What is a borderline nevus? Why is borderline nevus dangerous?

It belongs to the category of moles with a high risk of degeneration into melanoma, and therefore requires regular examination by a dermatologist (once every six months). It is asymptomatic and imperceptible. Treat with surgical excision, laser or radiotherapy. Avoiding direct exposure of ultraviolet rays to the area of the junctional nevus is the main preventive action.

Borderline nevus is a neoplasm that has a significant risk of degeneration into a cancerous form.

What is a border nevus called?

The name "borderline nevus" comes from its location. The localization between the epidermis and dermis leads to the term "intermarginal". Cells with a high content of melanin pigment move to the basal layer of the epidermis to form a borderline mole. They do not have processes in their structure, so they do not transfer melanin to nearby cells.

Benign formation with a high risk of developing into melanoma (every 3rd case). Often, moles are dark in color, ranging from gray (light brown) to black. The diameter does not exceed 1 cm, growth is possible at a rate of 1 mm/year. On average it is 20-50 mm, the edges are smooth. The shape is round or deformed. Smooth surface without hair. The high pigment content and location provoke this color. A borderline pigmented nevus appears on the body in any area, often located on the feet, palms or mucous membranes. It mainly appears in the first months of life, is not dangerous, but requires increased attention and control. They grow in different quantities: from one to several. May develop into nodular seals. In medicine it is called “functional nevus”.

Why does it occur?

Formed due to a violation of the formation of melanoblasts. The activity of the melanin pigment may be due to:

changes in hormonal levels;
exposure to ultraviolet rays;
the presence of infections;
genealogical factor;
oncology;
the effect of synthetic drugs;
disorders of the cardiovascular system.

The exact provocateurs of borderline nevus have not been studied to date.

A junctional mole often begins to appear in infancy. Factors influencing this process may include changes in the mother’s body during gestation, or exposure to environmental factors.

The exact cause of this type of stain cannot be determined. A more detailed clinical picture will be provided by a diagnostic study. Changes in shape, color, uniformity, lines are a signal to contact a dermatologist and determine whether the mole is benign. The development of a border nevus into its pathological appearance of a cockade nevus indicates the risk of melanocytes. Recurrence after treatment is a high probability of cancer.

Symptoms of education

Asymptomatic and imperceptible formation, appears virtually unnoticed. The presence of itching, burning, uneven edges, and redness of skin areas should alert the patient. These are not characteristic features of a borderline nevus. Hair does not grow in the mole area, the surface remains smooth. The main thing is not to confuse a functional mole with melanoma. Below is a table of differences.

As a rule, a borderline nevus, despite its danger, may be no different from an ordinary mole.

It is impossible to identify a borderline mole symptomatically, especially on your own. With age, complete disappearance is possible. The manifestation of tangible signs and changes in the appearance or condition of the patient is associated with outgrowth of the mole or its pathology. An increase in body temperature indicates the presence of inflammatory processes, which may be associated with melanoma. If such nevi are located in areas with an increased risk of injury, they need to be removed.

Diagnosis of a junctional spot consists of an examination by a doctor and a histological examination or ultrasound. Return to contents

Diagnosis of the junctional spot

An initial examination and consultation can be carried out by a general practitioner with further referral to a dermatologist or surgeon. Initially, an external examination is carried out, questions are asked to the patient and a visual characteristic is determined. For a more detailed analysis, an ultrasound examination of the mole may be performed. Diagnostics will show the location of the depression between the dermis and epidermis, the exact size and growth, and the effect on surrounding tissues. Siascopy may be prescribed as an additional diagnostic method.

To determine whether it is malignant, a blood test is taken for further laboratory tests. A biopsy is not recommended, since traumatizing the nevus to take material can provoke development into a dangerous form of the disease. The conclusion is given after histology, which is carried out from the excised material during surgery (if there was one). Only after diagnosis can the doctor fully describe the clinical picture and decide on the treatment method.

Features of treatment

Since the formation is benign, doctors do not recommend getting rid of it. The exception is the patient’s personal desire to change the nevus. The most common form of treatment is surgical removal, which prevents recurrence. The operation takes place quickly, under general anesthesia with a minimal recovery period. Beauty salons or dermatology offices may offer laser therapy or destruction by radio waves. After such procedures, no scars or cicatrices remain, and neighboring tissues are not affected. In order not to injure the skin, cryodestruction and electrocoagulation are not used.

Traditional medicine does not work on moles; its use is ineffective and ineffective. It is not recommended to remove a borderline mole using synthetic cosmetics. The influence of such products can lead to negative changes and worsen the situation. The treatment method should be chosen after consultation with a specialist. If preference is given to a beauty salon, you need to make sure that the master is professional and has a medical education. Without preliminary diagnosis of the oncogenicity of the nevus, no manipulations on the mole should be carried out.

To avoid degeneration of a borderline nevus, you should visit your doctor regularly and follow his recommendations. Return to contents

Preventive measures

The main prevention is regular visits to a dermatologist to examine the mole and record indicators of its changes. The frequency of visits should be once every 6 months. It is also recommended to apply sunscreen before going outside, cover the location of the borderline nevus with clothing, and avoid going outside during active sun hours. An important factor is maintaining the immune system, enriching it with vitamins and essential microelements. Under no circumstances should you injure a mole.

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The information on the site is provided for general information purposes only. We recommend that you consult your doctor for further advice and treatment.

Borderline pigmented nevus

Borderline pigmented nevus is a congenital neoplasm. In rare cases, it appears after the birth of a person, at any age. Together with such types of nevus as blue nevus, melanosis of Dubreuil, nevus of Ota, giant pigmented nevus, nevus undergoes malignant degeneration in 1.8% to 10% of cases. Therefore, experts classify it as a melanoma-dangerous species.

Symptoms of borderline pigmented nevus

A borderline pigmented nevus is a flattened black, gray, dark or light brown nodule with a diameter of several millimeters and up to 4-5 cm, but, as a rule, most often it does not exceed 1 cm. The surface of the nevus can be smooth, dry and slightly uneven. Borderline pigmented nevus differs from other types in that there is no hair (even vellus) on its surface.

Borderline nevus can occur on different parts of the body, as well as on the soles and palms. As a rule, a borderline nevus is a single formation, but foci of multiple nevi also occur.

Cockade nevus is a type of border nevus, the peculiarity of which is a gradual increase in pigmentation, due to which after some time the nevus acquires the outline of rings and has varying degrees of color.

A malignant transformation of a borderline pigmented nevus is indicated by a change in color, a sharp increase in size, the appearance of erosion, cracks and tubercles on its surface, redness around the formation or its blurry boundaries. If such changes are detected, urgent consultation with a dermatologist is required.

Pigmented border nevus should also be distinguished from cavernous hemangiomas, the consistency of which is softer, and from “senile” (seborrheic) keratoma, which is characterized by a “rough” greasy and less smooth surface. In the differential diagnosis between early melanoma and borderline pigmented nevus, special attention is paid to the anamnesis. Most patients diagnosed with melanoma indicate that the tumor developed over a long period of time at the site of an existing pigmented nevus, which did not cause any inconvenience. The nevus grows slowly according to the person’s body weight. During puberty, patients note that the nevus grows faster due to an increase in the level of metabolic and pigment processes, as well as hormonal changes in the body. Mechanical trauma is often one of the main factors that accompanies the malignancy of nevi, which previously did not cause discomfort.

Borderline pigmented nevus and its diagnosis

A borderline pigmented nevus in a patient is diagnosed during dermatoscopy and dermatological examination. An additional method is also used - siascopy. If there is a suspicion of malignancy, consultation with a dermato-oncologist is required.

A biopsy is usually not performed on a borderline pigmented nevus, since trauma to it can lead to degeneration into a malignant formation. Histological studies are carried out after the nevus is removed using radio waves or surgery.

Borderline pigmented nevus is distinguished from such pigmented formations as freckles, age spots, Setton's nevi, Dubreuil's melanosis and blue nevi.

Treatment of borderline pigmented nevus

Those patients who have been diagnosed with a borderline pigmented nevus should be regularly monitored by a dermatologist. If the neoplasm is benign, then such a nevus is not removed. But we should not forget that borderline pigmented nevus is also classified as melanoma-dangerous, therefore the best way to prevent melanoma is to remove the nevus. Permanent trauma to a nevus is an indication for its surgical treatment, especially if it is located on the surface of the palms or soles.

