Moles, moles and more moles

Isn’t it sad the way we age?

For men especially, we lose hair on our heads, and gain it in our nostrils and ears! We also develop more moles on our bodies as we age (this is true for women as well).

Moles come in two varieties: malignant and non-malignant (benign).

Malignant moles, by definition, are cancerous and will grow and invade the adjacent skin and underlying structures. Most common skin cancers are squamous cell carcinoma and basal cell carcinoma. For the most part, these are slow growing and may take years for them to invade adjacent structures or become metastatic (spread to other parts of the body).

Of more concern is melanoma, which is much more aggressive than the above. Unlike the above cancers, the risk for melanoma increases with occasional excessive sun burn. Both squamous and basal cell carcinomas arise from chronic exposure to sun. That once in a while trip to Mexico which gave you a bad sun burn will increase your risk of melanoma more than the other tumors discussed.

The most susceptible person for developing melanoma is fair skin with red hair and freckles. My advice to any one with fair or light skin living in Southern California is to have an annual skin examination by their family physician or dermatologist. Any change in size, color or shape of a mole should be investigated. Itching and bleeding is also of concern.

The only way to make the correct diagnosis is to remove all or part of the mole (depending on the size and location) and have a pathologist examine the lesion under the microscope. Depending on the diagnosis, additional surgery may be necessary. The main issue with melanoma is the amount of normal looking skin which has to be removed as part of the treatment. Even if the melanoma is very thin, a margin of 0.5cm (1/4 of an inch) has to be removed around the melanoma. If the melanoma is thicker, up to 3cm (slightly more than an inch) of skin has to be removed around the lesion. This will result in a large wound which typically requires a skin graft from another part of the body. Lymph node biopsy and removal may also be required. Therefore, it is critical to minimize exposure to sun and especially avoid sun burn. Living in Southern California, the only practical solution is to limit outside activities before 3PM and to wear a sun screen with SPF of 30 which has Titanium dioxide and or Zinc dioxide (or both) for maximal protection. The sun block must be applied 30 minutes before going outside and must be applied every 2 hours or less depending on the amount of perspiration and water contact.

I do not want to minimize the seriousness of squamous and basal cell carcinoma. These lesions must be addressed and treated sooner rather than later. However, overall, melanoma is more aggressive and the treatment more drastic than the above.

A non-malignant mole, also called benign, is not cancerous and does not invade adjacent tissue and never metastasize. The reason for removal is usually cosmetic. However, sometimes benign moles, because of their location may become problematic. A good example is a mole in the beard area, which bleeds every time the patient tries to shave.

Most moles can be removed under local anesthesia in the office. My recommendation is to send any mole excised to pathology for confirmation of clinical diagnosis. Normal looking moles are rarely cancerous, but only pathology will confirm this.

The advantage of having moles removed by a board certified plastic surgeon is to minimize chance of undesirable scarring. The plastic surgeon is also able to reconstruct the area if a large amount of tissue has to be removed. However, please note, the risk of developing a wide and/ or hypertrophic scar increases in areas of excessive motion and tension (shoulder, the chest skin between the breasts are common areas) regardless of technique.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon in Santa Ana with over 10 years of experience. His office is located in Santa Ana, California. To schedule a complimentary consultation, please call (714) 834-0101.