Dr Wai was interviewed at Skin Clinic Subang on how to identify malignant moles as well as the available options in Moles Removal in Health & Beauty Magazine.
THE BEAUTY MARK
Moles are More Than Just Distinguishing Marks, They Could Lead to a Type of Skin Cancer
What do Abraham Lincoln, Marilyn Monroe, Enrique Iglesias, Cindy Crawford and Eva Mendes have in common? They are all known for their trademark moles.
Since ancient times, moles have held some sort of cultural and cosmetic significance. In medieval Europe, moles were a subject of ridicule based on superstition as an odd mark on the skin is said to be an entry point for demons to possess a person. The Chinese, on the other hand, has a system of divination by observing bodily marks, especially facial moles, known as ‘moleomancy’. It wasn’t until the 1950s and 60s that having a perfect little spot on the face becomes glamorous.
While there is no doubt a ‘beauty mark’ have an impact on a person’s appearance, for better or for worst, their impact on health often goes unnoticed.
Moles from a Medical Perspective
Melanocytic nevus (nevi in singular) is the medical term for moles. Skin pigment-producing cells called melanocytes are evenly spread throughout the skin to produce pigment that gives the skin its natural color. Moles are growth that occurs when melanocytes grow in a cluster with tissue surrounding them. They usually appear pinkish, dark brown, tan or flesh-color.
A person may develop new moles from time to time, normally up to 10 to 40 moles, until around age 40. Many begin as small, flat spots that may slowly enlarges in diameter, become raised and darkened from sun exposure. Over many years, most moles may flatten or lightened in color.
There are various types of moles and most of them are not a course for concern. There are, however, certain types of moles that can develop into a type of skin cancer called melanoma. This cancer commonly develops on the back for men and on the lower legs for women. Generally, melanoma is more common among women ages 25 to 30.
Moles and Melanoma
Skin cells developed in a controlled and orderly way with healthy new cells pushing older cells towards the skin surface. Old cells eventually die and are sloughed off. When melanocytes gradually become more abnormal, new cells may begin to grow out of control, invading and destroying normal cells around them until they form a mass of malignant tissue on the surface of the skin.
When it comes to moles, only those that look different than other existing moles or those first appear after the age of 20 that are more likely to become cancerous. Unusual or atypical moles are medically known as dysplastic nevi. Unlike the appearance enhancing ‘beauty mark’, these moles usually appear larger than average, with uneven color and irregular shape. Dysplastic nevi should be checked a dermatologist from time to time, especially if there are any changes to their appearance.
Other types of moles that doctors believe have potential for developing melanoma are congenital nevi. Congenital nevi are present at birth and occur in roughly one in 100 people. The risk is low for small patches of congenital nevi, but increases if the mole becomes larger.
It should be noted that people with dysplastic does not necessarily get melanoma. The cancer can begin in an existing mole or as a new growth on the skin. The real cause of melanoma is still unknown. It is likely a combination of genetics and environmental factors such as overexposure to ultraviolet (UV) radiation from the sun and tanning lamps.
Mole Removal and Melanoma Treatment
According to skin physician, Dr. Sylvia Wai of Klinik Skin+Health, a practice specializing in aesthetic medicine, the decision to remove a mole need not be solely for aesthetic reason. “Some people have a lot of moles and there is a risk of developing melanoma,” she says.
There are three methods for removing moles; electrosurgery, Carbon dioxide laser or surgery. “Electrosurgery and CO2 laser removal methods work on the same principals. They damage mole cells directly, that means there is no need to cut and suture the skin so there is less scarring,” Dr. Wai explains. “A dry scab will form and peel off after seven to ten days spontaneously. When the dry scab peels off and skin will look normal,” she adds.
However, these methods can’t extract mole tissues for examination, so they can’t be done if a mole is suspected to be malignant. In that case, the patient will be sent for a skin biopsy. The only accurate way to diagnosed melanoma is by doing a skin biopsy where the entire suspicious mole or a sample tissue from it is removed for microscopic examination. “If the biopsy result shows a mole to be cancerous, then surgery is the only removal method,” says Dr. Wai.
To surgically remove a mole, the entire mole along with a rim of normal skin around it will be cut out and the wound stitched close. A very thin melanoma might have already been removed during the biopsy and no further treatment is required.
Most cases of melanoma can be cured with minimal surgery during early stages when the malignant tissue is still thin. If not discovered early, the malignant tissue could grown downward from the skin surface and the cancer cells will begin to spread, forming tumors in other parts of the body.
Anyone looking into a convenient and cheap removal method might have come across vendors selling topical formulas that claim to get rid of moles, but do they really work? Dr. Wai explains that these formulas are actually a type of acid that may permanently scar the skin, “If it’s applied onto the skin, it could penetrate too deep, leaving a permanent hypopigmention (white spot) behind where the mole used to be and there is no way to cure for that.”
But is there any risk to be aware off before deciding to remove a mole? “The laser treatment can have a temporary side effect of pigmentation marks known as post-inflamatory hyperpigmentation. This is more likely to happen to patients with darker skin and it usually lasts from one to four months, but there are creams to remedy that if it occurs,” says Dr. Wai. “Another thing to be aware of is the risk of infection, but this is easily treatable with antibiotics.”
It is important that melanoma is detected early. Otherwise, it becomes hard to control once spread beyond the skin. Since melanoma usually begins on the skin surface, the National Cancer Institute in the U. S. suggests doing the following skin self-examination at least once a month is one has dysplastic nevi and a lot of ordinary moles:
• After a bath, examine yourself from head to toe before a full-length mirror in a well-lighted room. Start from your head and face, and then slowly work your way down to your soles.
• Be sure to check hard-to-see areas like the scalp and back of neck. Get someone else to assist you if necessary.
• Be aware of how your moles look like, especially larger and unusual looking ones (see The ABCDEs of Melanoma) and take up-close pictures of them if necessary. Look for signs of change each time you self-examine.
• Check carefully during times of hormonal changes such as adolescence, pregnancy and menopause because moles ma change with hormone levels.
• Record dates of your self-exam and any observation notes. See a doctor if you notice anything unusual.
The ABCDEs of Melanoma
Webmd.com, an online resource for health information provided by health care professionals recommends looking for the ABCDEs when checking moles. If a mole displays any of the signs listed below, have it examined by a doctor:
• Asymmetry. The mole has a shape where one half didn’t match the other.
• Border. Look for ragged, blur or irregular edges.
• Color. An unusual mole with uneven color throughout with shade of black, blue, tan, brown, white or red.
• Diameter. Any mole that are about seven millimeter or larger than a pencil eraser.
• Evolution. Look for moles that are changing in size, shape and color.
In addition, any moles that bleed, itch, appear scaly, excessively hairy or become tender and painful should also be checked for melanoma.