A borderline pigmented nevus is removed using a surgical scalpel, as well as a radio wave or laser device. Electrocoagulation and cryodestruction of the nevus are undesirable, since, according to experts, such removal methods can cause severe tissue trauma, which can cause the development of melanoma.

As a rule, no cosmetic defect remains after laser removal of moles. However, laser treatment can be used only when the removed formation does not require histological examination. Removal of nevi using a radiosurgical knife is most often performed when the size of the formation does not exceed 5 mm. Such removal methods for small tumors do not require sutures.

If a nevus shows signs of malignant transformation, it should be immediately surgically removed and a histological analysis of the removed material should be performed.

for the disease Borderline pigmented nevus

Borderline nevus: should you be afraid of pathology?

A nevus is a benign formation on the skin, popularly called a mole. It is a cluster of cells of a certain type, which can be completely flat or in the form of a small growth. It can be either colorless or contain the pigment melanin. Some types of moles may be precancerous. One of them is called a border nevus.

What is a borderline nevus?

Melanocytes, the cells that make up moles and age spots, are formed during the development of the fetus in the womb. Their structure has special processes with which they secrete the substance melanin. Cells that have processes form the color of the iris of the eye, hair, and color the mucous membranes. If these processes are absent for any reason, they accumulate in the thickness of the skin, forming various forms of nevi.

Borderline nevus has this name because the process of development and accumulation of cells stops at the border of the upper (epidermis) and middle (dermis) layers of the skin, without affecting the lowest, basal layer. This type of formation is often present on the human body from birth; in rare cases, it can develop in early childhood.

In the absence of negative factors, the nevus grows with the body. The size of a mole usually reaches 0.8-1.2 cm; cases of nevi measuring up to several centimeters in diameter are very rare. The surface of the mole is smooth, uniform, not wet, and there is never any hair on it, even vellus hair. It contains a large amount of melanin, which at one time did not come out, but stayed between the upper and middle layers of the skin, so its color is most often dark brown, brown, purple, even almost black.

Borderline nevus has a variety - a coccard mole, the characteristic feature of which is the presence of concentric rings, and the concentration of melanin will be more intense towards the center of the formation.

Over time, pigment spots of this type can transform into mixed or intraepidermal forms. It is also one of the few types of moles that can appear on the surface of the feet and palms. Usually the mole is not compacted, and upon palpation it does not feel different from the surrounding areas of the skin. However, this formation is only conditionally safe, since it belongs to the group of melanoma-hazardous ones. If a compaction of the structure is detected, this may indicate the onset of malignancy - the process of transformation into a malignant form.

Development of melanoma

Melanoma is a malignant skin formation that occurs as a result of uncontrolled reproduction and proliferation of melanocytes, which replace healthy cells.

The tumor itself is not considered cancerous, but if you do not pay attention to its development in time, it can begin to grow uncontrollably; melanocytes can enter the bloodstream and spread throughout the body, after which metastases may occur. This stage is fatal in 90% of cases, so it is important to pay attention to its development in time.

Among the processes that provoke the development of melanoma from a benign formation are:

excessive exposure to ultraviolet rays, excessive use of tanning, especially in solariums. It is worth noting that the lighter the shade of a person’s skin, hair and eyes, the more genetically his skin is susceptible to such changes. Such people should especially avoid sunburn, use sunscreen and not overuse tanning beds.
mechanical or chemical injuries to moles and the skin around them. This especially applies to the removal of formations; it is not for nothing that doctors do not recommend removing some types of moles at all, much less independently or with the help of unqualified specialists. If you decide to have it removed, first consult a dermatologist or surgeon for a preliminary consultation. The same applies to lightening age spots with special cosmetics - you should first make sure that you distinguish freckles from a borderline nevus, which in no case should be lightened in this way
hormonal disorders - skin formations react especially acutely to hormone surges during puberty or pregnancy in women
genetic predisposition - if your closest relatives have had a similar problem, you need to closely monitor your health and, if you suspect the development of the disease, immediately consult a specialist

Signs of malignancy

The main signs of degeneration of a borderline nevus into a malignant formation that are worth paying attention to are:

Increase in size. We are talking specifically about the accelerated growth of education, disproportionate to the growth of the body.
Color change. Darkening of some types of moles during life is normal, but if the color becomes richer and darker in a short time, you should immediately consult a doctor.
Asymmetrical and uneven edges. A benign mole is quite symmetrical - if you draw a straight line through its middle, the halves will be approximately the same size. The contours of a healthy mole or birthmark are usually clear and not blurred. If the situation has changed, the contours have become blurred, and the mole itself has begun to spread and take on the appearance of a shapeless spot, this may be another reason to visit the hospital.
Change of structure. Normally, the surface of a border nevus is smooth, without hair or roughness on the surface. If cracks, inflammation, bulges appear on it, or it begins to bleed, it’s time to sound the alarm.

Diagnosis and treatment

If melanoma is suspected, consultation with specialists such as a dermatologist, surgeon or oncologist is necessary. The doctor will conduct a visual examination, interview the patient and, possibly, prescribe additional diagnostic procedures - dermatoscopy or skiascopy.

Dermatoscopy is a detailed examination of the formation at high magnification. Using a special device - a dermatoscope, the doctor will be able to determine the structure of the formation, the changes that occur to it, take pictures and observe the nevus over time. Skiascopy is a scanning of the cell layer, which will also help determine the structure of the formation and the composition of its cells. Both procedures are painless and completely safe.

If a border nevus does not cause inconvenience to its owner, it is left untouched. However, if it is located in an area that is easy to injure, represents a significant cosmetic defect, or there is a risk of it degenerating into a malignant formation, the doctor raises the question of surgical removal of the mole.

In the first two cases, laser or ultrasound removal is used. Thus, the mole is removed layer by layer using a laser or exposure to high-frequency radio waves. If melanoma is suspected, radical surgery is used: the mole is completely removed along with the area of adjacent skin. After this, the material is sent for histological analysis to determine the type of melanoma and predict re-development, after which the patient can be prescribed treatment aimed at preventing the development of metastases.

Nevi can be on the body from birth, or they can develop as the body grows. Often they do not pose any inconvenience or danger, but there are exceptions.

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What is a borderline pigmented nevus?

A borderline pigmented nevus is a benign pigmented formation no more than 1 cm, gray, brown or black. Simply put, this is an ordinary mole. Borderline nevus does not have a clear localization and can appear on any part of the body. The pathology is most often single in nature; multiple formations appear much less frequently. Typically, borderline nevus has a congenital etiology, but sometimes appears in infancy, adolescence, or even later. The surface of the border nevus is smooth and even. A characteristic feature of a borderline nevus is the absence of hair on its surface. Another characteristic feature is its localization on the palms and soles. Other types of nevi never appear in these places.

Causes

The leading role in the occurrence of this condition is played by disturbances in the maturation and migration of melanocytes. A border nevus consists of cells that contain large amounts of melanin. Melanocytes spread from the basal layer of the epidermis, migrate and form a borderline pigmented nevus. Factors that can trigger the development of nevus include hereditary predisposition and UV radiation. Unlike ordinary cells, melanocytes that form a borderline pigmented nevus do not have processes that transfer melanin to surrounding cells. They seem to concentrate all the pigment in themselves. For this reason, it can be said that the melanocytes that form a borderline nevus have a weak metabolic capacity.

Clinical picture

At an early stage of development, a border nevus appears as a light yellow spot with round, clear boundaries. It has a smooth surface that is devoid of hair. The average size of a borderline nevus is about 0.2-0.5 cm.

During its development, a pigmented nevus can transform into flat nodules or complex infradermal nevi. According to statistics, 35% of all borderline nevi can transform into a malignant disease, namely melanoma. One of the varieties of border nevus is the cockade nevus. It is characterized by gradual saturation of pigmentation along the edges, forming a peculiar pattern in the form of concentric rings on the skin. The degeneration of a nevus into melanoma or another form of malignant disease can be judged by changes in color, rapid growth of the nevus, the appearance of ulcerations, uneven edges, cracks and tubercles.

