Mole condition

The genetic inheritances we have from our parents, along with the amount of sun to which we are exposed (especially during childhood) are major factors in determining mole numbers. Skin with more sun exposure tends to have more moles. However, moles may also occur in sun-protected areas like the palms, soles, and genitals.

Both moles and freckles (medically termed ephelides) are darker than the surrounding skin. Moles may be raised or completely flat while freckles are always totally flat. Freckles and "sun spots" (medically termed lentigines) are due to an increase in the amount of dark pigment called melanin. Moles are more common in people prone to freckles. Freckles are flat spots that are tan, slightly reddish, or light-brown and typically appear during the sunny months. They are most often found in people with light complexions. Many people with blond or red hair and green or blue eyes are more prone to these types of skin spots. Sun avoidance and sun protection, including the regular use of sunscreen may help to suppress the appearance of some types of moles and freckles.

Moles occur in all races (Caucasian, Asian, African, and Indian) and skin colors. Moles also are seen in animals.

Can I still get new moles as an adult?

While many moles arise in the first years of life, the total number of moles typically peaks in the second or third decade of life to an average of 35. Most people do not develop new regular moles after the age of 30. Adults often develop non-mole growths like freckles, lentigines, "liver spots," and seborrheic keratoses in later adulthood.

New moles appearing after age 35 may require close observation, medical evaluation, and possible biopsy. A brand-new mole in an adult may be a sign of an evolving abnormal mole or early melanoma. It is important to have any new or changing mole evaluated by a dermatologist.

What else could it be?

There are many mole simulators, including freckles, lentigines, liver spots, seborrheic keratoses, melanomas, neurofibromas, hemangiomas, skin tags, café au lait macules, and pigmented basal cell cancers. The optimal way to distinguish between these other growths is by consultation with a dermatologist, which may include a skin biopsy. Sometimes, a mole may occur adjacent to or on top of a non-mole growth like a freckle or seborrheic keratosis. When in doubt, a skin biopsy can be very helpful in diagnosis.

Melanoma

This very dangerous form of skin cancer may appear even in young people and on parts of the body that are sun exposed as well as those that are protected. While the exact cause of melanoma is not entirely known, genetics and ultraviolet rays are known to play a part. Melanomas may arise from a previously normal mole or pigmented spot that has been present many years. Melanomas may also arise from completely normal skin without an apparent preexisting mole. In comparison with benign (noncancerous) moles, melanomas tend to be larger, darker, and have more irregular color and shape variations. Most melanomas are actually not raised as many people tend to incorrectly assume.

How can moles be prevented?

Since we cannot change our own genetics, it is not possible to prevent all moles. The following prevention measures are aimed at sun avoidance and sun-protection and include

• using sunscreens with SPF (sun protection factor) 50;
• using wide-brimmed hats (6 inches);
• using sun-protective clothing (shirts, long sleeves, long pants);
• avoiding peak sun hours of 10 a.m. to 4 p.m.;
• seeking shade and staying indoors.

Ideally, mole prevention is more effective than later trying to remove moles that have already developed. Mole removal will leave some type of scar at the site of the prior mole. Smaller moles are easier to remove and leave smaller scars. Larger mole removals often produce larger and more unsightly scars. Although lasers may be used in some countries and by some medical centers to remove some types of moles, laser treatments are not recommended for moles. Irregular moles need to be surgically removed and the tissue sent for testing. While sun spots or lentigines may respond to bleaching or fading creams, freezing with liquid nitrogen, laser, intense pulsed light, and chemical peels, true melanocytic nevi should not be treated by these methods.