This is a weird looking mole!
Do we pay attention to our moles? Perhaps because moles usually develop in our childhood or adolescence it has already become such a mundane spot on our body that we are less mindful of its appearance. This article however, serves to explore how atypical looking moles can in fact be the manifestation of certain skin cancers. Possibly, it can provide the impetus for you to check out your own moles now.
Atypical looking moles usually have the following key hallmarks: presence of 100 or more moles, 1 or more moles that are 8mm or larger in diameter and 1 or more moles that have the above 2 characteristics.
Collectively, these characteristics can be termed as the “atypical mole syndrome”. While the above provides a loose idea of what atypical moles can appear as, clinicians tend to identify an atypical mole with the following features: presence of asymmetry, irregular borders, varied and irregular colours, large diameter, and significant growth in the size of an old mole or appearance after the age of 40. Apart from the aforementioned factors, the surface of the mole, if raised in the centre and flat on the peripheries, should raise one’s suspicion of an atypical mole as well.
What can atypical moles tell us?
Atypical moles may very well be pre-cancerous[1] lesions!
There are 3 main types of skin cancers, namely basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. The aforementioned types of skin cancers are all malignant in nature and can be categorised into 2 broad categories – melanoma and non-melanoma. Melanomas are aggressive and have the high potential of spreading to other parts of the body. On the other hand, non-melanomas behave more benign, and also have a low possibility of spreading to other parts of the body. BCCs and SCCs fall under the category of non-melanoma skin cancers while melanomas, as its name suggests, belong to the melanoma category.
BCCs and SCCs arise from basal cells and squamous cells respectively whereas melanomas arise from melanocytes, which are pigment-producing cells. Basal cells, squamous cells and melanocytes are all found in the most superficial layer of our skin – the epidermis. Pre-cancerous lesions develop and manifest as atypical moles when the cells (basal, squamous or melanocytes) encounter some form of damage to its DNA[2]. When this occurs, vital cell-signalling processes that tightly control the proliferation of these cells go haywire as well. Eventually, this culminates into an uncontrolled growth of cells (basal, squamous or melanocytes), which raises the possibility of these accumulating abnormal cells becoming malignant.
Often, melanomas manifests as an atypical mole. On the other hand BCCs tend to manifest as a flesh-coloured, or pearl-like bump while SCCs frequently appears as a red firm bump or scaly patch on the skin. Having said this however, BCCs and SCCs can also manifest as atypical looking moles as well.
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
As such, it is prudent for us to be keeping an eye on the moles on our body.
When should I be concerned about this atypical mole?
There are several points of consideration that should ring alarm bells for us to check out atypical moles that we find. These include symptoms such as: bleeding, pain, swelling and itch. Apart from these warning symptoms, there are a few risk factors for skin cancer, which if present, should raise our index of suspicion that the atypical mole is cancerous. Namely, they are: fair skin[3] (especially those who freckle or sunburn easily) positive family history of skin cancer, the development of freckles in childhood, albinism and being under immunosuppressive therapy[4] and environmental factors such as excessive exposure to ultraviolet radiation which can come from sun rays or the radiation from tanning booths.
In the presence of any of the above risk factors and an atypical looking mole, it is best to bring it to the attention of a professional clinician. This way early diagnosis can be made and timely treatment given so as to minimise the risk of the pre-cancerous or cancerous lesion from progressing on to life-threatening stages.
The diagnosis of a cancerous mole – if you can spot it, you can stop it!
A proper consultation with a relevant medical professional is necessary. The diagnosis of a cancerous mole usually involves a few steps. These include: taking of relevant history, a physical examination and if necessary, a biopsy of the mole.
During history taking, pertinent questions surrounding the suspicious skin lesion will be brought up such as when it was first sighted, how it has evolved over time, presence of risk factors for skin cancer, and also if the patient has a positive family history of skin cancer. This aids in either raising or lowering the clinician’s index of suspicion for the disease.
As for the physical examination bit, clinicians will be examining the mole(s) to pick up the presence of aforementioned abnormalities such as asymmetry, irregular borders, varied and irregular colours and large diameter. Sometimes, it is difficult for the clinician to safely rule out a malignancy and hence will use a dermascope. This is a handheld magnifying device which allows the clinician to visualise the moles in terms of its colours, depth and internal skin structures. This way, the features of the mole are made more prominent and a more accurate identification can be made.
Followed by this—unless the doctor can completely rule out a malignant lesion—they typically recommend doing a skin biopsy of the suspicious lesion in order to test if this lesion is cancerous, and to also reveal the type and subtype of skin cancer. Apart from doing a skin biopsy, doing a biopsy of the patient’s lymph nodes is also important if the doctor suspects that the cancer has spread.