Diagnostics

The disease is diagnosed by a dermatologist upon examination based on clinical symptoms. In order not to make a mistake when making a diagnosis, dermatoscopy is used. The essence of the method is to use a special fluorescent microscope, which magnifies the image several times. Another diagnostic method is siascopy. The siascope helps to establish the true picture of the formation (structure of the nevus, color, tendency to malignancy). Histological studies are not carried out for borderline nevus, since damage to it can provoke the development of a malignant disease. A biopsy is performed after the nevus is removed.

However, there are known cases of nevus degeneration into a malignant formation after its surgical removal.

It is necessary to differentiate this pathology with the following pigmentary diseases:

age spots;
freckles;
blue nevi;
seborrheic keratoma;
Dubreuil's melanosis;
Setton's nevi;
cavernous hemangioma.

It is necessary to make a differential diagnosis between borderline nevus and early melanoma. When identifying melanoma, attention is paid to the fact that the cancerous tumor developed for a long time at the site of the pigmented nevus, which did not cause any subjective sensations. Typically, nevi develop slowly from birth according to the person's weight. However, mechanical damage to the nevus is one of the main factors in the malignancy of the mole.

Treatment of the disease

Those with borderline pigmented nevus should undergo regular medical examinations. Like any other benign skin disease, it does not require urgent excision. But you should know that this pathology belongs to the melanoma-dangerous group of nevi. Many experts are inclined to believe that the best way to prevent melanoma is to remove it surgically, especially when the nevus is localized in areas of increased trauma. At the same time, removal of a nevus, even surgically, can cause its malignancy. In this case, you need to conduct a detailed study of the nevus and consult a dermato-oncologist.

Among the methods for removing borderline pigmented nevus, the following predominate:

Other methods, such as electrocoagulation and cryodestruction of nevus, are not advisable. Many experts are inclined to believe that the above methods cause severe tissue damage, which can provoke the development of melanoma at the site of the removed nevus.

Removing a nevus using a carbon dioxide laser does not leave behind any scarring of the skin. But this method is used only when the doctor is completely confident in the benign etiology of the nevus.

If the size of the nevus does not exceed 5 mm, then the radio wave method is used. It is removed with a radiosurgical knife. This method, like the laser one, does not require sutures.

If malignant degeneration of a nevus is suspected, it is urgently removed. The removed material is sent for histological analysis.

Prevention

Prevention of the disease consists of systematic preventive examinations, since owners of borderline pigmented nevus are at risk due to its malignancy. For this reason, dermatoscopy of nevi is performed every six months. People at risk are prohibited from being exposed to UV radiation for a long time and permanent use of sunscreens with a high protection factor is recommended.

A borderline nevus is very similar to a dark-colored spot that appears on the top layer of the skin. It is completely flat and does not rise above the surface. In origin it refers to a change in skin color. It contains cells that contain quite a lot of melanin. As a result of this, it did not come out, but lingered between the layers of skin. Very often such nevi are called birthmarks. They can appear on the human body at birth or subsequently. If there are a lot of them or they appear in large quantities, you need to consult a doctor. Usually this type of formation is benign, but other pathologies also occur. What does a borderline nevus look like?

Why do they appear on the body?

Special cells that produce melanin are called melanocytes. These are what borderline birthmarks are made of. They appear in the neural fold and move into the skin. Some of them appear on various mucous membranes, which is why you can determine the color of a person’s eyes. Others concentrate in the skin, then it becomes a certain shade.

In nature, there are cells that are created without a process and pigment does not come out of them. Therefore, it is removed from certain areas of the skin and pigment spots form.

All spots that appear on the body and are pigmented can be divided into several groups:

Border group. They occur during division and reproduction, but if there is a delay between the layers of the skin.
Mixed group. In this case, the cells are located in a deep layer, which is called the basal layer.
Intradermal spots that fall deep into the dermis.

It was noticed that if the cells penetrate very deeply, the birthmark will become more convex. Why does this happen and how is it characterized?

Signs of birthmarks

Many types of moles can appear on the human body during life.

Borderline ones can be distinguished by characteristic features:

when examining a borderline nevus, it becomes clearly noticeable that it is located above the surface of the skin. But in their shape they do not protrude above it, but look like spots. Sometimes they may resemble small elevations;
Most often, borderline nevus occurs on the limbs, trunk, and face. It is also found on the genitals. It can develop into a large pigment spot on any surface except the palms, soles and organs of the reproductive system. Some experts are of the opinion that their rebirth is impossible while in these places;
The appearance of several pigment spots with such signs at once occurs during the period of reaching biological puberty. Sometimes they begin to rise above the surface of the skin;
when touched, the stain is smooth and dry;
formations can be from 1 millimeter to several centimeters. But when the size reaches 1 cm, a diagnosis of the formation of an atypical mole is made;
border nevus has a characteristic difference in the form of the absence of hair, even the smallest one;
the color ranges from a yellowish tint to dark brown. This is due to the amount of melanin that is present in them. They usually have light shades.
if the shade is dark, then the cockade type of nevus is diagnosed. The color will be quite deep, and the growth may resemble a ring shape.

You don't need to make a diagnosis yourself. It is important to contact a specialist who will accurately determine the type of tumor.

Similarities with other moles

How will a border nevus be similar to other moles? Pigment spots or moles appear on the patient’s skin; they can all differ in the nature of their formation or have common properties.

Doctors pay attention to the following similarities:

In terms of external characteristics, they can resemble freckles, which sometimes appear in entire lesions.
They may be similar to a benign tumor, which is formed from cells of vascular tissue. It will be soft when touched.
A dark brown keratoma that appears in older people. They are rough, and the secretions of the sebaceous glands are noticeable on their surface.

In order to determine the type of tumor, you need to visit a doctor. The danger lies in the possibility of rebirth. Melanoma sometimes develops at the site of a borderline nevus.

Wherein:

the patient does not experience any pain;
The color of the mole may change;
it will change its contours;
the surface will become rough to the touch.

These symptoms can be called mild, and with a long delay in receiving medical care, the disease will progress.

This process can occur under certain conditions. Most often this is an injury to the border nevus. Especially if it is located on the palms and soles. In these places there is a possibility of injury due to incorrectly selected or uncomfortable shoes. Therefore, it is recommended to remove stains in advance.

Establishing diagnosis

The diagnosis is made when visiting a dermatologist.

What will the doctor do:

The patient's entire body is examined. The doctor must find out how many birthmarks there are. If necessary, a dermatoscope is used.
If possible, modern spectrophotometric intracutaneous analysis can be used.
Carrying out a biopsy is inappropriate; this examination method can provoke the process of degeneration of the nevus into a malignant formation.

A specialist examines the mole under a microscope. This type of diagnosis helps to identify the type of formation, detect its core, and accurately determine its shape. Sometimes pathology occurs, and the congenital spot will have a loose structure or they will be scattered in the upper layer of the skin.

In order to prevent complications, you need to:

monitor the appearance of new spots on the body. If they arise, consult a specialist;
on the recommendation of a doctor, remove any nevi that appear. In this case, modern methods are used, but sometimes it remains advisable to use conventional surgery.

You should only contact experienced specialists and medical institutions. You can only resort to the services of beauty salons if you have full confidence in their professionalism.

Synonyms of border nevi: functional or transitional nevus, .

Definition. Acquired pigmented nevus, the nevus cells of which are located only at the border of the epidermis and dermis.

Age and gender. Appears in early childhood. The first elements appear, as a rule, from 6-12 months from birth. There are no gender preferences.

Elements of the rash of borderline nevi. A round or oval spot, sometimes slightly raised above the skin level, less than 1 cm in size, with clear, even boundaries. The lesions are usually multiple. All border nevi are flat in shape. The third chapter of the book details the various clinical options for flat common moles.

Uniform color: various shades of brown, pink.

Any localization. Sometimes nevi are located on the palms, soles and genital area.

a - borderline nevus nevomelanocytic pinkish-brownish
b - borderline nevi nevomelanocytic homogeneous brown

Histology of nevus borderline. Nests of nevus cells in the lower part of the epidermis. The upper layers of the epidermis are without any special changes, only an elongation of the epidermal outgrowths is noted. Nevus cells are larger than normal melanocytes, with round or, much less frequently, elongated nuclei, small basophilic nucleoli, with abundant light cytoplasm, which may contain a large amount of pigment.

