Although melanomas are more likely to appear on normal skin (without a previous mole), most of them appear on “normal” moles on the skin. That is why it is important to monitor any changes in our moles using simple guidelines (ABCDE rules) for the early detection of melanoma.

WHAT IS DERMOSCOPY?

Dermatoscopy is a technique developed by dermatologists for monitoring moles. It can be performed using a handheld dermatoscope or a digital dermatoscopy device.

Manual dermoscopy:

A manual dermatoscope is simply a type of “magnifying glass” that allows moles to be observed at higher magnification. When observing moles with the dermatoscope, patterns are assessed that provide guidance on the benignity, malignancy, or “uncertainty” of that mole. Based on this, and on how “disturbing” the mole is, the dermatologist may decide to remove it.

Digital dermatoscopy:

It allows all of a person’s moles to be photographed and monitored individually over time. The technique is also often referred to by the trade name of the most commonly used devices: Fotofinder® or Molemax®. In this way, if any “suspicious” changes are observed in any of them that indicate possible malignancy, they will be removed at an early stage, preventing them from “deepening” and thus worsening their prognosis. This is the most effective technique available today for mole monitoring.

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Traditionally, considerable importance has been attached to this type of mole, due to the potential risk of it becoming malignant (i.e., melanoma). Today, we have more data on this subject.

The risk of malignancy is greater the larger the congenital nevus, which is why it is important to classify these types of moles into three categories:

• small: less than 1.5 cm
• medium: 1.5 cm-20 cm
• large and giant: greater than 20 cm and 40 cm, respectively

Small and medium congenital nevi are relatively common, and we can say that they are “healthy skin.” The risk of them becoming malignant over time is considered to be very low (less than 1%) and, if it does occur, it would happen in adulthood. Given this evidence, it is important to remain calm about the mole; it is not essential to remove it, although we must not forget to protect it from the sun (just like the rest of the child’s skin!) and consult a dermatologist whenever we notice a change in color or size (see ABCDE rules). The option of removing it should be assessed according to its location, the parents’ wishes, and the aesthetic consequences of such removal.

Large congenital nevi are much less common. Traditionally, this type of nevus has been considered to have a higher risk of developing melanoma due to its size. With regard to treatment, the option is to monitor it or remove it. It is important to individualize the approach. Some nevi, if large, can be successfully operated on, thereby reducing the psychological consequences of having them throughout life, while others can leave such noticeable scars that treatment is not worthwhile from an aesthetic or functional point of view.

Giant congenital melanocytic nevi cover very large areas of the body (they can be shaped like a swimsuit, a T-shirt, etc.). Currently, dermatologists and surgeons who treat them agree that the risk of developing melanoma is not a sufficient reason to “insist” on removing the entire nevus “at all costs,” as this may involve complex surgical procedures or very noticeable sequelae for a child. In general, the approach to be taken should be decided jointly by the parents and the doctor, weighing the pros and cons of treatment. In any case, it is important to have frequent check-ups with your dermatologist for proper monitoring of the nevus.

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Keep in mind that the technical name for moles is melanocytic nevus. Melanocytic nevi, in turn, can be divided into different types based on their characteristics.

The fact is that most moles are brown in color. They can be dark brown, light brown, or have different shades. Not everything that is brown is a mole (for example, you can read about seborrheic keratosis here) and not all moles are brown.

There are nevi of different colors that are still “moles” even though their appearance may confuse us. We will discuss them below:

WHITE

For example, halonevus: these are moles, typically brown, which have a white border that gradually reduces in size until they disappear and become completely white. You can read more about them in the post “Halo nevus: disappearing moles”.

FLESH COLOR

Intradermal nevi are an example. This type of mole is flesh-colored or light brown, in most cases. I told you about them in the article, “Is it a mole or a wart?”

GREY/BLUE

This color is typical of the so-called blue nevi. This is because they are located deeper in the skin than other moles. Due to an optical effect called Tyndall, the brown color of the melanin is seen with this tone. Here you can see pictures of blue nevi.

BLACK

Some “normal” moles with no name of their own, especially in people with dark complexions, can be really dark in tone. For some reason, deep brown or black moles tend to be of more concern, and the reality is that there is no reason for this.

If the color, although dark, is homogeneous, this does not have to mean anything bad. There is a type of nevus called Reed’s nevus that characteristically tends to be darker than normal.

