Moles, Melanomas and Your Children
Parenthood is quite the experience. All we do is worry. We worry about everything, especially about school and health. School worries are a communal exercise, with everyone adding their two cents worth on every aspect. Health is no different; everyone has an opinion. So, let's talk about moles. As a dermatologist daddy, I scrutinize every inch of my kids' bodies, looking for bad moles. I'm lucky, because I know what to look for. However, our greatly increased knowledge of moles and skin cancer goes hand in hand with greater concern for our children. In this article, I will try to give you a feel for what is and isn't normal in a mole, and what to worry about.
Common moles can appear from age two years onward. The scientific name for a mole is a nevus, nevi for plural. The more moles you have, the greater the relative risk for problems in any given mole. "More" can be loosely defined as 20 or more moles on a child's body. Numerous larger moles (6-15 mm) should also raise an extra red flag on examination. However, just because you have a lot of moles doesn't mean that something bad is going to happen.
Many people get their first moles when they are a few years old, with more appearing over th ecourse of a lifetime. We call them acquired moles, and it is very normal to get new moles as we mature. Moles can occur in both sun-exposed and sun-protected sites like the scalp or buttocks. Deramtologist constantly preach sun avoidance and protection for a rewasion. Increased and unprotected sun exposure is certainly a factor when a mole is found to be cancerous, but problems can arise in even the most protected location. Two or more blistering sunburns before the age of 20 also increases the risks of getting melanoma skin cancer.
The ABCDs of melanoma can help you in evaluating suspicious lesions.
- A for Asymmetry: the shape of one half of the mole does not match the other
- B for Border: irregular edges with jutting points
- C for Color: browns, blacks, purples, tans
- D for Diameter: usually larger than a pencil eraser
Spots that bleed without being hit or scratched, spots that enlarge rapidly, or rise up in bumps are all lesions that beg further evaluation. However, these are just guidelines and not absolutes; if you have a concern about a particular mole, get it checked.
Atypical moles, sometimes referred to as dysplastic moles, can increase the risk of problems by up to 20%. These tend to be large (6-15mm) and have irregular borders, mixed colors, or indistinct margins. They sometimes have raised and flat components as well. These types of moles should be biopsied and, if necessary, removed.
One of the most difficult lesions to manage is the giant congenital mole. It is responsible for about 3% of childhood melanoma. They typically appear in approximately 0.05% of newborns and pose a greater risk in the first 10 years of life than later in life. Giant congenital nevi can range from 2 cm to as large as 20cm or greater. The larger the mole, the greater the risk, and every patient's course is different. Moles that are easily removed can be watched until puberty before deciding whether they should be removed. Sometimes, they are never removed. Changes noted over time are the best indicators of whether a lesion should be removed or not.
Family history is also very important in the evaluation of moles. A family history of atypical moles constitutes a major risk factor for melanoma. Dermatologists recommend that all first-degree relatives of a patient with melanoma undergo a full body exam to serve as a baseline for future evaluation.
If you notice a mole changing on yourself or your child, seek the advice of a dermatologist. Some dermatologists are more comfortable seeing children than others; yours friends or relatives may have recommendations for you. A full body examination is a simple and potentially life-saving procedure. As a general guideline, patients over the age of 30 with moderate sun exposure and 5 or more moles should have a full body examination once a year. A history of skin cancer, excessive sun exposure, or other predisposing factors may warrant examinations at a greater frequency.
Imaging techniques can also be helpful in observing your moles and evaluating suspicious moles. Most of these techniques try to tell whether a mole is cancer or not. A new twist on the old technique of full-body photography is available from Dermal Screening Centers. This technique takes full-body photography into the digital realm. With new software, photographs of the same body part taken at different times can be flashed back and forth to reveal changes in individual lesions, or the arrival of new ones. This information is then used by your doctor to decide whether to biopsy the lesion. It does not itself determine whether a lesion is cancer. It only documents change, which is the earliest warning sign for cancerous change.
Whatever you decide to do, your first step is a full-body evaluation done your dermatologist. Don't let modesty keep you from getting this invaluable examination. Remember, if it isn't seen, it can't be treated. If it's not offered to you, ask for it.