A retraction artifact is observed, due to which the melanocytes of the nevus are not adjacent to the surrounding keratinocytes. In cases where the nevus is highly pigmented, the elimination of melanin through the overlying layers of the epidermis is determined. Nevus cells may be clearly demarcated from the epidermis and dermis in the form of nests (“inactive border nevus”).

However, in some cases, nevus cells are intimately associated with the epidermis, as if sliding from its basal layer (the “accumulation” phenomenon) in the form of vaguely contoured groups and single cells that tend to penetrate the dermis (“active borderline nevus”). In this case, the correct structure of the layers of the epidermis is disrupted, its boundaries with the dermis become unclear. Histiocytic infiltration, usually mild, may be observed in the dermis.

In active borderline nevi, changes are observed that resemble early signs of malignancy. In childhood, such changes are often observed and should not cause alarm. Active borderline nevi in adults, especially in the presence of vacuolization, significant cell atypia and mitoses, should be regarded as the very initial phase of malignancy.

Diagnosis established clinically.

Borderline nevus is differentiated according to clinical signs with simple lentigo. These two melanocytic lesions are clinically indistinguishable from each other. However, lentigo simplex most often occurs on the lip (mainly on the lower lip) or on the penis (usually on the glans). In addition, in this atlas, in the third chapter, various clinical and morphological variants of ordinary moles are highlighted; in this regard, it is advisable to carry out differential diagnosis in these nosological groups.

Course and prognosis. Borderline nevus, which arose in early childhood, becomes mixed as a result of the proliferation of nevus cells and their advancement into the dermis. This usually occurs during puberty. After the borderline component disappears, it becomes an intradermal melanocytic nevus. This usually occurs between 10 and 30 years of age. In some cases, common acquired nevi remain borderline throughout the patient's life. This primarily concerns nevi of special localizations, which are discussed in the fifth chapter of the atlas.

Borderline nevi can resolve, and in some cases transform into dysplastic and then into melanoma.

a - regressive borderline nevomelanocytic nevus in a 36-year-old woman.
According to the patient, the nevus became lighter and decreased in size over the course of several months.
b - complex nevomelanocytic nevus, homogeneous light brown with preserved skin pattern on the surface.
The nevus is slightly and evenly raised above the surface of the skin
c - nevus complex nevomelanocytic evenly raised uniform brown with bristly hair growth
d - complex nevomelanocytic nevus of dark color

Nevus is a benign formation on the skin that can be congenital or appear at a certain stage of life. In ordinary life, such tumors are more often called moles or birthmarks. From a medical point of view, all these formations have a similar nature and mechanisms of occurrence.

In most cases, nevi do not require serious treatment and do not in any way affect a person’s quality of life. However, doctors classify some types of moles as precancerous conditions. In other words, such benign formations with some probability may develop into a cancerous tumor in the future. This is the main danger of nevi.

Interesting facts about moles

Most moles are congenital formations, but due to the small size of the entire organism, they are indistinguishable until a certain age.
Moles can change color throughout a person's life.
Often in women, nevi appear not only on skin, but also on mucous membranes. In men, this localization is much less common. Moles on the skin occur with approximately the same frequency in representatives of both sexes.
It is believed that one or another type of nevus is present in more than 90% of the population, but sometimes people themselves are not aware of it.
Some types of moles can reach very large sizes, causing serious inconvenience to people, not to mention a cosmetic defect. In the history of medicine, benign skin formations measuring more than 30 cm and weighing several kilograms have been described.
In the Middle Ages, in some European countries, people with a large number of moles were suspected of witchcraft. This was especially true for people with large birthmarks. Such formations were considered marks of the devil.
Many peoples believe that a person with a large number of moles will be especially happy in life.
People with blond hair and light eyes are genetically at higher risk of malignant degeneration of nevi of any type and development skin cancer.

Causes of nevi

Nevi are overgrowths of a certain type of skin cell that look like a growth or lump on the surface of the skin. Often moles contain a significant amount of melanin pigment, which gives them a darker color. Melanin is produced by cells called melanocytes in response to ultraviolet radiation. The neoplasm does not necessarily consist of melanocytes. Its structure may be dominated by completely different cells. Most often, it simply contains the pigment that these cells produce. For melanocytes, ultraviolet radiation is a stimulating factor, but it is not the only one that causes the production of pigment. The presence of melanotropic hormone, which is produced by the pituitary gland, is also important ( gland at the base of the brain). Thus, several body systems are involved in the process of staining nevi.

As for the direct formation of nevi, uncontrolled cell division takes place here. At a certain stage of development, it turns out to be excessive, which leads to the appearance of a neoplasm. Unlike skin cancer, nevi usually do not grow rapidly. Most types of moles and birthmarks are congenital and grow in parallel with the body. Thus, after the growth of the entire organism is complete at 20–25 years, the growth of the formations themselves stops or greatly slows down.

It is believed that the appearance of nevi is a consequence of the influence of certain factors:

local developmental defects;
hereditary factors;
ultraviolet radiation;
injuries;
hormonal factors;

Local developmental defects

This factor concerns, first of all, congenital moles. In some cases, they appear due to disturbances in the division of skin cells in the later stages of fetal development. Such defects are usually extremely small at birth and go unnoticed. Due to this, formations are noticed only at 2–3 years of a child’s life, when the surface of the skin increases significantly. It is believed that more than 60% of all moles have this origin.

Hereditary factors

It's no secret that sometimes moles and birthmarks seem to be inherited. This was noticed many centuries ago and served as proof of blood relationship even before the advent of tests. DNA. In reality, hereditary factors work as follows. Certain tumor formations or pigment spots are encoded by a chain of genes in the DNA molecule. When genetic material is transmitted, this chain is transmitted from chromosome from parents to children. After birth, the body develops according to the algorithm embedded in its genetic material. A mole appears in the process of deciphering and interpreting genes as the organism develops. Such formations are usually benign. In this case, the chance of passing on moles is approximately 50%, provided that the parent is also hereditary. Appeared during life ( acquired) nevi are not inherited because they are not programmed in the gene sequence.

Ultraviolet radiation

Ultraviolet radiation stimulates the functioning of melanocytes in the basal layer of the skin. For more intense pigment production, the body begins to produce more melanotropic hormone. If increased ultraviolet radiation continues to hit the skin, the number of melanocytes will increase to compensate. In other words, instead of tanning, which is an adequate protective reaction to radiation, a pathological reaction begins, which consists of the proliferation of skin cells. Nevi formed by this mechanism appear in adults and are acquired. Sensitivity to ultraviolet radiation is especially high in women after 30 years of age. Solarium in this case is also a risk factor.

Injuries

Mechanical damage to the skin ( insect bites, scratches, wounds) from the point of view of some experts may play a certain role in the development of acquired nevi. In this case, we are talking about an inflammatory process that affects various layers of the skin. Due to inflammation, tissues produce a large amount of biologically active substances that can stimulate cell growth. This factor in the appearance of moles is considered secondary and rare.

Hormonal factors

The participation of hormones in the process of mole formation was noticed when observing patients. Many researchers have noted that acquired moles appeared in adolescents during puberty. In addition, in rare cases, moles appear in women during pregnancy and in patients with serious endocrine disorders. In all these cases, physiological or pathological hormonal changes occur that affect the functioning of the pituitary gland. Melanotropic hormone, of course, plays the greatest role in the development of nevi, but other hormones can also influence the appearance of neoplasms.

Moles that appear against the background of hormonal changes rarely undergo malignant degeneration. Most often they do not reach large sizes ( less than 0.5 cm) and may disappear spontaneously without treatment several months after appearance.

Viruses and bacterial infections

Currently, the possibility of the appearance of nevi due to viral or bacterial infections affecting the skin is being considered. The reason for the emergence of this theory was the description of several similar cases in different countries. The mechanism of development of moles is similar to that of injuries. The leading place is occupied by the active inflammatory process. In case human papilloma virus neoplasms will be of a different nature. From the point of view of dermatology and histology ( by tissue structure) they will classify as papillomas, and not like nevi.

Based on the above factors and mechanisms of development of moles, risk groups can be identified. They include people who are more likely to develop acquired nevi throughout their lives. In addition, their skin tumors are more prone to malignant degeneration.

