ATYPICAL MOLES

What are Atypical Moles?

Atypical Moles are unusual-looking benign (non-cancerous) moles, also known as Dysplastic Naevi (plural of “naevus,”). Atypical Moles may resemble melanoma, and people who have them are at increased risk of developing melanoma in a mole or elsewhere on their body.

The higher the number of moles someone has, the higher their risk of melanoma. Those who have 50 or more have 12 times the risk of developing melanoma compared with the general population.

All individuals with these moles should practice rigorous daily sun protection, perform a monthly head-to-toe skin self-examination and have regular professional skin checks, ideally every 6 months or as directed by your Doctor.

Atypical Moles Risk Factors

Anyone with a history of sun exposure can develop Atypical Moles. However groups of people at greater risk include:

• Family History - Heredity appears to play a part in the formation of Atypical Moles. They tend to run in families, especially in Caucasians; about 2 to 8 percent of Caucasians have them. Those who have Atypical Moles plus a family history of melanoma have a very high risk of developing melanoma. This risk is 20 to 30 times higher than average.
• Fair Skin Types - people who are at highest risk have fair skin, freckles, blond or red hair, and blue, green, or grey eyes. They have a tendency to burn rather than tan
• Large Moles - People who have a large mole at birth (>6mm)
• Recreational -  People who pursue outdoor recreation activities for hours at a time

About Normal Moles

Normal Moles are common small brown spots or growths on the skin that appear in the first few decades of life in almost everyone. They can be either flat or elevated and are generally round and regularly shaped. Many are caused by sun exposure.

Normal moles rarely arise over the age of 40 and all moles tend to commence a process of  regression (i.e. start to disappear) over the age of 70.

About Atypical Mole Syndrome

Some people have so many normal and Atypical Moles that they are classified as having Dysplastic Naevus Syndrome. People with this “classic” atypical mole syndrome have the following three characteristics:

• 50-100 or more moles
• One or more moles 6 mm or larger in diameter
• One or more moles that have been removed and found to be either atypical or melanoma

At even higher risk of developing melanoma are those with Familial Dysplastic Naevus Syndrome (FDNS). These people not only have atypical mole syndrome, but also one or more first- or second-degree relatives with melanoma. While Atypical Moles often arise in childhood, they can appear at any time of life in people with Familial Dysplastic Naevus Syndrome.

Where Are Atypical Moles Found?

Atypical Moles appear anywhere on the skin. They most commonly occur on the trunk or limbs.

Why Are Atypical Moles a Concern?

Although the vast majority of Atypical Moles remain benign, some studies report that transformation into melanoma is a possibility. In a direct numerical association, the more Atypical Moles you have, the greater your chance of melanoma.

What Causes Atypical Moles?

95% of Atypical Moles in Australia are the result from skin damage caused by

• Cumulative long-term sun exposure  
• Intermittent overexposure to ultraviolet (UV) radiation from the sun (typically leading to sunburn)

Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, heightening UV exposure. This is especially the case at higher altitudes.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so our Doctors warn against using sunbeds.

It is not possible to pinpoint a precise, single cause for a specific Atypical Moles. Some Atypical

Symptoms of Atypical Moles?

If you have Atypical Moles, it indicates that you have sustained chronic sun damage and could be at higher risk of melanoma.

A key factor used to identify whether an Atypical Mole is transforming is any ongoing change that persists beyond a few weeks. If you observe two or more of the signs below, you should consult the Bondi Junction Skin Cancer Clinic immediately.

• A pigment change - as well as freckles, “age spots,” skin that is red is an indicator, but some will be light or dark tan
• A sore with a crust that only to heal up again. A persistent, non­–healing sore is a very common sign of transformation.
• A sore or skin with a surface that crusts In rare instances, Atypical Moles can even bleed, ooze, swell
• Bluish-black colour and unique features that may go right up to the edges of the mole
• A shin area that itches or produces a pricking feeling or sensation of tenderness
• A pink growth with a slightly elevated rolled edge and or take on a donut shape. The growth slowly enlarges, tiny blood vessels may develop on the surface.

Seek prompt medical attention if you find any of the warning signs of melanoma. Show the Doctors at Bondi Junction Skin Cancer Clinic any moles with suspicious signs, symptoms or changes. Schedule a head-to-toe skin examination at the Clinic annually or more often if moles are changing or if advised to do so

Atypical Moles Warning Signs

Melanoma one of the deadliest forms of cancer, most often appears as an atypical mole that is

• asymmetrical,
• irregularly bordered,
• multi-coloured or tan/brown spot or growth
• continuing to increase in size over time
• pre-existing or new especially over the age of 40
• It may begin as a flat spot and become more elevated. In rare instances, it may be amelanotic, meaning it does not have any of the skin pigment (melanin) that typically turns a mole or melanoma brown, black or other dark colours. In these cases, it may be pink, red, normal skin colour or even other colours, making it harder to recognize as a melanoma.

Sometimes it can be hard to tell the difference between an atypical mole and an early melanoma. (Some melanomas begin within an atypical mole). The degree of atypical features in the mole can provide clues as to whether it is harmless, or at moderate or high risk of becoming a melanoma.