Treatment options
Currently, there are several options available when it comes to treatment plans for individuals with pre-cancerous or cancerous moles. They can broadly be categorised into surgical and non-surgical procedures. Whichever plan of action is taken in the end is determined by the site, size, type stage of the lesion and a few patient factors.
Surgical procedures
Cryotherapy and curettage are considerations when the cancerous lesion is smaller in size. Cryotherapy involves removing the superficial layer of the cancerous lesion first and then freezing the bottom of it using liquid nitrogen. In a similar procedure known as cryosurgery, liquid nitrogen is utilised to freeze and kill off the cancerous cells. Both procedures are non-invasive and no anaesthesia is required. Despite these benefits, it is not the best treatment option for those with mole lesions that are highly invasive as this procedure may not ensure complete clearance of the deeper cancer cells and hence may lead to cancer recurrence.
Surgical excision on the other hand is preferred when the cancerous lesion is considerably big. It is a procedure which involves surgically removing the entire cancerous lesion as well as a little of its peripheral healthy tissue, in order to ensure complete removal of cancerous cells.
Last but not least, Mohs micrographic surgery is another treatment option and is the gold standard for surgical treatment of cancerous moles. In this surgery, thin layers of cancer cells are repeatedly excised and subsequently observed under the microscope until no more cancerous cells are found. A benefit of this procedure over the other options is the minimisation of unnecessary removal of healthy tissue and in so doing, also does not compromise on the complete removal of cancerous cells from the patient. Mohs surgery is highly recommended for recurrent skin cancers and moles with irregular borders which makes impedes complete excision of the mole. This procedure also leaves the most cosmetically appealing results because it has minimal scarring. As such, if the site of the mole of interest is on the face for example, this is a suggested treatment option. Often, Mohs microsurgery is usually followed up by radiation therapy.
Non-surgical procedures
Radiation therapy, for one, is a better choice for patients who are unable to undergo surgery for various reasons. Additionally, pharmacological agents such as iplimumab, nivolumab and trametinib, imiquimod and fluorouracil are FDA[5] approved drugs for immunotherapy.
While there are many possible courses of action for one to take, there is always a risk of recurrence. This is especially so for cancerous lesions which occur on the nose region. Furthermore, it is prudent to note that an individual has a heightened risk of developing other forms of skin cancer once you are diagnosed with one.
Conclusion
The prevalence of skin cancers is rapidly increasing. Not only does it bring with it devastating impacts to one’s quality of life and for some, death, it too places a considerable burden on the healthcare services. As such, there are some precautions and habits that one can cultivate in order to reduce the risk of getting skin cancers. Some of them include minimising exposure to the sun, not frequenting tanning booths, using sunscreen to protect oneself from ultraviolet radiation. It is also advisable to have a heightened awareness of unusual skin changes and atypical moles but not worry excessively. Should there be any suspicious skin lesions, it is always wise to bring it up to a relevant medical professional and seek a consultation and treatment for it promptly.
References:
- Board, P. A. (2017, August 28). Skin Cancer Treatment (PDQ®). Retrieved 3 February, 2019, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032519/
- Liu, Y., & Sheikh, M. S. (2014). Melanoma: Molecular Pathogenesis and Therapeutic Management. Retrieved May 24, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346328/
- Goldberg, L.H., & Lebwhol, M. (n.d.). How to Spot an Atypical Mole. How to Spot an Atypical Mole. Retrieved 3 February, 2019, from http:// skincancer.org/skin-cancer-information/atypical-moles/warning-signs-and-images
- “Atypical, Abnormal, and Irregular Moles: Is Your Mole Normal?” WebMD, WebMD, webmd.com/melanoma-skin-cancer/skin-mole-normal#2.
- “Atypical Moles.” Palmoplantar Pustulosis – American Osteopathic College of Dermatology (AOCD), aocd.org/page/AtypicalMoles.
- Watson, Stephanie. “Typical vs. Atypical Moles: How to Tell the Difference.” Healthline, Healthline Media, healthline.com/health/managing-skin-cancer/typical-vs-atypical-moles#4.
[1] Pre-cancerous lesions are changes in the skin that are not cancer, but likely to progress on to cancer if untreated
[2] DNA stands for deoxyribonucleotide, a protein which contains our genes
[3] Skin type 1 and 2
[4] Immunosuppressive therapy involves the taking of medication to reduce the immune response of an individual. People in need of this tend to be post-transplant patients.
[5] Food and Drug Administration
