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Should You Get That Mole Removed?

How to know when they’re worth worrying about, and what to expect at your dermatologist visit

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You have this mole. Maybe it’s been with you since high school, or maybe it’s a more recent acquisition. Either way, something about it doesn’t look quite right. The color is a little off or the edges seem too jagged. Is it your imagination, or has it gotten bigger? Should you mention it to your dermatologist?

A mole is really nothing more than a collection of pigment cells called melanocytes. Most of us have between 10 and 40 moles, which we started collecting in childhood. By around age 40, most of us will have accumulated all the moles we’ll ever possess.

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Is it a normal mole — or cancer?

When pigment cells are “well behaved,” meaning they multiply only when needed, a mole is benign. “But as with any cell type in the body, there is the potential for transformation into something dangerous or cancerous,” explains Allison Darland, a dermatologist at University of Michigan Health.

Atypical moles are larger than usual or they have unusual features, like uneven borders and multiple colors. “An atypical mole is not a skin cancer, but having these moles is a risk factor for developing melanoma,” says Neelam Vashi, a dermatologist at Boston Medical Center.

It’s rare for an existing mole to turn into melanoma — fewer than 1 in 10,000 do. Melanoma is the deadliest type of skin cancer because it has the potential to spread into your lymph nodes and other parts of your body. It’s also very treatable when caught at an early stage. “It’s always better to either remove them or monitor them frequently, so that if a melanoma arises, it can be detected and treated as early as possible,” Vashi says.

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To learn whether you have any questionable spots, do monthly skin checks. Using a mirror or with the help of your partner, scan your entire body to look for any new or changing moles.

The ABCDEs of moles

Unless you have a medical degree, you probably won’t know which moles are harmless and which ones could be cancer. That’s why dermatologists have come up with a few simple tricks to help you spot the warning signs.

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One is the so-called ugly duckling sign. Named for the lone mismatched bird in the fairy tale, the ugly duckling is the mole that stands out. “It’s something on the body that just doesn’t seem to match other spots on the body,” says David Reid, chief of dermatology at Rush University Medical Center.

A more common guide, which dermatologists refer to by the mnemonic ABCDE, highlights the five warning signs of atypical moles.

1. Asymmetry. If you were to draw a line down the center of a healthy mole, one side would be the mirror image of the other, Reid says.

2. Border. Normal moles have smooth and even borders. Atypical moles have jagged or uneven borders.

3. Color. A solid brown, tan or black mole is a good sign. More than three colors — brown, tan, black, red, pink or white — or changing colors could be concerning.

4. Diameter. Moles that measure over 6 millimeters across need to be examined.

5. Evolution. Change is a possible sign of cancer. Has the mole changed color? Does it suddenly itch or bleed?

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Should you remove your mole?

Don’t try to figure out a mole’s threat level on your own. Visit a dermatologist, who has the training to distinguish a harmless growth from a cancerous one. Your doctor will start by asking about your history of moles and sun exposure to gauge how you make moles, Reid says.

Then the doctor will look deeply into the mole in question, examining its pigment cells and network of blood vessels using a handheld magnifying tool called a dermatoscope. Any spot deemed suspicious will be biopsied, which involves removing part or all of the mole for testing.

How doctors remove moles

The biopsy technique used depends on the size and location of the mole, as well as on how suspicious it looks. Darland says she removes most moles with a shave biopsy. “We numb up the skin, and we use a blade to shave off the top layer of skin,” she says. “You’re left with a little open sore that heals from the bottom up. Most often, it’s a really quick and easy procedure that doesn’t require any stitches or downtime.”

A less common alternative is the punch biopsy, which uses a cookie-cutter-like tool to punch down into the deeper layers of skin. Afterward you will need a stitch or two to close the wound. Very large moles are removed with a scalpel in a football-shaped pattern, which the doctor then sews up to create a straight scar.

The sample goes off to a lab, where a pathologist examines it under a microscope. Mildly atypical moles typically don’t need any more attention. For a moderately to severely atypical mole that’s closer to the “melanoma neighborhood,” you may need to return to your doctor’s office to have the rest of it removed, Vashi says.

Some moles clearly look suspicious and need to be biopsied. Others fall into a gray area. This is where your dermatologist’s skill comes in handy, Reid says.

If you’re reluctant to undergo a procedure for a mole that is likely harmless, your dermatologist can take measurements and photos and then check it again in a few months. In that time, if the mole hasn’t grown, “that’s generally a reassuring finding,” Reid says.

Will my insurance cover mole removal?

Insurance coverage can vary based on the type of plan you have. If a mole looks suspicious enough for your dermatologist to suggest removing it, most plans will cover it.

Also typically covered are moles that cause problems — for example, ones that are painful or that block your vision. If, on the other hand, you want to remove a mole simply because you don’t like the way it looks, your insurance company will likely consider the procedure cosmetic and make you pay for it yourself.

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