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Atypical Moles

Nevi (plural of nevus) is the medical term for a mole, birthmark, or beauty mark. Moles are common skin lesions made of pigment-producing cells known as melanocytes. Melanocytes exist throughout the skin to provide melanin to skin cells. However, in moles, these melanocytes cluster into groups rather than spread evenly in the skin. They can appear flat, slightly raised, or round and range in color from brown, black, tan, red, pink, blue, to colorless.

Acquired nevi, or common moles, describes nevi that develop after birth. Most adults have 10 to 40 common moles that continue to develop through middle-adulthood (1). Moles may fade with time as well. People with fair skin tend to have more moles than people of color. People with 10 or more moles are at 12 times the risk of developing melanoma, the most serious type of skin cancer (2). Moles present at birth are known as congenital nevi.

A common mole is a spot on the skin that develops when melanocytes cluster together. Common moles are round or oval, flat or raised, of a single color, including pink, brown, or black, have a well-defined border, and are smaller than a dime in size. Common moles can be found anywhere on the body, including underneath fingernails, and between fingers and toes. A common mole has the potential to become a melanoma.

The primary causes of moles are genetics, sun exposure, immune diseases, and some drug treatments.

About 1 in every 10 Americans is estimated to have at least one atypical mole (3). An atypical mole has an irregular shape, is larger than a common mole, and has poorly defined borders. With features similar to melanoma, atypical nevi have several colors and varying surfaces that could be flat, smooth, or scaly. These dysplastic moles can appear anywhere the skin is exposed to the sun but may also appear in areas not exposed to the sun.

While dysplastic nevi are not melanoma, people with dysplastic nevi are at increased risk for melanoma. The more atypical nevi you have, the greater the chance of developing melanoma. People with atypical moles and a family history of melanoma are at increased risk for melanoma (4). Moles that look atypical should be evaluated by a dermatologist and monitored regularly.

The ABCDEs are the warning signs to evaluate atypical moles at risk for melanoma.

Asymmetry means the shape is different from one side of the lesion to the other. If you drew a line down the middle of the mole, the halves would not be a mirror image of each other.

Borders are irregular, notched, scalloped, or blurred, and are not smooth and even as with common moles.

Colors of dysplastic moles vary, including brown or black, with red, blue, or white spots, unlike common moles, which are typically skin-colored, brown, or black.

Diameter means the size is larger than 6 mm or the size of a bead. However, smaller moles with other danger signs could also be melanoma.

Evolving means the mole changes shape, size, color, or elevation, or another new symptom occurs, such as bleeding, itching, or crusting. Crusting is the most concerning sign.

Melanoma is the most important reason for at-home skin exams and annual skin checks from your dermatologist.

Nevi are typically diagnosed through visual examination, supplemented by a technique known as dermatoscopy. This method aids board-certified dermatologists, such as Dr. Michelle Pennie, in differentiating benign nevi from cancerous lesions. A dermatoscope, a specialized magnifying instrument, enhances diagnostic accuracy, particularly for the early identification of suspicious nevi.

During your annual skin check, your Bliss Dermatology provider will examine you from head to toe. Moles can hide anywhere, including the ears, between the fingers and toes, near the eyes, and in the genital area. If he or she is concerned about a nevus, a biopsy, or small piece of the mole, will be taken and send it to a laboratory for microscopic evaluation. If she finds dysplastic nevi, you will monitor the mole for changes over time and schedule more frequent exams if you notice changes.  However, if you have more than five dysplastic nevi, she will recommend that you have your skin examined on a more frequent schedule. If you have a family history of melanoma, you should have your moles checked more frequently. Discuss a care plan with your provider.

Depending on how atypical they appear, dysplastic moles can be monitored regularly or biopsied for further evaluation. The more dysplastic the nevus, the more complete removal is warranted.

Schedule a dermatology appointment today.

If you’re concerned about a mole or skin growth, schedule a dermatology appointment today at Bliss Dermatology. Bliss Dermatology provides board-certified dermatology and fellowship-trained Mohs micrographic surgery care. Bliss Dermatology is proud to be regarded as one of the best dermatology practices on the Gulf Coast of Florida, with offices in Venice and Englewood. Schedule a consultation today.

At a Glance

Michelle Pennie, MD

  • Board-Certified Dermatologist
  • Fellowship-Trained Mohs Surgeon
  • Founder and Lead Dermatologist of Bliss Dermatology
  • Learn more

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