignancy, a combination of treatments may be used. Possible, although rare, complications of surgical removal of moles and birthmarks include infection, allergic reaction to the anesthetic used, and nerve damage.

Risks Factors for Malignant Moles

Certain factors may increase the risk of melanoma, including:

  • Fair skin
  • History of sunburn
  • Family history of melanoma
  • Excessive UV-radiation exposure from the sun or tanning beds
  • Living close to the equator or at higher elevations
  • Having several moles or unusually shaped moles
  • Weakened immune system

Surgical removal leaves a scar, the severity of which depends on the size, location and type of birthmark, mole or melanoma. Prior to treatment, a patient should be informed about the type and location of a potential scar.


Pigment Disorders

Vitiligo

Vitiligo is a skin condition caused by progressive depigmentation; it presents as white patches on the skin. Although any part of the body can be affected, vitiligo is usually found on the face, elbows, knees, hands, feet, genitals and upper thighs. When the scalp is affected, the hair growing on the vitiligo patch is white. Vitiligo can also affect the chin or eyelid, in which case the lashes or beard become white. The texture of the depigmented skin is not altered and the condition is not painful, although the affected skin may be much more sensitive to the sun.

Vitiligo affects both sides of the body equally, often symmetrically, and the borders of the white patches are irregular but well-defined. White patches may appear gradually or suddenly. Vitiligo is not uncommon, affecting between one-half and one percent of the population. While not serious medically, it can cause emotional distress for the sufferer because of how it makes the skin look.

Melasma

Melasma is a common skin condition in which patches of skin on the face darken. Typically, the affected areas are the cheeks, bridge of the nose, forehead or upper lip. The dark patches are often symmetrical. Melasma can occur in anyone, but is much more frequently found among women, especially women who are pregnant when it is called chloasma, and is sometimes referred to as the "pregnancy mask." Although not a painful or dangerous problem, melasma can be very distressing emotionally because of its alteration of the appearance. Melasma is not always a permanent condition. It may disappear in a woman several months after she gives birth, but may reoccur after unprotected exposure to the sun.


Scar Revision

Scar revision reduces the prominence of scars that result from injury or previous surgery. Although many scars fade over time and become barely noticeable, disruptions to the healing process can cause them to become red, raised, indented or otherwise deformed. The prominence of a scar depends on the type and severity of the injury that caused it, and the patient's age, overall health and ability to heal. For people who are unhappy with or embarrassed by their scars, there are a number of procedures available to make scars less apparent.

Scar-Revision Treatments

Scars are by definition permanent, but certain treatments can narrow, fade and otherwise make them less noticeable, which is especially helpful when they form on conspicuous areas such as the face and hands. Although there are many surgical scar-revision methods, including surgical excision, skin grafts and flap surgery, not all are appropriate for treating all types of scars. The best procedure for scar revision varies depending on the location and severity of the scar, the age and overall health of the patient, and the extent of revision the patient wants.

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