Peds Derm Corner- Moles- September
Each month, Dr Swanson posts information about a common pediatric dermatology issue to educate patients and parents. This month, the topic is moles.
What are moles?
Moles are brown flat spots and bumps that are typically darker and larger than freckles.  They are dark because of an increased number of melanocytes (pigment making cells) and increased melanin (pigment).
What causes moles?
Two things contribute to the development of moles.  The first is genetics.  If a parent or family member has lots of moles, a child is more likely to have lots of moles too.  The second factor is sun, which makes protecting children’s skin from the sun very important.
What special types of moles occur in children?
There are several types of moles that occur more commonly in children, but there are probably 3 types that are worth mentioning.  Eclipse moles are very common on the scalp of kids, especially blond haired children.  They tend to have a dark center and lighter rim or a lighter center and darker rim.  They are often larger than a lot of other moles.  They are completely benign (normal), but often get noticed because of the different coloring and large size.
Congenital moles are moles that are present at birth or appear soon after.  They are often larger than most moles, more darkly pigmented, and often will eventually grow hair.  Congenital moles are benign (normal), but they do have a slightly increased chance of developing into a bad or dangerous mole.  The chance of becoming bad increases as the size of the mole increases so the risk is quite small with a small congenital nevus but more significant for a giant congenital nevus.  Small congenital moles have about a 1% chance of becoming a bad mole, so they can be surgically removed but typically do not have to be.  Oftentimes, we simply choose to monitor them every year.
Spitz moles are a special type of mole that typically occurs in children.  They are usually pink, rather than brown, and appear suddenly.  They are classically described as a pink dome shaped bump.  Spitz moles are benign, but they are a bit of a gray area in pediatric dermatology and we frequently recommend that they be removed.
When should I be worried about a mole?
General criteria to think about when looking at a mole can be described as the ABCDs.  A stands for asymmetry; a normal mole is typically very symmetrical.  B stands for border; we like to see a smooth, regular border and a scalloped or irregular border can be atypical.  C stands for color.  We like to see a uniform brown color and we worry when we see shades of blue, gray or black.  D stands for diameter and is probably the weakest of the criteria.  Lastly, we always tell people to pay attention to any changes in any moles.  This is a difficult criteria to apply to children as it is normal for moles during childhood to grow (both in proportion to the child and sometimes out of proportion with a child’s growth).  Overall, though, anytime you are worried about a mole for any reason, it is very reasonable to have it checked.
When should I bring my child in for a mole check?
This depends on a lot of things.  If you are worried about a mole or several moles, it’s a good idea to have them seen.  If there is a family history of atypical moles or melanoma, then a child of any age should be evaluated with a baseline skin exam.  If a child has a lot of atypical moles, meaning moles that are irregular in shape or coloring, then a mole check is a good idea.
If you have any other questions regarding moles and how it is affecting your child, please schedule an appointment with Dr Swanson, our pediatric dermatologist.
What is a pediatric dermatologist?
A pediatric dermatologist is someone that has undergone extensive training to deal with the specific skin conditions and issues that affect children. Pediatric dermatologists have typically completed medical school, a general dermatology residency, and a pediatric dermatology fellowship. While all dermatologists receive some experience dealing with children with skin problems, a pediatric
dermatologist has chosen to subspecialize and receive more extensive education and training with the pediatric population.