Skin Moles

Moles cancer has been associated with large congenital skin moles, acquired atypical skin moles, or arise de novo.
Cancerous change in a mole may be in the form of:
1. Asymmetry. Irregular pigmentation with darkening of one portion of the mole, a small dark elevated papule within an otherwise flat papule, or flaking, scaling, ulceration or bleeding
2. Border irregularity. tumor appears to be growing in one direction with scalloped edges
3. Color variation. Appearance of black, dark brown or admixture of red, white and black
4. Diameter more than 6mm; most benign acquired skin moles are less than 6mm
5. Symptoms: burning, itching, or tenderness

* Risk factors:
1. New or changing mole
2. Age more than 15 years
3. Atypical skin moles, prior melanoma and familial melanoma
4. Large congenital mole
5. 50 skin moles, more than 2mm in diameter
6. 12 skin moles, more than 6mm in diameter
7. Light skin color
8. Marked freckling
9. Sun sensitivity
10. Excessive sun exposure

* Associations:
1. Family history of melanoma
2. Presence of multiple atypical skin moles (atypical mole syndrome)
3. Xeroderma pigmentosum
4. Transplacental spread of maternal melanoma

Pathogenesis:
* Genetic factors with resultant progressive changes in DNA and inability to repair DNA
* Familial cutaneous malignant melanoma (OMIM no. 15560) can be caused by germline mutations
in CDKN2A on chromosome 9p21 and CDK4 on 12q14 and 1p36

Diagnosis of moles cancer:
* Clinical features
* Histology: increased numbers of atypical basal melanocytes with atypical nuclei of different sizes, epidermotropism, nest of melanocytes with variation in size and shape, asymmetrical no maturation of melanocytes, signs of regression

Differential diagnosis:
* Spitz mole
* Acquired atypical mole
* Blue mole
* Traumatic hemorrhage (especially under the nails, on the heels, or on the mucous membranes)
* Septic granuloma

Treatment of moles cancer:
* Excision with wide margins based on microscopic depth of melanoma cells:
1. In situ: 2–5mm excision margin
2. Less than 1 mm: 1 cm excision margin
3. 1–2mm: 1–2 cm excision margin
4. 2.1–4mm: 2–3 cm excision margin
5. More than 4mm: 2–3 cm excision margin
* Adjunctive treatments: interferon, chemotherapy

Moles cancer survival:
* Influenced by depth of the tumor and involvement of lymph nodes
* Five year survival (in general; many factors influence staging): stages I–II: 79%; stage III: 13–69%; stage IV: 6%