Moles and liver spots (nevi) are benign growths of certain skin cells. They can have different sizes, shapes as well as colors and can appear all over the body. Moles are benign in themselves, but skin cancer can develop from some moles. We will show you how to recognize a dangerous birthmark and what options are available to have such a birthmark removed.
The development of birthmarks
A birthmark develops when a particularly large number of pigment-forming cells (melanocytes), which produce the skin pigment, accumulate in one place. That is why most birthmarks are brown or black in color. However, moles can also be reddish or bluish. In addition, there are the so-called nevus cells, which are closely related to melanocytes and can also form moles or liver spots.
Moles or birthmarks?
There is no single definition to distinguish a mole from a birthmark. In common usage, the terms are often used interchangeably. Occasionally, the term mole is used for a congenital spot, whereas the acquired form is called a mole. Sometimes the terms are used differently depending on the size and shape of the spot. In medical terminology, moles and birthmarks are assigned to the generic term pigment nevi. This refers to benign skin changes that originate from pigment-forming skin cells. Non-elevated skin spots are called lentigo. Moles that originate from the nevus cells are called nevus cell nevi by dermatologists.
Moles: Causes
Moles can either be congenital or develop during life. Genetically, people with very fair skin in particular tend to develop many moles. However, recent studies indicate that the number of moles is not only determined by genes. In addition, the number of hours spent unprotected in the sun as a child and adolescent probably plays a decisive role. This is because the UV light stimulates melanocytes to multiply and produce the skin pigment melanin, which causes the skin to tan. However, frequent exposure to UV light also increases the likelihood that some melanocytes will proliferate and aggregate: a mole develops. Due to hormonal influences, moles can also form more frequently during pregnancy. In addition, it is particularly common during this time for benign moles to develop into malignant spots. Therefore, pregnant women should check their moles especially carefully.
Moles and skin cancer
Moles in themselves are benign – however, some moles can develop into skin cancer. Moles whose size, shape, or color change are considered dangerous. Such moles are called dysplastic nevus. In contrast to the other moles, atypical cells proliferate more in them. A dysplastic nevus can – but does not have to – be the precursor of a black skin cancer (malignant melanoma). People who have very many moles (more than 40) or irregularly shaped moles are considered to be particularly at risk. They have up to a 15-fold increased risk of developing skin cancer. In addition, skin cancer cases in close relatives also significantly increase the risk of developing the disease themselves. Recognize skin cancer – these pictures show how it works!
Dangerous moles recognize: The ABCDE rule
To get a first impression of whether a mole could be dangerous, you should regularly examine your moles according to the ABCDE rule.
- Asymmetry: spots that are not uniformly round or oval are considered conspicuous.
- Border: the border of the mole should be sharp. On the other hand, caution should be exercised when the border is washed out, frayed.
- Color: If the birthmark has multiple shades, it should be checked by a dermatologist.
- Diameter: moles larger than five millimeters should be observed.
- Development: special attention should be paid to moles that change in any of the four points above.
In other variants of the ABCDE rule, the E stands for raised: if the mole stands out from the surrounding skin and is palpable, a check by the dermatologist is also advisable.
Moles – when to the dermatologist?
If you have a particularly large number of moles or think you have discovered a suspicious mole, you should not hesitate to visit your dermatologist. Because if skin cancer is detected at an early stage, the chances of cure are almost 100 percent. In addition, you should also consult a dermatologist if you have scratched open a birthmark, if a birthmark itches or hurts, and if a birthmark is inflamed, oozing or bleeding. Even if a conspicuous spot should be clarified by a dermatologist, there is no reason to panic. The criteria of the ABCDE scheme are only clues and do not necessarily indicate skin cancer.
Examine moles: the skin cancer screening.
Those who belong to a risk group should have their moles checked regularly (about once a year) by a dermatologist. The dermatologist uses a special light magnifier to search the entire body for moles and can quickly identify dangerous moles. In addition, the appearance of the moles can be recorded with the help of photos – so changes can be easily detected at the next check-up appointment. Whether a birthmark is actually malignant, however, can only be definitively determined after its removal by examining the tissue (biopsy). From the age of 35, skin cancer screening is paid for by the statutory health insurance every two years – privately insured persons can be examined every year free of charge. Before the age of 35, those with statutory health insurance must pay for skin cancer screening themselves; depending on the practice, the screening costs approximately between 30 and 50 euros. Under certain circumstances, however, the cost of the examination can also be covered by health insurance.
Removal of moles
If a mole is suspected of being malignant, it is removed – usually under local anesthesia. There are several methods to choose from to remove the birthmark. Larger moles are cut out with a scalpel, smaller moles can also be punched out. If the mole is cut out with a scalpel, the wound must then – depending on the size – usually be stitched with one or more stitches. If possible, the birthmark – unless it is a cosmetic procedure – should not be removed with a laser or with the help of cold therapy, because the tissue is destroyed in the process and can no longer be examined afterwards. By the way, under no circumstances should you try to remove the birthmark yourself. This can not only lead to ugly scars, but can also result in life-threatening infections. If a birthmark has been removed, sports activities as well as movements that put particular stress on the affected region should be avoided for about two weeks. In addition, the wound should not come into contact with water for a certain period of time.
Removing a mole for optical reasons
If a mole is visually disturbing due to its size or location, removal can be performed at the patient’s request even without a medical reason. In this case, the tissue is excised less generously to minimize scarring. However, even in the case of removal for cosmetic reasons, a tissue sample is examined to detect possible malignant changes in the early stages. The statutory health insurance companies generally cover the costs of removal if there is a medical necessity. Removal for purely aesthetic reasons must therefore generally be paid for by the patient. However, if the mole is so visually disturbing that there is a psychological burden, cost coverage is possible under certain circumstances.
Four tips on the correct behavior in the case of moles
Consider the following tips on how to properly deal with moles:
- If you belong to a high-risk group, you should examine your skin closely once a month and watch for changes. Places that you cannot see well yourself, such as the scalp, should be examined by another person.
- Have your moles checked regularly by a dermatologist. The earlier skin cancer is detected, the better the chances of cure. If you observe suspicious changes in a mole, they should immediately make an appointment with your dermatologist.
- If you suffer from particularly many or irregularly shaped moles, you should avoid the blazing sun and rather stay in the shade in summer. If you go out in the sun, you should apply sunscreen with a high sun protection factor.Especially for children, adequate sun protection is important, because sunburns in childhood and adolescence increase the risk of skin cancer by two to three times.
- Do not immediately panic if you discover an irregular birthmark. Only rarely is behind the birthmark actually a black skin cancer – usually the spots are harmless.