PINK OR RED

Some intradermal nevi, for example, may have a certain pinkish hue. Spitz’s nevus, a type of mole that usually appears in children, can have all kinds of colors, but it is very characteristic for it to be reddish. You can see pictures of Spitz nevus here.

And what if the color changes?

If a mole is one color and remains stable for months or years, there is probably nothing wrong with it. It has its characteristics and that’s all there is to it.

However, if you notice a change in the color of a mole, be sure to see a dermatologist. Sometimes a change in color can be a clue to a melanoma. Remember the ABCDE rule, where C is for color changes.

And you, do you have any moles other than the typical brown ones?

The post Are moles always brown? first appeared on Dra. LOREA BAGAZGOITIA.

What are intradermal nevi and compound nevi?

Both are a type of mole (technically called a “melanocytic nevus”) that are usually not present at birth. They are lumpy, soft, brown or flesh-colored moles that usually appear on the face, neck, and back starting in adolescence. Sometimes they have some hair inside. They can easily be confused with warts or fibroids, but they are not the same.

Intradermal nevi are frequently on the face, neck and trunk.

Why do compound nevi and intradermal nevi appear?

Moles usually originate in the lower zone of the epidermis (the most superficial layer of the skin) and are technically called “junctional nevi” (because they are located at the junction between the epidermis and the dermis). As the years go by, they gain volume and go deeper into the dermis (which is underneath the epidermis), first becoming “compound nevi” (when they are both in the junction and in the dermis) and later becoming “intradermal” (when they are only in the dermis).

As they become larger, they also lose their ability to produce pigment (called melanin) and therefore become lighter over the years, becoming flesh-colored in many cases. Hence they are easily confused with warts or skin tags.

How are intradermal nevi diagnosed?

A simple clinical examination by a dermatologist is usually sufficient. A dermoscope is often used to confirm the diagnosis. In very rare cases, it may be necessary to analyze the lesion to confirm that it is a nevus and not something else (e.g., basal cell carcinoma).

Should compound or intradermal nevi be treated?

It is not necessary to treat compound or intradermal nevi, as they are benign lesions by definition and do not pose a health risk. It is not better to leave them or to remove them; depending on the circumstances, one or the other may be chosen. For example, they can sometimes be uncomfortable or unsightly, and one may prefer to remove them for these reasons.

It is not necessary to remove compound or intradermal nevi as they are benign.

How can compound or intradermal nevi be removed?

The removal of compound or intradermal nevi is performed under local anesthesia in a simple procedure that we usually perform in the same office. Sometimes sutures may be necessary, and in other cases (most) we use techniques such as electrocoagulation or CO2 laser to heal the wound, with great aesthetic results.

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WHAT IS a dermatofibroma?

Dermatofibromas are very common benign tumors (again, meaning by “tumor” simply “lump”, without meaning it is malignant or anything similar), which are usually harder than normal brown skin. It is not uncommon for a person to have more than one on their legs or arms.

More images of dermatifibromas

They are firm to the touch and in many cases are not bothersome, although some people find them slightly painful, especially when squeezed. They are usually less than a centimeter in size, although sometimes larger dermatofibromas occur.

They appear more frequently in adults, usually on the legs. They are twice as frequent in women as in men.

WHY do dermatofibromas occur?

Traditionally, they have been blamed on small wounds, bites, or ingrown hairs. If you have any, you have probably thought that was the cause. However, as with so many things in dermatology, the cause is still not entirely clear.

Are dermatofibromas RISKY?

No. Dermatofibromas are benign and have no chance of turning into something bad.

How are dermatofibromas DIAGNOSED?

They are usually diagnosed with a simple examination. Dermatofibromas characteristically show what is called the pill sign. This means that when they are squeezed from the side, they become depressed and sink into the skin, as you can see in the picture.

When pressed laterally, dermatofibromas are slightly depressed.

In any case, dermatofibromas can have very varied aspects and colors, so sometimes it can be difficult to differentiate them from melanocytic nevi, basal cell carcinoma, certain scars or even melanoma. To differentiate them, the dermatologist will use the dermatoscope and if this is not enough, he/she may indicate that they should be removed to confirm the exact diagnosis.

How are dermatofibromas TREATED?

