Introduction
The term mole (in reference to skin) describes a variety of skin imperfections. Many prefer the term beauty mark. The medical term for mole is melanocytic nevus. Moles may be tanned, brown, black, reddish brown, red, purple, or skin-coloured and perfectly flat or raised. Most moles are smaller than a pencil eraser (about 1/2 inch). Moles are skin coloured or red-brown-coloured macules, papules, or nodules composed of nests of melanocytes. Moles develop on nearly everybody, and are significant primarily because they can become dysplastic or malignant and need to be differentiated from melanoma
A melanocytic nevus is composed of masses of melanocytes, the pigment-producing cells of the skin. However, there are a variety of similar skin lesions. These include seborrheic keratoses, skin tags, dermatofibromas, lentigines, and freckles. Certain moles become darker and more apparent with sun exposure and in pregnancy. Moles can occur anywhere on the skin, including the scalp, ears, eyelids, lips, palms, soles, genitals, and anal area.
Moles occur in all races (Caucasian, Asian, African, and Indian) and skin colours. Even animals have moles. Moles may be present at birth or gradually appear later in the new born period. Many children continue to develop moles through the teenage years and into young adulthood. Moles tend to grow very slightly in proportion to normal body growth. Congenital moles are those present at birth and so must have been present during foetal development. Other moles may arise later due to factors that are not genetic but environmental, such as sun exposure. While many moles arise in the first years of life, the total number of moles typically peaks in the second or third decade of life to an average of 35. Most people do not develop new regular moles after the age of 30.
Signs & symptoms
The typical mole is a brown spot. But moles come in different colours, shapes and sizes:
- Colour and texture – Moles can be brown, tanned, black, red, blue or pink. They can be smooth, wrinkled, flat or raised. They may have hair growing from them.
- Shape – Most moles are oval or round.
- Size – Moles are usually less than 1/2 inch (about 6 millimetres) in diameter — the size of a pencil eraser. Rarely, moles present at birth (congenital nevi) can be much bigger, covering wide areas of the face, torso or a limb.
This ABCDE guide can help you determine if a mole or a spot may indicate melanoma or other skin cancers:
- A is for asymmetrical shape.One half is unlike the other half.
- B is for border.Look for moles with irregular, notched or scalloped borders.
- C is for colour.Look for growths that have changed colour, have many colours or have uneven colour.
- D is for diameter.Look for new growth in a mole larger than 1/4 inch (about 6 millimetres).
- E is for evolving.Watch for moles that change in size, shape, colour or height, especially if part or all of a mole turns black. Moles may also evolve to develop new signs and symptoms, such as itchiness or bleeding.
Cancerous (malignant) moles vary greatly in appearance. Some may show all of the features listed above. Others may have only one or two.
Causes
The exact cause for development of moles is unknown. The genes from parents, along with the amount of sun exposure (especially during childhood) are major factors in determining number of moles. Skin with more sun exposure tends to have more moles. However, moles may also occur in sun-protected areas.
Hormonal changes of adolescence and pregnancy may cause moles to become darker and larger
The basic types of moles are as follows:
Regular and symmetrical,
Irregular or Atypical
Cancerous.
Regular moles are typically benign and harmless. Regular moles are usually symmetrical, have regular borders, uniform colour, and are about the size of a pencil eraser or smaller. Regular moles may be flat or raised. The presence of hair growing from a mole is unrelated to its chance to become cancerous.
Irregular or atypical moles are usually asymmetrical, with irregular borders, multiple colours, and tend to be bigger than the size of a pencil eraser. Irregular moles are often flat or nearly flat. Having more than 20-25 irregular moles may increase the person’s overall risk of developing melanoma. The presence of a giant congenital mole greater than approximately 8-10 inches in size also may confer an increased risk of melanoma. Irregular moles signal the potential for developing melanomas over time. Irregular moles themselves rarely turn into melanoma or carcinoma.
Cancerous moles called melanomas, are highly irregular and are often asymmetrical. Rarely, regular moles may evolve into a melanoma over time. It is important to watch all moles closely for change or atypical features. In those with greater than 50 moles or several abnormal moles, monthly skin self-examinations and at least annual full-body moles exam by a dermatologist are important in the early detection of abnormal moles and melanoma.
Irregular moles can occur anywhere on the body but are most commonly located on sun-exposed skin, especially on the upper back and shoulders where people frequently get their most severe sunburns. The risk of melanoma is greater on chronically sun-exposed skin like the shoulders, upper back, head, and neck. Ears are a particularly common site of atypical moles because of the difficulty in applying sunscreen and frequent sun exposure. Women have increased risks of atypical moles, particularly on the lower leg and calf. Any new or changing irregular mole on a woman’s calf warrants immediate medical evaluation.
