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Moles are usually present at birth or appear early in life. In time they may grow larger. In color, most of them resemble the surrounding skin. Although they may never make trouble aside from their unsightliness, some of them may become cancerous, spreading cancerous cells through the bloodstream to other parts of the body. Black, bluish black, grayish blue, and flat moles, especially those located where they are exposed to irrigation, are most likely to become malignant. Any mole that shows a sign of irritation or that begins to grow rapidly, whatever its color, should be considered suspicious.

In general, a benign mole is a small (less than 5 mm), well-circumscribed lesion with a well-defined border and a single shade of pigment from beige or pink to dark brown. Most or all of the individual patient’s moles often are similar to each other with respect to color and size, or there may be two or three different types of moles on the same patient. The physical examination takes precedence over the history, though a reliable history that a lesion has been present without change for decades is obviously a comfort.

Suspicious moles have an irregular and asymmetric or fuzzy border where the pigment appears to be leaking into the normal surrounding skin; the topography may be irregular, i.e., partly flat. Color variation is disturbing, and colors such as pink, blue, gray, white, and black are indications for referral. A mole that stands out from the patient’s other moles certainly deserves special scrutiny. A patient with a large number of moles is statistically at increased risk of melanoma and deserves careful and periodic examination, particularly if the lesions are atypical.

The history of a changing mole is the single most important historical reason for close evaluation and possible referral. Referral of suspicious pigmented lesions is always appropriate. Moles have their own natural history. In the first decade, moles often appear as flat, small, brown lesions. They are called junctional nevi because the nevus cells are at the junction of the epidermis and dermis. Over 2 decades, these moles grow in size and often become raised, reflecting the appearance of a dermal component, giving rise to compound nevi. Moles may darken and grow during pregnancy. As caucasian patients enter their seventh and eighth decades, most moles have lost their junctional component and dark pigmentation and undergo fibrosis or other degenerative changes. Still, at every stage of life, normal moles should be well-demarcated, symmetric, and uniform in contour and color.

What to do:
1. Do not attempt self-treatment.
2. Have a physician, preferably a skin specialist, remove the growth, particularly if it is dark-colored, begins to change color or grow, or feels tender or irritated.