From a medical perspective, once the diagnosis is confirmed, no treatment is needed for dermatofibromas. They are usually removed under two circumstances: if they are painful or for cosmetic reasons. In rare cases, as I mentioned earlier, they may need to be removed to confirm the diagnosis.

To remove them, local anesthesia is used; small punctures are placed in the area of the dermatofibroma to render the skin insensitive. After removal, stitches are usually given. It is important to keep in mind that in the area where the dermatofibroma was, there will be a scar, so it is not always compensated to remove them for aesthetic purposes.

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In my experience as a dermatologist, these are spots that tend to cause some discomfort. They can appear suddenly and last a long time, or they can stay for a long time. These lines can be caused by many things. Among them, the most feared is melanoma, which is rare in the nail, but with serious consequences. This is why it is important to consult a dermatologist (either in person or as an online dermatologist) when a spot appears on the nail.

Why do spots appear on the nail?

The appearance of brown spots on the nail can have several causes, most of which are not serious. In some cases, the stains may have a linear appearance that remains over time. Below is a list of the most common causes of discoloration:

• Racial pigmentation: People with brown or black skin may naturally have more pigmented lines on their nails. They are often seen on more than one fingernail and toenail. They can appear at any age, even in children. There is no health risk.
• Punctures: Sometimes we see irregular spots that may be more reddish or black in color after a blow or repeated minor trauma (such as wearing a tight shoe). They usually appear abruptly, sometimes with pain, and disappear as the nail grows. They are usually small bruises (which turn brown) under the nails. Sometimes they can be an increase in pigmentation.
• Medications: Some medications can cause increased pigmentation of the nails. The change usually occurs some time after starting the medication and usually appears on more than one nail.
• Pregnancy: During pregnancy, some nails may become more pigmented or brown lines may appear.
• Some skin conditions: psoriasis, fungal infections, warts, or other less common tumors may cause brown lines to appear on some nails.
• Some general diseases and syndromes: some endocrinological diseases, among others, can be accompanied by linear spots on the nails. Peutz-Jeghers and Laugier-Hunziker syndromes present these spots on the nails, usually accompanied by spots on the lips. A doctor can help diagnose all of these conditions, which usually have symptoms other than nail spots.
• Moles or melanoma: These brown lines can be the expression of a mole or a melanoma located in the nail matrix. Most often it is a mole (nevus), which is a benign spot. However, especially in adults, it is important to make sure that it is not a melanoma, which has a much worse prognosis.

Warning signs of a spot on the nail

Of all the possibilities mentioned in the previous section, the one that should undoubtedly make us more alert is that the spot in question is due to a nail melanoma. This is rare. It accounts for less than 3% of melanomas in fair-skinned people, although its frequency is higher in darker-skinned people, where it can account for up to 30% of melanomas. The prognosis of melanoma of the nail is poor, so it is very important to consult a dermatologist when in doubt. It is important to take into account some details that can be particularly alarming:

• Being an adult: Children are much less at risk. In them, the line is most likely due to a mole or melanocytic nevus.
• Line width greater than 4 mm.
• Different shades of brown in the line.
• Changes in color or size over time.
• Observation that the skin surrounding the nail is also pigmented (this is called Hutchison’s sign, which you can see in this photo).
• Changes in the nail itself, with breakage, ulceration, or irregularity of the nail.
• A family history of melanoma.

Importance of seeing a dermatologist

ou may be familiar with a case that went viral on Facebook some time ago. It was about a girl who was diagnosed with melanoma of the nail. She insisted on the need to consult a dermatologist in case of any nail lesion. She hoped that her experience could help others…so let’s take note!

Consulting a dermatologist online is fast, convenient and useful. It can provide reassurance and guidance if you don’t have access to a dermatologist in person. However, in the specific case of a nail stain, if you have the option, I advise you to do it in person (I work as a dermatologist in Madrid, if you find it useful, you can find me here). This way the professional will be able to evaluate your spot with dermatoscopy.

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In this post I will talk about this phenomenon called halo nevus or Sutton’s nevus…..

What is a HALO NEVUS OR SUTTON NEVUS?

These are moles that have an area that is lighter than the surrounding normal skin. This area is usually symmetrical and can appear either in lifelong moles (congenital nevi) or in moles that have appeared throughout our lives.

It is more common in children and adolescents, most often on the back. It is also more common in people with a high number of moles. It is also more common in people who have vitiligo or whose parents have vitiligo.