Pathophysiology
Melanin is a natural pigment that gives your skin its colour. It is produced in cells called melanocytes. Moles are caused when cells in the skin (melanocytes) grow in clusters or clumps. Melanocytes are distributed throughout your skin and produce melanin, the natural pigment that gives your skin its colour.
Diagnosis
- Clinical evaluation
- Biopsy
Because moles are extremely common and melanomas are uncommon, prophylactic removal is not justifiable. However, biopsy and histologic evaluation should be considered if moles have certain characteristics of concern (known as the ABCDEs of melanoma):
- A: Asymmetry—asymmetric appearance
- B: Borders—irregular borders (i.e., not round or oval)
- C: Colour—colour variation within the mole, unusual colours, or a colour significantly different or darker than the patient’s other moles
- D: Diameter—>6 mm
- E: Evolution—a new mole in a patient >30 years of age or a changing mole
If a mole becomes painful or itchy or bleeds or ulcerates, biopsy can also be considered.
The biopsy specimen must be deep enough for accurate microscopic diagnosis and should contain the entire lesion if possible, especially if the concern for cancer is strong. However, wide primary excision should not be the initial procedure, even for highly abnormal-appearing lesions. Many such lesions are not melanomas and, even with melanoma, the proper treatment margin and recommendation for lymph node sampling is determined based on histopathologic features. Excisional biopsy does not increase the likelihood of metastasis if the lesion is malignant, and it avoids extensive surgery for a benign lesion.
Treatments
Most moles don’t need treatment.
If a mole is cancerous, a surgical procedure is needed to remove it. A mole that causes irritation while shaving etc can also be removed.
Mole removal takes only a short time. The surgeon will numb the area around the mole and cut it out, along with a margin of healthy skin if necessary. The procedure may leave a permanent scar.
If a mole has grown back, follow up is needed.
Prevention
The following measures can help limit the development of moles and the main complication of moles — melanoma.
Watch for changes
Become familiar with the location and pattern of your moles. Regularly examine your skin to look for changes that may signal melanoma. Do self-exams once a month, especially if you have a family history of melanoma. With the help of mirrors, do a head-to-toe check, including your scalp, palms and fingernails, armpits, chest, legs, and your feet, including the soles and the spaces between the toes. Also check your genital area and between your buttocks.
Talk with your doctor about your risk factors for melanoma and whether you need a professional skin exam on a routine basis.
Protect your skin
Take measures to protect your skin from ultraviolet (UV) radiation, such as from the sun or tanning beds. UV radiation has been linked to increased melanoma risk. And children who haven’t been protected from sun exposure tend to develop more moles.
- Avoid peak sun times.The sun’s rays are strongest between 10 a.m. and 4 p.m. Schedule outdoor activities for other times of the day, even on cloudy days or in winter.
- Use sunscreen year-round.Apply sunscreen about 30 minutes before going outdoors, even on cloudy days. Use a broad-spectrum sunscreen with an SPF of at least 15. Apply it generously and reapply every two hours.
- Cover up.Sunglasses, broad-brimmed hats, long sleeves and other protective clothing to avoid damaging UV rays.
- Avoid tanning lamps and beds.Tanning lamps and beds emit UV rays and can increase your risk of skin cancer.
Prognosis
Moles are chronic skin lesions with a poor prognosis and increased chance of recurrence.
Complications
Melanoma is the main complication of moles. Some people have a higher risk of their moles becoming cancerous and developing into melanoma. Factors that increase your risk of melanoma include:
- Being born with large moles.These types of moles are called congenital nevi. On an infant, such moles are classified as large if they’re more than 2 inches (5 centimetres) in diameter. Even a large mole seldom becomes cancerous and almost never before the child reaches puberty.
- Having unusual moles.Moles that are bigger than a common mole and irregular in shape are known as atypical (dysplastic) nevi. They tend to be hereditary.
- Having many moles.Having more than 50 ordinary moles indicates an increased risk of melanoma.
- Having a personal or family history of melanoma.
Disease & Ayurveda
Mashaka
Nidana
Not mentioned separately.
Causative factors of kushtha can cause the same
Purvaaroopa
Not mentioned.
Samprapti
When the vitiated Vaata dosha gets lodged in skin, it causes hard/raised black, painless and chronic skin lesion resembling a mosquito.
Lakshana
A chronic black skin lesion which is painless, hard on touch, elevated or not, , and resembling a mosquito.
Divisions
Not mentioned
Prognosis
Krichhrasadhyam
Chikithsa
Samana
Lepanam with Rookshana dravyas
Sodhana
Dahanam
Then treatment of wound should be done
Commonly used medicines
Varanadi kashayam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Applying turmeric paste
Lose excess weight and shred off the excess fat
Apple cider vinegar intake
Avoid intake of fat in food
Take enough omega 3 fatty acids
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles