dermatologic disorders
Moles
Diagnosis of Moles
Clinical evaluation Sometimes biopsy Because moles are extremely common and melanomas are uncommon, prophylactic removal is not justifiable. However, biopsy and histologic evaluation should be considered if moles have certain characteristics of concern (known as the ABCDEs of melanoma): A: Asymmetry—asymmetric appearance B: Borders—irregular borders (ie, not round or oval) C: Color—color variation within the mole, unusual colors, or a color significantly different or darker than the patient's other moles D: Diameter—>6 mm E: Evolution—a new mole in a patient>30 years of age or a changing mole If a mole becomes painful or itchy or bleeds or ulcerates, biopsy can also be considered. The biopsy specimen must be deep enough for accurate microscopic diagnosis and should contain the entire lesion if possible, especially if the concern for cancer is strong. However, wide primary excision should not be the initial procedure, even for highly abnormal-appearing lesions. Many such lesions are not melanomas and, even with melanoma, the proper treatment margin and recommendation for lymph node sampling is determined based on histopathologic features. Excisional biopsy does not increase the likelihood of metastasis if the lesion is malignant, and it avoids extensive surgery for a benign lesion. 