From the point of view of the development of skin cancer, as well as the appearance and growth of moles, the following risk groups are distinguished:

people exposed to increased ultraviolet radiation in the workplace;
people who regularly vacation in southern latitudes ( in equatorial countries);
people involved in the chemical industry or other industries using carcinogenic substances;
people who have been on treatment with hormonal drugs for a long time;
people with low immunity or chronic endocrine disorders;
people with a large number of congenital nevi ( increased risk of the appearance of new formations and their development into cancer);
relatives of patients who had histologically confirmed skin cancer ( melanoma ).

These categories of people should be especially attentive to their health. They are recommended to undergo preventive examinations with a doctor more often than others.

Types of nevi

The division of nevi into certain types is the subject of widespread debate among dermatologists and oncologists. The fact is that there are quite a large number of criteria by which skin tumors can be classified. In addition, there are a lot of descriptions of the types of moles themselves. As a result, there is no single universal classification that would be used in all medical areas and in all countries.

From the point of view of the mechanism of appearance of nevi, they are usually divided into two large groups:

Congenital moles. Congenital moles are less at risk of degenerating into melanoma, but are still considered by specialists to be precancerous conditions. When the growth of the body stops, the growth of the formation usually stops. Congenital nevi also include those moles that were first noticed by parents or a doctor before the age of 3 years inclusive. It is believed that up to this point the formations were so small that they were simply not detected at birth.
Acquired moles. Acquired moles appear throughout a person’s life under the influence of the factors mentioned above. According to statistics, they are more at risk of malignancy ( malignant degeneration) rather than congenital formations. This can be explained by the fact that the very appearance of nevi is a consequence of the influence of external or internal factors. Their further influence can also contribute to the transformation of the neoplasm into cancer.

However, both congenital and acquired forms of moles can be similar in structure. The histological classification of nevi is of greatest importance in medicine. It takes into account the main features of each type of tumor and makes it possible to predict the course of the disease with a high degree of probability. Of the variety of types of moles, of which there are more than 50, only about 10 types are the most common. They are conventionally divided into melanoma-mono-dangerous and melanoma-dangerous nevi. The former almost never undergo malignant degeneration, so their removal is mainly for cosmetic purposes. The latter pose an increased risk of developing cancer, so it is recommended to remove them in the absence of other contraindications.

There are the following types of melanoma-free nevi:

intradermal pigmented nevus;
papillomatous nevus;
halonevus;
Mongolian spot;
fibroepithelial nevus.

Intradermal pigmented nevus

Most often, this type of mole appears during adolescence. At first, the formation is localized inside the skin, without protruding above its surface ( hence the name of the type, “derma” in Greek - skin). The dimensions usually do not exceed a few millimeters. Such moles may change slightly in color and shape as the body grows and ages. However, to progression and a sharp increase in old age ( as happens with some other types) they are not inclined. Malignancy ( malignant degeneration) occurs in less than 20% of cases and only in the presence of additional predisposing factors.

Intradermal nevi are localized mainly in the following parts of the body:

skin of the neck and throat;
skin folds at the base of the limbs ( in the groin or armpit area);
under the chest ( among women);
skin of the trunk or limbs ( rarely).

Papillomatous nevus

This type of mole usually quickly catches the eye of patients due to its unpleasant appearance. Often people turn not only to a dermatologist, but also to an oncologist, immediately suspecting a malignant tumor. A nevus is a pronounced elevation above the surface of the skin, sharply different in color and texture. At first glance, it has a granular surface that is brownish in color, but can also be pinkish. The mole is soft and painless to the touch. There is usually no concern other than a cosmetic defect.

The predominant localization of such formations is the scalp, but they can also occur on the skin of the trunk or extremities. If there is a hair follicle on the surface of the mole, the hair sometimes differs in color from other hair. The formation may slowly increase throughout a person's life, but rarely undergoes malignant transformation. Due to the great external similarity with some types of malignant melanoma, it is recommended to biopsy the nevus as quickly as possible and determine its type based on its cellular composition.

Galonevus

Halonevus is often also called Setton's nevus. It is most often acquired and appears in people with severely reduced immunity, impaired hormonal status or severe autoimmune diseases. With this type of mole, a type of autoimmune reaction occurs when the body fights defective cells. This reaction is mild and does not lead to inflammation or other acute manifestations. However, it leaves a characteristic imprint on the appearance of this formation.

A halonevus is a round or oval mole that protrudes slightly above the surface of the skin. Its characteristic feature is the corolla of pale skin that surrounds its base. The size of the nevus itself is several millimeters, and the width of the depigmented area around it is up to half a centimeter ( more often 1 – 2 mm). This type of mole is localized on the skin of the trunk or extremities, but is extremely rarely found on the face, soles, feet or mucous membranes. Single formations are atypical, and when one formation of a similar type appears, others should be looked for. Most often, doctors do not recommend removing halonevus, but prescribe a large number of diagnostic procedures. These moles may be manifestations of more serious diseases that require timely, qualified treatment. The neoplasms themselves often go away without treatment several months or years after their appearance. The transformation of Setton's nevus into skin cancer is very rare.

Mongolian spot

The Mongolian spot is a type of birthmark in newborns that may be present in a less pronounced form in adults. In fact, it is a variant of a genetically determined pigment disorder, which allows it to be classified as a nevus. This type received its name due to the fact that such spots occur in almost 90% of newborn Mongolians. True, after a few years they disappear in 19 out of 20 children. In representatives of other nationalities, Mongolian spots are also found, but they are less pronounced and the prevalence usually does not exceed 0.5%.

The Mongolian spot is usually localized in the sacral area or on the skin of the buttocks. The average size of the formations is several centimeters, but sometimes they reach 10–15 cm in diameter. Even if such a spot remains in adulthood, it rarely causes the development of melanoma. Due to its inconspicuous localization and minimal cosmetic defect ( in adults, the spots are pale and do not differ much from the surrounding skin), special treatment is usually not prescribed.

Fibroepithelial nevus

This type of mole is one of the most common in medical and cosmetology practice. Such formations can be either congenital or acquired during life. However, there is no significant dependence on age or gender. Like other nevi, the peak occurs during periods of hormonal changes, but quite a few cases have been described in which such moles developed in old age.

Fibroepithelial nevus is usually round in shape or close to it. Sizes and location may vary. For example, patients usually turn to cosmetologists with formations about half a centimeter in diameter located on the skin of the face. The pigmentation of such moles is moderate, so the color is often pinkish or reddish. The formation is soft to the touch, but elastic. Patients do not experience pain upon palpation.

Since the tumor contains a significant number of connective tissue cells, its removal does not present much difficulty. On the other hand, malignant degeneration of fibroepithelial nevi is also rare. The growth of education slows down at a certain stage and usually does not accelerate until the end of life. The problem is that such moles are not prone to spontaneous disappearance without medical attention.

There are the following types of melanoma-dangerous nevi:

blue nevus;
borderline pigmented nevus;
giant pigmented nevus;
nevus of Ota;
dysplastic nevus.

Blue nevus

Blue nevus ( also blue or Jadassona-Tiche) is a variant of a precancerous condition, but in general refers to benign formations. It is an accumulation of melanocytes in the thickness of the skin, which appears more often throughout life. Typically, such moles are single, but multiple variants have also been described ( up to 4 – 5) formations. Blue nevus is called because its cells actively produce melanin. In practice the color may vary. Moles of this type are found in dark blue, dark purple, gray or black colors.

The mole most often protrudes above the skin, but can sometimes be palpated in the form of an intradermal node. This formation does not have a clearly defined statistical localization. Upon closer inspection, you can notice clear boundaries and some tension in the skin. The mole almost never exceeds 1 cm in diameter. Hair growth from it is not typical.

Despite the fact that in medical practice, the degeneration of a blue nevus into melanoma is not observed very often ( more often after injury or an unsuccessful attempt to remove it), patients with this type of mole should undergo regular preventive examinations.

Borderline pigmented nevus

Most often, this type of mole is congenital. Only in 15–20% of cases does it appear in the first few years of life. There is also evidence of the development of borderline nevus in adolescence, but this option is extremely rare.

