Dermatologist examining moles of patient on light background

Nevus, also known as a mole or birthmark, are areas of increased melanin production on the skin. They can vary in size and color, from small brown spots to large darker patches. While most nevi are harmless, some may be associated with an increased risk of skin cancer. Here, we will explore the different types of nevi and their associated risks. We’ll also discuss ways to prevent and treat them if needed.

History and Definition

A nevus, also known as a mole, is a type of skin lesion that is made up of melanocytes, the cells that produce pigment in the skin. The term “nevus” is derived from the Latin word for “birthmark.” The neuroectodermal origin of the nevus cell was not definitively proven until the 1970s when it was shown that melanocytes in nevi arise from the neural crest cells, a group of cells that give rise to many different tissues in the developing embryo.

Before this discovery, it was believed that nevi were simply an accumulation of pigment cells in the skin. Today, nevi are commonly classified based on their appearance and the amount of pigment they contain, with some types having a higher risk of developing skin cancer.

Symptoms

A nevus, or mole, is usually a small, dark spot on the skin that is generally harmless. However, some moles can develop into skin cancer, so it’s important to be aware of the signs and symptoms of abnormal moles.

The following are the symptoms of an abnormal nevus:

  • Changes in size, shape, or color: A mole that changes in size, shape, or color over time can be a sign of skin cancer.

 

  • Irregular border: A mole with an irregular or uneven border can also be a sign of skin cancer.

 

  • Multiple colors: A mole that is more than one color, such as brown and black, can be a sign of skin cancer.

 

  • Asymmetry: A mole that is not symmetrical can be a sign of skin cancer.

 

  • Diameter: A mole that is larger than the size of a pencil eraser (6mm) can be a sign of skin cancer.

If you have any concerns about a mole or notice any changes, it’s important to see a dermatologist or a plastic surgeon for a proper evaluation. Early detection and treatment of skin cancer can greatly improve the outcome.

Causes

The exact cause of nevi is not known, but several factors may play a role in their development, including:

  • Genetics: Nevi can run in families and are more common in people with a family history of moles.

 

  • Sun exposure: Prolonged exposure to the sun can increase the number of moles on your skin.

 

  • Hormonal changes: Hormonal changes during pregnancy, puberty, and menopause can trigger the growth of new moles or the darkening of existing ones.

 

  • Immunological factors: Certain immune system disorders can cause an increased number of moles.

 

  • Age: The number of moles on the skin tends to increase with age.

It is important to note that the majority of moles are not cancerous. However, some moles can develop into skin cancer, so it’s important to monitor your moles and have any suspicious ones evaluated by a doctor.

Diagnosis

Diagnosis of a nevus, or mole, is typically based on a physical examination of the skin lesion. A dermatologist or a plastic surgeon will examine the mole and look for signs of abnormal growth or changes, such as uneven color, irregular border, or asymmetry. In some cases, the doctor may also perform a biopsy, which involves removing a small sample of the mole for further examination under a microscope.

The following diagnostic tests may also be used to diagnose a nevus:

  • Dermoscopy: This is a non-invasive technique that uses a special device with a magnifying lens to examine the mole in detail.

 

  • Total Body Photography (TBF): This involves taking photographs of all of the moles on a person’s body, and then using these photos to track changes over time.

 

  • Confocal laser scanning microscopy (CLSM): This is a non-invasive diagnostic technique that uses a laser to obtain detailed images of the mole.

It is important to have any new or changing moles evaluated by a dermatologist or a plastic surgeon, as early detection and treatment of skin cancer can greatly improve the outcome.

Treatment

Treatment of a nevus, or mole, depends on several factors, including the type and size of the mole, as well as the patient’s overall health. The following are the treatment options for a nevus:

  • Surgical excision: This is the most common treatment for a suspicious or cancerous mole. During the procedure, the doctor removes the entire mole and some of the surrounding tissue. The tissue is then sent to a laboratory for analysis to confirm the diagnosis.

 

  • Shave excision: This is a minimally invasive procedure in which the doctor uses a scalpel to shave off the mole and the surrounding tissue.

 

  • Curettage and electrodessication: This is a minimally invasive procedure in which the doctor uses a spoon-shaped instrument (curette) to scrape away the mole and then uses an electric current to cauterize the area.

 

  • Cryotherapy: This is a minimally invasive procedure in which the doctor uses liquid nitrogen to freeze the mole and cause it to fall off.

What to Expect After the Surgery:

  • Pain and swelling: After the surgery, some patients may experience mild pain and swelling at the site of the incision. This is usually temporary and can be managed with over-the-counter pain medication.

 

  • Scarring: Depending on the type of procedure, the incision site may leave a scar. The scar will gradually fade over time, but it may remain noticeable.

 

  • Stitches or staples: If the doctor removes a larger piece of tissue, you may need to have stitches or staples to close the incision site. These will need to be removed within one to two weeks.

  • Healing time: The length of time it takes for the incision site to heal will depend on the type and size of the mole, as well as the patient’s overall health. In most cases, the incision site will fully heal within two to four weeks.

It is important to keep the incision site clean and dry and to follow the doctor’s post-operative instructions carefully to minimize the risk of infection and promote proper healing. If you have any concerns or questions about your recovery, it’s important to contact your dermatologist or plastic surgeon.