Halo nevi usually appear on the back of children and adolescents.

Usually the mole will start out brown, its original color, but it may turn pink until it disappears completely, leaving a circle in the area that is lighter than normal skin, which will eventually return to its normal color. More rarely, but occasionally, some moles can “resist,” with the white area around them disappearing over time.

More photos of halo nevus or Sutton nevus

Why does this phenomenon occur?

It is believed that the gradual lightening of the mole or its disappearance is the result of a kind of attack by our defenses (immune system) on the cells that make up the mole, called melanocytes. The reason why this occurs in some people and not in others is not clear.

SHOULD WE BE CONCERNED about a halo nevus or Sutton’s nevus?

Halo nevi are not a cause for concern, especially when they appear in children or adolescents. However, it is advisable to consult an online dermatologist or a face-to-face dermatologist if they appear, especially in adults who have not had similar moles before. In these cases, it is important to see a dermatologist to rule out melanoma, which is rare.

If one or more halo nevi appear in an adult who has never had similar moles before, it is advisable to consult a dermatologist.

Is it TREATABLE?

There is currently no treatment for halo nevi. It is normal to let them grow and run their course until they disappear, as they pose no health risk.

The post Halo nevus: vanishing moles first appeared on Dra. LOREA BAGAZGOITIA.

As I have discussed in previous posts, moles, or technically melanocytic nevi, can be present from birth (“congenital nevi”) or can appear throughout life (“acquired melanocytic nevi”), especially during the first 20 years of life.

Both can occur on the feet and hands. They are more common in people with many moles or in dark-skinned people.

What do moles on the feet and hands look like?

They are usually brown patches, millimeters to centimeters in size, circular or oval in shape, and have a “striped” appearance caused by the skin lines on the palms and soles (called dermatoglyphs).

They can be any size and anywhere on the hands and feet. They do not itch or hurt. They should not bleed (if they did, it would be a reason to see a doctor).

Are moles on the feet and hands dangerous?

There is a misconception that moles on the feet are more dangerous than moles elsewhere on the body. This is not the case. Moles that appear on the palms of the hands and soles of the feet are exactly the same in terms of biology and medical characteristics as those we see on other parts of the body. Contrary to popular belief, these moles or nevi are not more dangerous because they are on the palms of the hands or soles of the feet.

Moles on the palms and soles are no more at risk than any others

Well, it is important to insist that monitoring ALL the moles we have on our body is equally important, including, of course, those on our feet and hands.

In fact, perhaps the belief that moles on the soles or toes are more aggressive comes from the fact that if we do not monitor them and a “malignant” change occurs, we would notice it later than if it occurred on, say, an arm, and therefore that lesion would already be more advanced (but not because it is really more aggressive, but because we would have diagnosed it later).

There is no scientific study to support the idea that moles on the palms of the hands and soles of the feet have a higher risk of becoming malignant than those on the rest of the body. Therefore, it is not necessary to remove them. This does not mean that we should not be aware of the importance of keeping an eye on them, ALL OF THE TIME, in order to prevent a melanoma from “escaping”.

I remind you of the ABCDE rule to look for possible changes in moles that should make us consult a dermatologist:

• A. Asymmetry
• B: Edge changes
• C: changes in Color
• D: increase in Diameter
• E: Evolving: the mole is changins in size, shape or color over time.

Are moles on the nails dangerous?

Because moles can appear on any part of the body, it is possible to see them on your nails. When a mole appears in the nail matrix (the area where the nail originates), the pigment it produces grows with the nail and can be seen as a brown line along the nail.

These moles are also no more likely to go bad, although they may be a little more difficult to monitor. In any case, there are some clues that should make us consult a dermatologist:

• The line becomes wider or parallel lines of varying thickness are observed.
• The line has different shades of brown
• The spot not only affects the nail, but also the skin around the nail (the nail fold). This is called “Hutchison’s sign”..

In conclusion…

It is important that we know ourselves well and frequently observe our moles, as well as those of our family. In case of changes in moles (ABCDE rule), whether on the hands, feet or any other part of the body, it is essential to consult a dermatologist (here you have my location) just in case.

Despite the agility and convenience of the system in this case, consulting a dermatologist online may not be entirely conclusive, as it is not possible to perform dermatoscopy, which is usually of great help to us.

Do you have any moles on your feet or hands that concern you?

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