Changes in Moles: When to Seek Dermatological Advice

Changes in moles?

Thank you, doctor, for taking the time to respond.
About three months ago, I noticed that a mole on my left forearm seemed to have developed a "foot," with changes in shape and a brown color.
It is flat, not painful or itchy, and although it is approximately 0.4 cm in size, it has caused me some concern.
Additionally, I have two moles on the soles of my feet that have been present for many years (0.1-0.2 cm) and have not changed.
Feeling uneasy, I visited a dermatology clinic last month for an examination.
The doctor initially believed that both moles were benign, but regarding the changing mole on my arm, he suggested that if I was still concerned, I should go to a larger hospital for a biopsy.
Therefore, I was referred to a larger hospital.
After examining me, the doctor stated that for such a small mole, no one performs a biopsy unless it is at least 0.6 cm in size.
If I was still worried, I could have the moles removed with laser treatment, which would be out-of-pocket at a cost of 600 per mole...
it was up to me to decide.
At that moment, I felt a bit confused because I didn't understand whether my mole was problematic or not.
When I pressed the doctor for clarification on whether this was a necessary procedure, he replied that it was my decision.
I ultimately chose not to undergo laser treatment because if there was no immediate diagnosis of a potential issue, it seemed better to continue monitoring rather than pursue unnecessary treatment.
Thank you for your patience!

Chen, 40~49 year old female. Ask Date: 2016/10/26

Dr. Wu Yuxin reply Dermatology

To determine whether a mole has undergone any pathological changes, a biopsy is necessary for a definitive diagnosis.
If there are no changes in the short term, it is reasonable to monitor it; however, if there are significant changes, a biopsy should still be considered.

Reply Date: 2016/10/26

More Info

When it comes to changes in moles, particularly those that exhibit alterations in shape, color, or size, it is essential to approach the situation with caution and awareness. Your concern regarding the mole on your left forearm, which appears to have changed shape and color, is valid and warrants careful consideration.

Moles, or nevi, are common skin growths that can vary in color, size, and shape. While many moles are benign, certain changes can indicate potential issues, including the risk of melanoma, a serious form of skin cancer. The characteristics you described—specifically the change in shape and color—are significant factors to consider. According to the ABCDE rule for melanoma detection, you should look for:
- Asymmetry: If one half of the mole does not match the other.

- Border: Irregular, scalloped, or poorly defined edges.

- Color: A variety of colors (brown, black, tan, red, white, or blue).

- Diameter: A mole larger than 6mm (about the size of a pencil eraser).

- Evolving: A mole that changes in size, shape, or color over time.

In your case, the mole's change in shape and color, despite being small, is concerning. The fact that it does not itch or hurt is somewhat reassuring, but it does not eliminate the need for further evaluation. The recommendation from your dermatologist to consider a biopsy if you remain concerned is a prudent one. A biopsy can provide definitive information about the nature of the mole, helping to rule out malignancy.

The advice you received from the second dermatologist regarding the size threshold for biopsy (greater than 0.6 cm) is a common guideline, but it is not absolute. The decision to perform a biopsy should also consider other factors, including the mole's characteristics and the patient's history. If you feel uncomfortable with the mole's appearance or if it continues to change, seeking a second opinion or insisting on further evaluation may be warranted.

Regarding the option of laser removal, it is important to understand that while this procedure can remove moles, it does not provide a pathological diagnosis. If there is any suspicion of malignancy, it is crucial to obtain a biopsy first to ensure that any potentially harmful cells are not left behind.

In conclusion, while your decision to monitor the mole rather than undergo unnecessary procedures is reasonable, it is essential to remain vigilant. Keep an eye on the mole for any further changes, and do not hesitate to seek further medical advice if your concerns persist. Regular skin checks by a dermatologist, especially if you have a history of skin changes or family history of skin cancer, are advisable. Your skin health is paramount, and proactive monitoring can lead to early detection and treatment of any potential issues.

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