Nail Clinic: Moles and Melanoma

We answer your most common mole-related questions so you can make safe choices when you spot a suspicious-looking mole at your station or on your own body.

Q: How and when do moles develop?
A: Moles are hereditary, so your genetics largely determine how many you’ll have and where you’ll have them. Other factors that may play a role include skin color and amount of sun exposure. According to the American Academy of Dermatology (AAD), the dark color of moles is caused by melanocytes, which are cells that produce the pigment melanin—the same pigment that determines an individual’s skin color and tans the skin after sun exposure. These pigmented spots develop throughout a person’s life, most starting relatively soon after birth. “Moles tend to grow over a lifetime—it’s very unusual to see them at birth, but they typically start to grow within the first five years of life,” says Joel Schlessinger, M.D., a board-certified dermatologist whose Omaha, Nebraska-based practice includes a full-service day spa. “Interestingly, moles sometimes disappear as one ages.” They also tend not to appear after age 40 or 50, he says. Robert T. Brodell, M.D., professor of internal medicine, dermatology, at Northeastern Ohio Universities College of Medicine in Rootstown, Ohio, explains the life cycle of a typical mole: Pigmentation begins between the ages of 5 and 10 when the mole is a flat brown lesion that’s smaller than a pea, at which point it’s called a junctional nevus. It then rises for the next 5 to 10 years—a compound nevus. Over the course of several decades it will continue to rise as an intradermal nevus.

Brodell further explains, “Moles that a person is born with are called congenital melanocytic nevi, or birthmark moles, and are more likely to turn into melanoma skin cancer; they should be either removed or watched carefully.” Regardless of type or stage of progression, moles can take on a variety of appearances with different people. “The size of a mole and its characteristics—whether it’s raised or flat, how dark the color is, whether it’s multicolored and whether hair grows on it—vary from person to person and can even vary on the same person, depending on the area where it’s located,” explains Raffy Karamanoukian, plastic surgeon and assistant clinical professor in the Department of Plastic Surgery at the University of California, Irvine. “They usually change gradually and uniformly.” When nonuniform and/or sudden changes take place in a mole, there may be a problem.

 

Above: This spot ended up being melanoma. Note the irregular shape and uneven color.

Q: How will I know if a mole has developed into melanoma?
A: It’s not a guarantee that a mole will develop into melanoma. Brodell estimates that only about 1 in 50,000 “normal benign acquired moles” will become cancerous. Here are some warning signs to look for when assessing a mole: “A typical mole is round and about the size of a dull pencil tip; it has a uniform color and is not symptomatic,” Karamanoukian says. “Symptoms are important in moles: If they scab or itch, are painful or rapidly change, something is usually not right.” When a mole turns into melanoma, he continues, the melanocytes produce excessive pigment and begin to multiply quickly. These dangerous cells can spread to other layers of the skin and areas of the body. Many physicians advocate learning the “ABCDs of melanoma,” which list four warning signs of the disease. Schlessinger describes them as:

A: Asymmetry (each half of the normal mole should be identical)
B: Border (an irregular border is abnormal)
C: Color (dark and/or multiple colors signify a potentially dangerous change)
D: Diameter (if the mole is larger than a pencil eraser, it may need evaluation)
*Other doctors add an “E” to the list—for “evolution,” meaning that a sudden change in the mole can indicate a problem.

Remember that these are just guidelines, and it’s always best to see a doctor to obtain a professional’s opinion. Not all moles signal melanoma. For example, according to the AAD, a type of mole called dysplastic nevus exhibits some of the above characteristics (they are often larger than a pencil eraser and irregular in shape with an uneven color), but is not necessarily dangerous. However, this type of mole is at a greater risk for developing problems, so it should be regularly checked by a doctor.

Q: What are the available treatments for a mole that has developed into melanoma?
A: Early detection is especially important, Karamanoukian says, because treatments for advanced melanoma are still largely ineffective. “The most effective treatment is early diagnosis and surgery—the melanoma must be removed from the body with a margin of normal tissue around it,” he says. “Even with surgery, some aggressive types of melanoma have very poor survival rates.” As with other forms of cancer, catching the melanoma before it spreads to other areas of the body is absolutely crucial.

 

Above: all normal moles

Q: How can my clients and I spot potentially troublesome moles? Should I take any special precautions when working around a client’s moles?
A: Brodell offers up a sound suggestion that everyone should implement: “People should examine all of their moles on the first day of every month—mole day!” he says. “Sudden changes require a visit to the doctor.” Schedule the monthly check on your calendar, date book or cell phone—whichever way you’ll be sure to remember—and stick to it. For help with identifying possible melanoma and tips on handling self-examinations, Brodell recommends the website checkyourskin.org.

Karamanoukian agrees that regular monitoring is important. “Because everyone has multiple moles, we always need to be vigilant about monitoring these dark spots and making sure that they don’t turn into something more serious,” he warns. “The best way to identify problematic moles is to get to know your body and become familiar with the moles you have, so you can easily recognize one that looks different.” He suggests that nail techs keep an eye out for potentially dangerous moles on the bottoms of clients’ feet and under their nails. If you think that a mark under the nail is a bruise, ask your client about it to ensure that it isn’t more serious.

Most of your services should not affect moles, even if they are raised from the surface of the skin. “Scrubs, lotions, massage, etc. will not turn a mole into melanoma or make a melanoma spread,” Brodell says. “But any strange-looking mole should be examined by a physician.”

“There is no reason to avoid touching a mole,” Schlessinger agrees. “But nail techs should look carefully for dark streaks on the nail bed; moles on the nail tend to be more problematic as they grow slowly and people may ignore them. If there is a dark streak that darkens or becomes more obvious, encourage your client to have it evaluated by a dermatologist—it may just be a lifesaving referral!” He also mentions other odd moles that can appear on the hands and nails: a glomus tumor is a reddish mole that’s usually painful and often seen near the base of the nail; a pyogenic granuloma is a mole that easily bleeds and appears due to blood vessel growth; and a digital myxoma is a nearly translucent, raised fluid-filled bump at the bottom of the nail or on the skin below it.

Ultimately, you can help your clients by merely pointing out any moles that look unusual and advising them to see a doctor for a more thorough checkup. Don’t panic, but do let them know that a skin problem can signal a more serious issue, such as melanoma. Medical research is currently underway to provide better treatments for this disease, but right now we can only hope to catch the problem early, if and when it occurs. Moles can certainly be beautiful, and most are completely normal, but it’s up to you to keep an eye out for those that can cause harm, for the sake of everybody’s health!  -Tracy Morin

[Images: visualsonline.cancer.gov; National Cancer Institute]