In the absence of provoking factors, the formation grows and increases in proportion to the growth of the body. On average, its dimensions reach 0.8 - 1.2 cm. With increased growth, the mole can reach several centimeters in diameter. Usually it does not rise much above the surface of the skin. The color is determined by the high content of melanin and can be brown, purple or close to black. In some cases, concentric rings are noted. In this case, the color changes in stripes from the periphery to the center. However, this sign is not constant and does not occur in all border nevi.

Such formations do not have a particularly characteristic localization. However, this type of mole is one of the few found on the skin of the palms and soles. On palpation, the consistency does not differ much from adjacent areas of the skin. Compaction may indicate the onset of malignancy, which is observed quite often ( especially after injury or intense sunburn).

Giant pigmented nevus

This type of mole is difficult to confuse with other skin tumors. Firstly, it is always congenital and noticeable, as a rule, from the first days of a child’s life. Secondly, increasing as the body grows, the mole reaches a larger size than other skin formations. On average they vary from 3 to 7 cm in diameter, but sometimes cover an entire anatomical region ( neck, significant part of the body, cheek). Moles of this type have been described, measuring up to 35–40 cm. The cosmetic defect is aggravated by the fact that the formation protrudes strongly above the surface of the skin, representing a massive tumor.

The color of a giant pigmented nevus is usually gray or dark brown. For large sizes, it may be different in different places. No pattern is visible, and spots of different shades are located chaotically. Typical of such formations is the presence of deep cracks, grooves and small warts on the surface. Often there is increased hair growth from the follicles on the surface of the mole, which is not so common with other types.

Treatment of such nevi is usually prescribed for cosmetic purposes. However, cases of malignancy are not so rare ( up to 10% of cases). This is due to the fact that formations of such large sizes are easier and more often injured. Treatment is recommended surgically with wide excision of tumor tissue and skin grafting ( for large moles).

Nevus Ota

Nevus of Ota belongs to a small group of neurocutaneous syndromes in which the nervous factor also plays a certain role in the development of the neoplasm. This type of mole is located exclusively on the face, in the cheekbone area or along the edge of the eye socket. It is a spot with a high melanin content. A less common option is when several merging formations are located in one area.

Typical for this type of mole are changes in the mucous membrane of the eye, lip, or even palate, if the nevus has reached a fairly large size. The color is most often black-bluish. Visually, pigment spots in the sclera of the eye are sometimes striking ( eye white) or in the cornea area.

You can suspect nevus of Ota by collecting a detailed medical history. This formation in most cases is congenital ( Quite rare cases of occurrence in adolescence have been described). It has a clear genetic predisposition and is found only in Asian peoples or their descendants. Moreover, this type of moles is most common among the Japanese and Mongols. It is less common among the Chinese and representatives of the peoples of Central Asia.

Malignant degeneration of such age spots is not often observed, but has been reliably confirmed by many authoritative studies. This is associated with intense exposure to ultraviolet radiation. It is difficult for patients with nevus of Ota to protect themselves from it due to the relatively large size of the formation ( a few centimeters) and its position.

Dysplastic nevus

This formation is congenital in approximately half of cases. Familial cases of the disease have been repeatedly observed, when moles of this type were diagnosed in two or more members of the same family ( congenital dysplastic syndrome). However, it is believed that their spontaneous appearance during puberty is also possible. To make a preliminary diagnosis, it is necessary to clarify whether the patient had any relatives diagnosed with malignant melanoma. The formations themselves rarely exceed half a centimeter in diameter. A patient, as a rule, has several dysplastic nevi, but variants with a single formation are also possible.

On the body, this type of moles is located in the following places:

upper back;
lower limbs;
back of thighs ( to the coccyx);
inguinal folds and skin around the external genitalia;
other localizations ( are observed noticeably less frequently).

Such moles can have a variety of colors - from light brown to pronounced black ( There are even reddish and pink formations). Uneven coloring is often observed, when the edges of the neoplasm are one color and the center is another. The surface of the nevus is flat and relatively smooth. A biopsy helps confirm the diagnosis, which determines the typical arrangement of cells for this species. Prognosis for patients with this neoplasm ( especially with the purchased version) the most unfavorable. Without removal or appropriate care, they will at some point develop into malignant melanoma in more than 90% of cases.

What do nevi look like?

In most cases, detecting nevi of any kind is not too difficult. Their owners themselves know very well about neoplasms. Problems usually appear if moles are not saturated with melanin and do not differ in color from the surrounding skin. In addition, tumors of small sizes or in atypical places often go unnoticed ( inguinal folds, armpits, etc.). In all these cases, the patient himself may not be aware of his problem.

With moles of normal size, difficulties arise in recognizing the type of neoplasm. Even experienced doctors sometimes cannot correctly classify a disease without microscopic tissue analysis. However, each type has some more or less specific external characteristics.

Visual differences between some types of nevi

Type of nevus	Photo	Brief description and characteristics
Melanomic nevi
*Intradermal pigmented nevus*		Moles are small, usually pigmented ( painted), are located in the thickness of the skin, but can sometimes protrude slightly above its surface. At the same time, the skin pattern is preserved, and the nevus itself seems to push the top layer of skin from below.
*Papillomatous nevus*		A distinctive feature is the rough surface with numerous irregularities, grooves and warts. Often localized in the scalp.
*Galonevus*		The presence of a depigmented crown around the mole is characteristic. Its center almost always rises above the surrounding area of skin.
*Mongolian spot*		Pigmentation can be very intense in newborns and barely noticeable in adults. The spot reaches a large size, but does not rise above the surface of the skin.
*Fibroepithelial nevus*		Most often round in shape with relatively smooth and regular edges. Not necessarily highly pigmented, but may be pinkish or light brown in color.
Melanoma-dangerous nevi
*Blue nevus*		Almost always, bluish or bluish shades are discernible in the pigmentation of this nevus. The mole is small in size and is often a single formation.
*Borderline pigmented nevus*		The appearance of this type of mole can vary greatly. A specific feature is a concentric change in color in circles from the periphery to the center of the formation, but such coloring is observed quite rarely.
*Giant pigmented nevus*		Easily distinguishable due to its large size, uneven surface, and significant elevation above the surrounding skin. Increased hair growth is often observed on the surface of such moles.
*Nevus Ota*		Located in the area of the orbit, upper jaw or zygomatic bone. In parallel, age spots may appear on the mucous membranes of the eyes, nose, and oral cavity.
*Dysplastic nevus*		May vary greatly in appearance from one patient to another. Most often they have an irregular shape, uneven edges and uneven surface color.

The above visual features play a big role in the process of diagnosing nevi. However, even experienced doctors with extensive experience can make a mistake in classifying a mole by appearance. The table lists only the most common forms of nevi. In practice, they have to be distinguished not only from each other, but also from many other skin formations. In this regard, a visual assessment is more important for patients to know when to see a doctor and for what reason.

Diagnosis of nevi

The most important task in diagnosing nevi is their clear differentiation from malignant neoplasms of the skin ( primarily with melanoma). The latter requires urgent qualified assistance, since we are talking about the patient’s life. In this regard, the doctor at the appointment will try to exclude a malignant formation and only after that will determine the type of nevus. The latter is important for making a correct prognosis of the disease, informing the patient and the regime of preventive examinations.

The following types of examination can be used in the diagnosis of nevi:

history taking ( patient interview);
visual data;
dermatoscopy;
indication by phosphorus isotope;
echography;
radiography;
thermometry;
biopsy.

History taking

Questioning the patient and asking the right questions is a very important source of diagnostic information. This is especially felt when diagnosing skin tumors, when other rapid research methods do not provide sufficient data.

Diagnosis by any specialist begins with collecting an anamnesis. In the case of nevi, you should pay attention to a number of issues that may somewhat clarify the situation. First, it is necessary to clarify the family history. The doctor determines whether any of your blood relatives have moles or birthmarks. Here the question should also be asked about cases of diagnosed melanoma in the family. A positive family history may clarify the situation and facilitate classification of the neoplasm.

Secondly, the doctor will definitely ask about the presence of external and internal factors that could predispose to the appearance of nevi and the development of melanoma. We are talking about conditions in the workplace ( hypothermia, exposure to high temperatures, contact with chemicals or radiation) and the presence of chronic pathologies. If you establish which factors caused the appearance of the nevus, it will be easier to make the correct diagnosis and begin the correct treatment.

