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When a mole is more than a mole

February 12, 2014 Sean M. Wells, MD, FACS

As a general surgeon, I am often asked to evaluate a patient with an abnormal mole (pigmented nevus) or one that has been biopsied, revealing a premalignant or malignant growth.  It is not uncommon for the patient to tell me they either were totally unaware of the lesion or dismissed changes in the lesion over time. 

All skin cancers are not alike, and melanoma, a malignant cancer of pigmented skin cells (melanocytes), is by far the most dangerous of the group, accounting for over 75% of skin cancer deaths in the United States.  This amounts to about 48,000 melanoma related deaths world wide per year. 

Found early, when the lesion is superficial and small, cure rates are high, but as the cancer progresses, it invades deeper into the skin, and becomes far more likely to spread far from where it started.  It is for this reason that being aware of any pigmented lesions and how they may change over time is critical to prompt diagnosis and treatment. 

Fair skinned individuals, and those with a history of sunburns, UV light exposure (think sun worshipers and tanning booths) as well more rare, inherited conditions, are at increased risk.

A common mnemonic used by clinicians to help distinguish common moles from suspicious ones is “ABCDE”.  This stands for “Asymmetry” (one side is not a mirror image of the other), “Borders” (irregular), “Color” (varying within the lesion), “Diameter”(larger than the diameter of a pencil eraser), “Evolution” (changing over time).  Add to this any pigmented lesion that is firm, raised above the skin, ulcerates or bleeds.

If you are aware of anything even slightly suspicious, you should bring it to the attention of your primary care doctor or your dermatologist.  A simple biopsy of the lesion in the office can answer the question and leave no uncertainty in diagnosis.  When performed, an effort should be made to obtain the full thickness of skin and immediately underlying tissue, so that an accurate determination of the lesion’s depth can be made. 

Knowledge about abnormal pigmented lesions and awareness of any changes in them can make the difference for the early detection of a potentially deadly condition.

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