By Eduardo Gonzales, MD
Is it true that moles can become cancerous? I’m concerned because I have many moles on my chest, although most are small. Should I have them all removed?–firstname.lastname@example.org
Moles or nevi (pleural for nevus), pigmented spots, marks, or small permanent protuberances on the skin, generally follow a benign natural course. They are, as a rule, absent at birth and start to appear only during childhood. They occur when the cells in the skin that produce melanin (the pigment that gives the skin its natural color) grow in a cluster instead of spreading throughout the skin. They usually start as small (less than five millimeters), flat and well-circumscribed areas that are light to dark brown in color. Over a period of many years, most gradually grow in size. They also become darker and raised or elevated. Some hair may likewise appear on them.
As a rule, moles do not present any problem or inconvenience. They remain well demarcated, symmetric, uniform in contour and color, and harmless throughout a person’s lifetime.
A small percentage of moles, however, do become cancerous. A cancer that arises from a mole is called a malignant melanoma, or simply melanoma, one of the three most common types of cancer of the skin—the two others are basal cell carcinoma and squamous cell carcinoma.
Of the three, malignant melanoma is the most dreadful because once it has penetrated the skin it spreads rapidly and becomes highly fatal. Malignant melanoma accounts for the greatest number of deaths due to skin disease worldwide and, in fact, in the US (no local figures are available), it is one of the 10 most common forms of cancer.
Incidentally, although most malignant melanomas arise from moles, not all do. Some develop in normally pigmented skin, especially in those areas exposed to sunlight. A melanoma that develops in normal skin resembles a mole in appearance and may be mistaken for one.
Despite its invasive nature, however, the cure rate for malignant melanoma is almost 100 percent if it is diagnosed and removed early, which means before it has spread to any other tissue or organ. Malignant melanomas that have already spread or metastasized have a very low cure rate.
The ABCDE of potentially cancerous moles
The surefire way to prevent a mole from becoming cancerous is to excise or surgically remove it, although it is impractical to have all your moles excised or removed if there are many of them. Besides, most of them will remain harmless. What you therefore need to do is examine your moles periodically and consult a doctor if you detect a potentially cancerous one. What then would be the characteristics of a mole that is potentially cancerous?
The American Academy of Dermatology came out with the following ABCDE signs of melanoma. A mole that has any or a combination of the attributes listed below should arouse your suspicion and necessitate consultation with a physician:
A (Asymmetry) = one half of the mole is unlike the other half.
B (Border) = a mole with an irregular, scalloped or poorly defined border.
C (Color) = a mole whose color varies from one area to another; has shades of tan, brown or black, or is sometimes white, red, or blue.
D (Diameter) = melanomas are usually greater than six millimeter (the size of a pencil eraser) when diagnosed, but they can be smaller.
E (Evolving) = common, benign moles look the same over time. Be on the alert when a mole starts to evolve or change in any way—in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting.
Potentially cancerous moles or suspicious moles have high risks of becoming malignant and must be removed, preferably by surgery. Surgical excision allows for complete removal of the mole and for the excised tissue to be sent to the laboratory for microscopic examination to determine whether the mole is benign or malignant.
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