Visual data

As noted above, each type of nevus is characterized by certain visual signs. As a result, the doctor will try to study the tumor itself in as much detail as possible. Often, to obtain sufficient information, a thorough examination of not only the affected area, but the entire surface of the body may be necessary. As noted above, some types of moles are characterized by localization even on the mucous membranes. In this regard, at the first appointment with a dermatologist or oncologist if melanoma is suspected, an examination of the oral cavity, as well as a rectal and vaginal examination, may be necessary.

The doctor evaluates detected tumors according to the following criteria:

number of moles;
size;
localization;
color;
consistency;
time of appearance;
changes since the last inspection.

The last point is especially important. Sometimes benign tumors are very similar in appearance to melanoma. If a favorable prognosis was confirmed after a biopsy, then in the future it will no longer be the above criteria that will have diagnostic significance, but the changes that occur with the tumor.

Based on an objective examination, benign and malignant formations can be distinguished as follows:

formations more than 1 cm in diameter are more often prone to malignancy;
sharpening of the edges of the mole, loss of the correct shape and its growth to the sides indicates a gradual malignant degeneration;
the appearance of pain or itching in the area of the nevus, which previously did not cause any inconvenience;
the appearance of small nodules ( most often black and dense) on the surface of a mole;
rapid compaction, or, conversely, softening of the nevus ( not during therapy);
pinpoint bleeding on the surface of a birthmark or mole ( including the release of ichor with the formation of a crust);
drying and peeling of the surface of the nevus;
hair loss from hair follicles ( if there were any on the surface of the mole);
gradual color change ( especially if the coloring eventually becomes uneven);
redness of the skin and signs of inflammation around the mole;
the appearance of small pinpoint formations around the nevus.

The appearance of any of the above symptoms may be the first sign of a malignant transformation of a mole into melanoma. Patients themselves can notice these signs, which should certainly lead them to consult a doctor. If such signs are detected during examination, the doctor may recommend removing the formation without further tests and studies.

Dermatoscopy

Dermatoscopy is a thorough examination of neoplasms on the surface of the patient's skin. It is carried out using a special device that magnifies the image several tens of times. Thanks to this, the specialist has the opportunity to notice minimal changes on the surface of the nevus. Nowadays, this examination method is considered very effective for the early diagnosis of melanoma. The main advantages are quite high information content with complete painlessness and relatively low cost of the procedure.

The examination can last from 3 – 5 to 15 – 20 minutes or more, depending on the number of nevi. The method has no contraindications, since it is non-contact, that is, the patient is not affected either mechanically or by any physical radiation.

Most often, dermatoscopy is prescribed during the first examination of the patient and during repeated scheduled examinations. It does not allow you to confirm or exclude the diagnosis 100%, but it can tell the doctor which studies will be the most informative in the future.

Phosphorus isotope indication

This method is highly sensitive, as it is based on the accumulation of radioactive phosphorus by a malignant tumor. Phosphorus normally takes part in the process of cell division. With melanoma, division occurs very intensively, which is why the need for phosphorus increases. The test uses an isotope because it is easy to detect when scanned. In patients with melanoma, labeled phosphorus accumulates more intensely in the area of nevi. This indicates increased cell division and makes it possible to confirm the diagnosis with a high degree of probability.

Echography

Echography involves examining the soft tissue at the base and around the nevus to determine its exact size. Some formations ( especially malignant) intensively grow into the thickness of the skin and even subcutaneous fat. Of course, echography is prescribed only for nevi of sufficiently large size. Most ultrasound machines simply will not pick up flat moles that are a few millimeters in size. In addition, the accuracy of the study will be quite low if the density of the nevus tissue is the same as the density of the surrounding tissues. In this case, it can be very difficult to catch the boundary of the neoplasm. As a result, echography is prescribed as a preparation for surgery to remove large nevi and does not have widespread practical use in the diagnostic process.

Radiography

In the process of diagnosing melanoma, an X-ray examination may also be necessary. In this case, the doctor must have access to special equipment, since standard X-ray machines will not provide the necessary information. The picture is taken with increased sensitivity of the device in various projections and with a magnification of 5–10 times. This method allows you to see and evaluate the tissue structure of the nevus itself. With malignant degeneration, it will be heterogeneous with a large number of small cavities or compactions. The method has virtually no contraindications, since the dose of radiation that the patient will receive during the study is extremely small.

Thermometry

Thermometry is a local measurement of skin temperature using a special device. It is believed that the growth of any tumor formations ( both benign and malignant) is accompanied by a slight increase in temperature. This is explained by active metabolism, which always accompanies the process of cell division. During local thermometry, the temperature on the surface of the skin in healthy areas and on the surface of tumors is compared. On average, with benign nevi, the difference will fluctuate within 1 degree. With malignant degeneration of the tumor and the development of melanoma, the difference in local temperature indicators can be up to 2 - 2.5 degrees.

This research method is painless, fast and quite accurate. Many doctors try to re-prescribe local thermometry during regular monitoring of the patient in order to be able to compare changes in indicators over time. Directly during the procedure, pay attention to comfortable environmental conditions, as they can greatly distort the results of the study.

Biopsy

A biopsy is the most reliable way to determine the type of nevus and identify the first signs of malignant degeneration into melanoma. The accuracy of the method when the procedure is performed correctly reaches almost 100%. A biopsy involves taking a piece of tissue from a tumor for analysis. Using staining, a special substance is made from the resulting sample, convenient for microscopic examination. After this, the doctor, based on the type of cells, their location and shape, makes a conclusion about the nature of this neoplasm.

There are two main types of biopsy:

Needle biopsy. This procedure involves taking a piece of tissue using a special needle. Cells are taken pointwise and in limited quantities, so the information content of the method is limited. However, in most cases this is enough to make a correct diagnosis and give the patient a correct prognosis regarding the development of the disease. The procedure is usually done under local anesthesia ( pain relief).
Total excisional biopsy. This method can be classified as both diagnostic and therapeutic measures. The fact is that it removes the tumor for subsequent histological examination. The accuracy of this method is the highest because the doctor has enough material at his disposal. This diagnostic method is applicable only to superficial nevi up to 0.5 - 1 cm in size. Removal is usually performed under general anesthesia. The purpose of examining a mole after its removal is to detect signs of degeneration into melanoma. If they are found, the patient is prescribed a course chemotherapy, since the tumor may reappear.

A biopsy is resorted to at the final stage of the diagnostic process, when other research methods have already been carried out, and the final diagnosis has not been made. Histological analysis is required before radical surgery ( large-scale tissue excision, amputation) regarding malignant skin tumors.

An alternative to a biopsy is a cytological examination of the imprint of the nevus. In this case, the doctor obtains the material by scraping cells from the surface of the mole or simply pressing a glass slide onto the formation. This method is especially informative if there are any discharge or ulcerations on the surface. Cytological analysis of a nevus imprint is less informative than a biopsy, but does not require anesthesia and is easier to perform.

Diagnostic tests such as general blood analysis , blood chemistry or Analysis of urine for nevi they are usually not prescribed, since specific changes are not observed in this pathology. Sometimes these tests are performed before a biopsy or surgery to remove the tumor. In this case, the purpose of the study is to assess the functioning of the internal organs and systems of the body. Sometimes they help to identify contraindications to surgery and some chronic diseases that can affect the course of the disease.

If nevi appear against the background of chronic diseases or infections, repeated blood and urine tests, as well as bacteriological studies, may be necessary. They are necessary for the correct treatment of the underlying pathology, since nevi in this case are considered as a symptom and do not require urgent treatment.

Treatment of nevi

Treatment of nevi begins after all diagnostic procedures have been completed ( preferably with tissue biopsy). Drug treatment is practically not used, since it does not have a pronounced effect on formed tumors. A course of treatment with various drugs is prescribed if moles appear against the background of other pathologies. Treatment of the nevi themselves, as a rule, involves their removal.

There are the following methods for treating nevi:

surgical removal of a mole;
treatment with folk remedies;
preventive measures in case of refusal of removal.

