Spots - moles and skin lesions

Everyone has moles. Sometimes 40 or more. Most people think of moles as a dark brown spot, but moles have a wide variety of appearances. In the past, a mole in a certain location on a woman's cheek was considered fashionable and therefore called a "grace point". Sometimes such points were drawn on purpose using make-up. But not all moles are beautiful. They can be raised from the skin and very noticeable to the eye, they can contain dark and coarse hairs and some can even be dangerous. 

Moles 

Moles can appear anywhere on the skin. They are usually brown but can also be skin tone and there is a wide variety of shades, sizes and shapes. The brown shade is created as a result of the pigment melanin produced by special cells that reach the skin from the nervous system during embryonic development and are called "nevus cells". These cells are very similar to the cells from the same source that are responsible for determining skin tone and are called "melanocytes". Most likely, the appearance of the moles originates before birth. Most appear in the first 20 years of life although some may appear later. Exposure to the sun causes an increase in the number of moles and they can darken. In general, even without exposure to the sun, during puberty and during pregnancy, moles tend to darken and grow, and new ones can appear. Each mole has its own growth characteristics. The lifespan of a typical mole is about 50 years. At first the moles are flat and tan freckle-like, or they can be pink, brown or black. As the years progress the moles slowly change and become more raised and lighter in color. Over time they also grow and hairs grow out of some of them. Some of them become more and more prominent and raised and some progress to the point of forming a thin stem from which they fall off and disappear. Some moles do not change at all. Others disappear slowly and seem to fade away. 

Different types of moles 

Recent studies show that certain types of moles are at increased risk of developing malignancy. They may develop into skin cancer known as malignant melanoma. Sunburns increase the risk of developing melanoma and multiple moles are also a marker of increased risk of developing melanoma. Moles are present from birth in about 1 in 100 newborns. These moles are called congenital moles and are considered to be accompanied by an increased risk of developing melanoma compared to moles that appeared after birth. The risk is higher the larger the congenital mole. The so-called dysplastic or atypical moles are larger than average (usually larger than the diameter of a pencil) and have an irregular shape. The color in these moles is not uniform, usually with a dark center and lighter or reddish edges and uneven borders or with black dots on the border. Such moles often run in the family. People with dysplastic moles have an increased risk of developing melanoma and should be regularly monitored by a dermatologist to look for changes that may indicate the development of skin cancer. These people should also study and check themselves regularly to look for changes in the color, size or shape of their moles or the appearance of new moles. It is recommended to make sure to use sunscreens and protective clothing to protect the moles from exposure to the sun. Knowing the early warning signs for the development of melanoma is important. 

You should look for the signs: 

• Geometry - the shape of the mole is not symmetrical, one half is not equal to the other half. Border - a mole whose border is not rounded, clear and defined. 
• Shade - a mole whose color is not uniform and consists of several shades such as: brown, black, pink and more. 
• Size - a mole whose diameter exceeds 5 mm (the diameter of a pencil). 
• Height - a point that was flat and developed a "hump". 
• Development - changes in size, color, bleeding, itching, etc. 

A mole showing characteristics of the aforementioned variety should be examined as soon as possible by a dermatologist. As a rule, there is a huge variety of benign moles - colors, shapes and sizes, but changes and characteristics as above and any mole that worries its owner warrant vigilance and inspection by a professional eye.
It is difficult to expect that those with multiple moles will be able to track changes in all their moles by themselves and to help with this tracking, in recent years there have been a number of institutes established that specialize in photographing and tracking moles. 

Other dark spots on the skin 

Dark pigmented lesions can be present on the skin, that are not moles. The most common of which are freckles, often the size of less than a pea, especially in areas exposed to the sun, and in these areas they can also be darker, especially in the summer. Freckles appear with high frequency in those with red and blond hair. Other common lesions usually appear in middle age, look dark, rough and calloused and as if stuck to the skin in all areas of the body, including the face. These lesions are called seborrheic keratoses and are completely benign. Additional gray-brown lesions that appear on the eyebrows, back of the hands, forearms and face are sun spots (Solar lentigo). 

Treatment 

The vast majority of moles and lesions are benign and will never pose a health hazard. Moles or lesions that behave differently from the other seemingly similar lesions on a person's skin are the ones that require medical attention and examination. In such a case, you should contact a dermatologist who will examine the lesion and decide if it is indeed suspicious and if it should be removed for examination and diagnosis. In cases where such lesions constitute a functional disorder due to their location or an aesthetic disorder, they can be removed by local anesthesia and shaving of the lesion or excision and closure with stitches. This is usually a simple and short procedure. The main risk is the formation of a hairline scar that may appear in about 10% of cases. In some cases, moles can reappear after excision, in which case you should return to the dermatologist for an examination. Freckles and sun spots that appear on the skin of the face can be treated by several means - the safest and most effective of which is the Alexandrite laser at a wavelength of 532nm. This means is also the most expensive and least available. Another means, simple and relatively available, is to freeze the spots until causing superficial frostbite using liquid nitrogen. Since it is known that the melanocytes, which produce the pigment, are much more sensitive to cold than the other skin cells - such a “cold burn” can selectively damage the melanocytes and remove the pigment from the spots. The risks in this treatment are related on the one hand to the skill of the therapist and on the other hand to the patient's skin type. In patients of dark-skinned ethnic origin and in those who have dark skin themselves, there is a danger in about 10% of patients of the appearance of a dark spot secondary to the burn, which results from the deposition of pigment in the skin as a result of the inflammation during the recovery process from the treatment. In most cases, these spots disappear after several months when the patient is careful to avoid exposure to the sun. Additional risks are scarring due to sensitivity of the skin or too strong burning by the therapist. Commercial lightening products and those specially prepared in pharmacies according to a doctor's prescription have no role in the treatment of spot spots but in the general lightening of the skin tone and are intended for the treatment of problems such as "pregnancy mask" or extensive skin spots on the background of burns or other skin damage. 

Answers to frequently asked questions 

• Many ask if it is safe to shave over a mole or remove or pluck hairs growing out of a mole. Such irritation and friction will not cause the mole to become cancerous, but in cases where the mole is repeatedly damaged, it is sometimes justified to remove it. 
• In moles that grow hair, you can cut, shave and even remove the hair permanently through electrolysis. Moles that are abnormal in size or location, the surgical removal of which may cause aesthetic damage, can be camouflaged by special make-up preparations adapted to this. Removing a mole does not increase the risk of developing cancer in other lesions or moles.
• In patients who have an especially large number of moles and in patients who are at increased risk of developing skin cancer of the melanoma type against the background of the discovery of this type of cancer in first degree relatives, regular and strict monitoring of moles should be performed. 
• A means that can increase the effectiveness of follow-up over time and its sensitivity is an examination using a dermatoscope and photography and digital mole documentation to enable monitoring of changes in existing moles and the appearance of new moles over time.

In the clinic, examination and mapping of moles are carried out using dermatoscopy and digital photography as part of monitoring moles in patients at increased risk.