Risk Factors

There are several risk factors associated with nevi or moles:

  • Family history: People with a family history of moles are more likely to have moles themselves.

 

  • Sun exposure: Prolonged sun exposure can increase the number of moles on the skin and can also increase the risk of skin cancer.

 

  • Skin type: People with fair skin, blonde or red hair, and blue or green eyes are at a higher risk of developing moles and skin cancer.

 

  • Age: The number of moles on the skin tends to increase with age, and older individuals are at a higher risk of skin cancer.

 

  • The number of moles: People with many moles on their skin are at a higher risk of developing skin cancer.

 

  • Previous skin damage: People who have had sunburns or other forms of skin damage are at a higher risk of developing skin cancer.

It is important to monitor your moles and have any suspicious ones evaluated by a doctor, as early detection and treatment of skin cancer can greatly improve the outcome. Regular skin checks by a dermatologist or a plastic surgeon can also help detect skin cancer in its early stages when it is most treatable.

Complications

There are several potential complications associated with nevi or moles:

  • Skin cancer: Moles can develop into various forms of skin cancer, including melanoma, which can be life-threatening if left untreated.

 

  • Scarring: Surgical excision of a mole can result in scarring, which may be noticeable and disfiguring.

 

  • Infection: There is a small risk of infection after surgery to remove a mole, especially if the incision site is not kept clean and dry.

 

  • Recurrence: In some cases, a mole may regrow after surgical excision, and further treatment may be necessary.

 

  • Pigment changes: The skin around the incision site may develop a different color than the surrounding skin, which is called post-inflammatory hyperpigmentation or hypopigmentation.

It is important to have any new or changing moles evaluated by a doctor, as early detection and treatment of skin cancer can greatly improve the outcome. If you have concerns about a mole or experience any complications after mole removal, it’s important to contact your doctor.

When to See a Doctor

You should see a doctor if you notice any changes in an existing mole or if you develop a new mole, especially if it has the following warning signs:

  • Asymmetry: If one half of the mole does not match the other half in shape or color, it could be a sign of skin cancer.

 

  • Border: If the border of the mole is irregular, it could be a sign of skin cancer.

 

  • Color: If the color of the mole is not uniform, or if it changes over time, it could be a sign of skin cancer.

 

  • Diameter: If the diameter of the mole is larger than the size of a pencil eraser, it could be a sign of skin cancer.

 

  • Evolution: If the mole changes in size, shape, or color, or if it begins to bleed, itch, or crust over, it could be a sign of skin cancer.

In addition, if you have a family history of skin cancer or if you have a large number of moles, it is important to have regular skin exams by a doctor. Early detection and treatment of skin cancer can greatly improve the outcome.

Step-by-Step Guide to Nevus Removal Treatment

Here is a step-by-step guide to the nevus treatment process:

Consultation

Schedule a consultation with a dermatologist or a plastic surgeon to have your nevus evaluated. During the consultation, the doctor will examine the nevus and ask about any changes in size, shape, color, or symptoms you may be experiencing.

Diagnostic Tests

The doctor may perform a biopsy or a skin scrape to determine if the nevus is cancerous. If the nevus is found to be cancerous, further tests may be required to determine the extent of cancer.

Treatment Plan

The doctor will develop a treatment plan based on the type, size, and location of the nevus, as well as your overall health and medical history.

If the nevus is found to be cancerous, or if it is causing cosmetic concerns, the doctor may recommend surgical excision. This involves removing the nevus and a surrounding margin of healthy tissue to ensure that all cancerous cells have been removed.

After the surgical excision, the incision site will be covered with a dressing, and you will be given instructions for caring for the site and managing any pain or discomfort.

Follow-Up

The doctor will schedule a follow-up appointment to monitor the healing process and to check for any signs of recurrence.

It is important to follow the doctor’s instructions and attend all scheduled appointments to ensure a successful outcome. If you experience any changes or symptoms after the treatment, it is important to contact your doctor as soon as possible.

Conclusion

In conclusion, nevus is an extremely common skin condition. It can occur anywhere on the body and has a variety of sizes, shapes, and colors. Although most nevi are benign and do not cause health problems, it is important to monitor them for changes in size or color that may indicate the development of melanoma.

If you notice any unusual changes in your nevus or have concerns about your overall skin health, it’s best to consult with a dermatologist or a plastic surgeon for further evaluation. Early diagnosis and treatment of melanoma can significantly improve outcomes, so seeking medical attention quickly is essential. By taking proactive steps to protect yourself from sun damage and being aware of potential warning signs related to nevi, you can help reduce the risk of developing skin cancer. 

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Dr. Colin Hong is one of Toronto’s premier plastic surgeons, boasting over 35 years of experience in the field. He offers some of Toronto’s most competitive rates for Cosmetic, Plastic, and Reconstructive surgeries in North York, Markham, and beyond.

To book a consultation to discuss any nevus-related procedures with Dr. Hong, please contact his office at (416) 222-6986 or email us at info@drcolinhong.com with your full name, email address and phone number so we can get back to you promptly. It is also important that you obtain a referral from your family doctor prior to setting up an appointment with Dr. Hong.

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