At the Bondi Junction Skin Cancer Clinic we use the adage ‘The faster a Atypical Moles grows or changes the faster it needs to go’.

Faster changing or growing Atypical Moles need your attention because they may be rapidly transforming into melanoma .  Any rapidly changing skin growth should prompt an immediate visit to a Bondi Junction Skin Cancer Clinic.

Have regular eye examinations by your Optometrist or Ophthalmologist, since moles and melanomas may also arise on and in the eyes.

Atypical Moles Screening

Diagnosis and management of Atypical Moles is best performed via a Full Body Scan.

In the first incidence, this process includes

• Digitally Mapping a patient's entire body for any suspicious skin damage or lesion
• Followed by a detailed Dermoscopic Examination by a trained skin cancer Specialist
• Recording and combining all images and skin metrics (size, shape, colour, and other attributes) into the patient record

Our expert Doctors at Bondi Junction Skin Cancer Clinic will then clearly identify and diagnose any skin disease.

Having a digital molemap or a baseline of all your skin’s moles skin for all family members with Atypical Moles, those with a large number of moles, or have been diagnosed with melanoma is recommended. Any changes can be more easily spotted and understood.

Atypical Moles Self Checks

It pays to “know your skin.” You and all your family members should keep track of all moles on their skin so they can be aware of any changes and bring them to the attention of the Doctors at the Bondi Junction Skin Cancer Clinic.

This can help minimize the risk of melanoma progressing to advanced stages which could be life-threatening.

Anyone, especially someone with an increased risk of developing melanoma, should

examine their skin completely on the first day of each month, using a full-length mirror and a handheld mirror, plus a good light source to help see each area. Ask a family member or friend to look at the back and other parts of the body that are hard to see.

A hair dryer is useful when checking the scalp. Don’t forget the bottom of the feet and between the toes.

Atypical Moles Diagnosis

This diagnostic process involves a Doctor visually examining the suspect skin lesion. Rarely it can involve taking a tissue sample known as an excision biopsy by removing the lesion and sending it for histopathological analysis..

Untreated Atypical Moles

Atypical moles may transform into melanoma at any time, and this change may be subtle and easily missed.

If melanoma does develop from an atypical mole and is caught early the result is usually just minor scarring after this is removed.

If it is not and goes untreated, the result is usually fatal.

Atypical Moles Treatment Options

If an Atypical Mole is at risk of transforming, or if it’s status is in doubt the lesion is surgically removed.

Surgical Removal of Atypical Moles or Excision

Surgical removal of suspect Atypical Moles is the most common treatment and are almost always surgically removed under local anaesthetic. This approach offers:

• Is immediate,
• Removes the entire lesion
• Lesions margins are checked to confirm the diagnosis and complete clearance

If melanoma is detected in an Atypical Mole, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells are cleared.

Excision Treatment Process - After careful administration of local anaesthetic, the Doctor uses a scalpel to remove the entire growth, along with surrounding apparently normal skin as a safety margin. The wound around the surgical site is then closed with sutures (stitches).

Excision Treatment Recovery - For a few days post excision there may be minor bruising and swelling. Scarring is usually minimal. Pain or discomfort is minor. Typically, where sutures are used, they are removed soon afterwards.

Surgical Excision Prognosis - A histopathological report is generated for any Atypical Mole that is removed and once clearance is confirmed there is effectively no chance of this Mole causing any problem in the future.

General Prognosis After Treatment

Atypical Moles that are suspected of transforming are almost always successfully treated.

When Atypical Moles are removed, the scars are usually cosmetically quite acceptable.

Atypical Moles Recurrence

Regular checks at the Bondi Junction Skin Cancer Clinic should be performed so that not only the site(s) previously treated, but the entire skin surface can be examined, and mapped digitally and compared to the images taken at subsequent skin checks.

Atypical Moles Prevention

Anyone who has had one Atypical Moles has an increased chance of developing melanoma. That is usually because the skin has already suffered irreversible sun damage and that there are more pigment cells present on the skin from which a melanoma may arise

Thus, it is crucial to pay particular attention to any previously treated site, and any changes noted should be shown immediately to your Doctor at the Bondi Junction Skin Cancer Clinic.

Atypical Moles on the nose, ears, and lips are especially prone to recurrence.

Even if no suspicious signs are noticed, regularly scheduled follow-up visits including total-body skin exams are an essential part of post-treatment care every 6 months.

To prevent Atypical Moles make sure you follow the recommendations below:

• Seek the shade, especially between 10am and 3pm when UV levels are most intense
• Avoid sunburn by minimising sun exposure when the SunSmart UV Alert exceeds 3 and especially in the middle of the day in the warmer half of the year
• Avoid tanning and never use UV tanning beds
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses
• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 30+ or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30+ or higher
• Apply sunscreen to your entire body 10 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating, or towelling down
• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months
• Examine your skin head-to-toe every month looking for unique changes.

If you see unique changes anywhere and of any kind, keep an eye on it and if it continues to change for more than 2-3 weeks the notify the Bondi Junction Skin Cancer Clinic without delay.

The most important factor in surviving Melanoma is early diagnosis