Scalp Nevi: When to Worry About Skin Changes

Scalp mole

Hello Doctor: When I was in high school (around 16 years old), I noticed a bump on my scalp.
At that time, I thought it was just a pimple on my scalp and didn't pay much attention to it.
It wasn't until last summer (when I was 20) that I discovered I had two raised black moles on my scalp, both about 1 centimeter in size.
One is very prominent, while the other is slightly raised (similar to the degree of a typical pimple on the face).
Compared to the size I felt in high school, they have increased in size.
In March of this year, I found a new flat mole on my scalp (about 0.6 centimeters), and recently I noticed that its color has darkened.
1.
I would like to ask if these are just regular moles or if they could be melanoma? 2.
Would you recommend having them removed?

Mia, 20~29 year old female. Ask Date: 2023/10/16

Dr. Wu Yuxin reply Dermatology

Please consult a dermatologist for an initial assessment, which will allow for further recommendations.

Reply Date: 2023/10/16

More Info

When it comes to scalp nevi, or moles on the scalp, it's important to understand the characteristics that differentiate benign moles from potentially malignant ones, such as melanoma. Based on your description, you have several moles that have changed in size and color over time, which warrants a closer examination.

1. Characteristics of Moles: Generally, benign moles (nevi) are uniform in color, symmetrical, and have well-defined borders. They typically do not change significantly over time. In contrast, concerning features that may indicate melanoma include asymmetry, irregular borders, multiple colors, a diameter larger than 6mm, and any changes in size, shape, or color over time. The fact that you have noticed changes in size and color, particularly the deepening of color in one of the moles, is a red flag that should not be ignored.

2. When to Worry: The changes you describe, especially the increase in size and the change in color of the flat mole, could indicate that these moles are not just ordinary nevi. The appearance of new moles, especially if they are changing, is also a cause for concern. Melanoma can develop in existing moles or appear as new spots on the skin. Given that you have a history of noticing changes in these moles, it is advisable to consult a dermatologist for a thorough evaluation.

3. Recommendation for Removal: If a mole exhibits any of the concerning features mentioned above, it is often recommended to have it removed and biopsied. This is the only way to definitively determine whether a mole is benign or malignant. Even if a mole appears to be benign, if it has changed in size or color, removal may still be warranted for peace of mind and to prevent potential issues in the future.

4. Consultation with a Dermatologist: I strongly recommend that you schedule an appointment with a dermatologist as soon as possible. They can perform a physical examination and may use dermatoscopy, a technique that allows for a detailed view of the mole's structure. If necessary, they can perform a biopsy to analyze the mole's cells for any signs of cancer.

5. Self-Monitoring: In the meantime, keep an eye on your moles. Document any changes in size, shape, color, or texture. Take photographs to track changes over time, which can be helpful for your dermatologist. Additionally, be aware of any new symptoms such as itching, bleeding, or crusting around the moles, as these can also indicate a problem.

In summary, while many moles are harmless, the changes you have observed in your scalp nevi are concerning. It is crucial to seek professional medical advice to ensure proper evaluation and management. Early detection is key in the treatment of skin cancers, including melanoma, so do not delay in seeking care.

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