Surgical removal of a mole

Treatment of nevi in most cases involves removal of the tumor. It can be prescribed for medical reasons or at the request of the patient in case of a pronounced cosmetic defect. Medical indications for this are considered to be signs of malignant degeneration of a mole. Removing tumors in most cases does not pose serious problems. This type of operation is performed not only by dermatologists, but also by many beauty salons. The main requirement before intervention is the exclusion of melanoma or other types of malignant tumors. In this case, not only removal of the tumor will be required, but also an intensive course of treatment after that. If melanoma is suspected, dermatologists and cosmetologists should not undertake surgery without consulting an oncologist.

Mole removal can be done in the following ways:

Tissue excision. Excision of tissue is performed using an ordinary scalpel. The surgeon removes the overgrown pigment cells and some area of skin around ( up to several centimeters). The operation is performed under local or general anesthesia, depending on the location of the mole and its size. After removal, a scar may form at the site of the nevus ( even when applying an invisible intradermal suture). All this has led to the fact that in recent years, surgical removal of benign nevi is almost never used.
Cryodestruction. Cryodestruction is the freezing of tissue. In this case, the cells stop dividing and die. The frozen area of tissue is removed without damaging the skin underneath. The advantage of this method is that it is painless and there are no scars after the procedure. However, with cryodestruction there is a high chance that the nevus will not be completely removed, which can lead to its re-development. Therefore, it is prescribed mainly for small moles located superficially.
Laser surgery. Laser surgery is perhaps the most common way to remove nevi. Using a laser, liquid is evaporated from the tissue, which leads to cell death. This procedure is usually performed without pain relief. During removal, the patient may feel a slight tingling or warmth. The advantage of the procedure is that it can be successfully used for a large number of nevi. There are no scars or scars left after removal. Only moles of significant size can pose a problem ( more than 1 – 2 cm in diameter). Evaporating this amount of tissue takes longer and sometimes cannot be completed completely ( part of the nevus remains and can grow again). In such cases, it is better to resort to regular mole excision.
Electrocoagulation. Electrocoagulation is a process that is in many ways similar to laser evaporation of tissue. Cells are destroyed under the local influence of electric current. This method is also used mainly to remove small formations.

Folk remedies

Considering that the prognosis for most moles is favorable, it is possible to try to remove them using traditional medicine. Before this, it is necessary in any case to visit a dermatologist or oncologist to rule out precancerous conditions or malignant degeneration of nevi. In these cases, neglect of traditional medicine can greatly aggravate the course of the disease and even pose a threat to the patient’s life.

There are the following traditional methods for removing moles:

lapis pencil. Lapis is an alternative name for silver nitrate. This substance has been used in medicine for many hundreds of years to cauterize and disinfect wounds and other skin lesions. In traditional medicine, this remedy is not very common, since there are more effective silver preparations with a similar effect. Nevi should be cauterized with lapis 1–2 times a day until signs of tumor reduction appear. Since concentrated silver nitrate is used to remove moles, it should not be used for a long time. If 2–3 weeks after the start of the procedures the mole does not shrink, then you should look for other treatment methods.
Celandine juice. Celandine juice also has disinfectant and cauterizing properties, which can help in the fight against certain types of nevi. This product is used several times a day, applying a thin layer to the surface of the tumor. Since celandine juice does not have sufficient viscosity and can quickly wear off or evaporate, it is sometimes mixed with petroleum jelly. The result is a mixture that will be most effective in the fight against moles.
Vinegar essence. Treating nevus with vinegar essence is a more effective remedy than lapis or celandine. It can eliminate the tumor within a week. The effect of the essence is based on cauterization of tissues with acetic acid, which makes up 70–80% of the substance. Cauterization may be painful. It should not be done more often than once a day. After the procedure, the cauterized area must be bandaged with a clean bandage to avoid infection. Cauterization with vinegar essence is fraught with residual defects after mole removal.
Hemp oil. Hemp oil promotes tissue evaporation, which can be used to try to remove nevi. It is necessary to lubricate the formations 3 – 4 times a day for several weeks. There is no direct tissue destruction, so the procedure is completely painless. In practice, the effectiveness of this method is approximately 3–5%, depending on the size and shape of the moles.
Lemon juice. The effect of lemon juice is also based on cauterization of the neoplasm with acid. However, the acid concentration is not high enough to cause direct tissue destruction. You need to lubricate the mole at least 4 – 5 times a day. In some cases, the nevus may disappear within a few weeks.

The above folk methods, unfortunately, help on average only in 10 - 15% of cases. In addition, the use of concentrated acids to cauterize moles is associated with tissue injury, pain and the risk of infection in the wound. In this regard, most doctors do not approve of self-removal of moles using folk remedies. Cutting off tumors with sharp objects ( razor, scissors) is strictly prohibited due to the high risk of complications. Nowadays, the best solution is to contact a qualified specialist who will help quickly and efficiently solve the problem.

Preventive measures in case of refusal of removal

As already explained above, some types of nevi are classified as precancerous conditions that threaten malignant degeneration in the future. To avoid this, it is necessary to follow a number of preventive measures that reduce the likelihood of cancer.

Prevention of skin cancer comes down to the following rules:

Limited exposure to direct sunlight. In this case, the intensity of ultraviolet radiation, which promotes cellular mutations, matters. Ordinary solar cells also play a certain role. burns after a long tan. Such harmful effects should be avoided even by healthy people without skin tumors. Patients with moles should not only not sunbathe for a long time, but also additionally protect the nevi with an adhesive plaster or cloth.
Combating dry skin. Dry skin also predisposes to malignant cellular changes in nevus tissue. In this regard, it is recommended to use special moisturizers. To choose a quality product, you can consult a dermatologist or cosmetologist.
Timely treatment of skin diseases. There are a large number of dermatological diseases that can contribute to the malignant degeneration of nevi. Skin manifestations of infectious or systemic pathologies sometimes have a similar effect. As a result, patients with moles need to, when the first symptoms appear ( rash, persistent redness, itching, peeling) consult a doctor.
Protection from mechanical injuries. If the mole is located on the palm, foot, neck, or in another place subject to frequent mechanical stress, it is recommended to remove this growth. Regular trauma and, as a result, inflammation contribute to the development of skin cancer. If it is impossible or unwilling to remove the nevus, you should at least protect it using a patch.
Protection from exposure to carcinogens. A number of chemical compounds used in everyday life or in industry can have a mutagenic effect ( provoke the development of cancer). If you have moles, it is necessary to limit skin contact with such compounds. If possible, it is recommended to avoid other types of contact of the body with carcinogens ( inhalation, ingestion). Smoking in this case it can also be considered a risk factor. It has been proven that tobacco combustion products also contain some carcinogenic substances.
Regular consultation with a doctor. Compliance with all of the above rules does not exempt the patient from the need to regularly undergo preventive examinations by a dermatologist or oncologist. The recommended frequency of consultations is once a year. If necessary, the specialist himself notifies the patient about the need for more frequent examinations.

What is a borderline nevus? Why is borderline nevus dangerous?

What is a border nevus called?

Why does it occur?

Symptoms of education

Diagnosis of the junctional spot

Features of treatment

Preventive measures

Borderline pigmented nevus

Symptoms of borderline pigmented nevus

Borderline pigmented nevus and its diagnosis

Treatment of borderline pigmented nevus

Borderline nevus: should you be afraid of pathology?

What is a borderline nevus?

Development of melanoma

Signs of malignancy

Diagnosis and treatment

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What is a borderline pigmented nevus?

Causes

Clinical picture

Diagnostics

Treatment of the disease

Prevention

Why do they appear on the body?

Signs of birthmarks

Similarities with other moles

Establishing diagnosis

Causes of nevi

Local developmental defects

Hereditary factors

Ultraviolet radiation

Injuries

Hormonal factors

Viruses and bacterial infections

Types of nevi

Intradermal pigmented nevus

Papillomatous nevus

Galonevus

Mongolian spot

Fibroepithelial nevus

Blue nevus

Borderline pigmented nevus

Giant pigmented nevus

Nevus Ota

Dysplastic nevus

What do nevi look like?

Diagnosis of nevi

History taking

Visual data

Dermatoscopy

Phosphorus isotope indication

Echography

Radiography

Thermometry

Biopsy

Treatment of nevi

Surgical removal of a mole

Folk remedies

Preventive measures in case of refusal of removal