Moles (nevi) can appear flesh-colored, pink, or even translucent, contrary to the common perception that they must be dark brown or black. A mole is a common skin growth that develops from a cluster of melanocytes, the cells responsible for producing skin pigment. While most nevi contain high amounts of melanin, leading to a dark appearance, some do not. These unpigmented or lightly pigmented moles are a normal variation that requires careful observation.
The Mechanism Behind Colorless Moles
A mole appears flesh-colored when the melanocytes within it either produce very little pigment or are situated deep within the skin’s layers. These growths are often classified as amelanotic nevi when they entirely lack melanin, or hypopigmented nevi when they contain significantly reduced pigment. Melanocytes are present, clustered together to form a mole, but they fail to effectively manufacture or transfer melanin.
The Intradermal Nevus is another common type, frequently presenting as a soft, raised, flesh-colored bump. Here, the melanocytes have migrated deep into the dermis, the layer beneath the surface epidermis. Since the pigment-producing cells are located far below the surface, the melanin they produce is visually obscured by the overlying skin tissue, making the lesion appear skin-toned.
The appearance of a mole is determined by the type and location of the melanocytes. As a person ages, many moles naturally lose pigment and move deeper into the dermis. This causes them to transition from a flat, brown spot to a raised, flesh-colored dome. This depigmentation and migration process is a normal part of the life cycle for many benign nevi.
Differentiating Moles From Benign Bumps
Many common, harmless skin lesions can be mistaken for a flesh-colored mole, making visual differentiation difficult for the untrained eye. One frequent look-alike is the skin tag (acrochordon), a small, soft, often pedunculated growth attached to the skin by a thin stalk. Skin tags are composed of loose collagen fibers and blood vessels, not clustered melanocytes. They typically appear in areas of friction like the neck, armpits, and groin.
Another benign growth that appears flesh-colored is seborrheic keratosis. While they can range from light tan to black, they often remain skin-toned. These growths are characterized by a waxy, “stuck-on” appearance and a rough or scaly texture. Unlike moles, seborrheic keratoses are composed of an overgrowth of ordinary skin cells.
Dermal nevi (intradermal nevi) are a type of true mole that is almost always flesh-colored and often raised in a dome shape. These growths are soft to the touch and can sometimes develop fine hairs. While other flesh-colored bumps are not true moles, the dermal nevus is a common, harmless mole whose color is masked by its deep location in the skin.
Recognizing Warning Signs in Flesh-Colored Spots
While most flesh-colored moles are harmless, a rare concern is Amelanotic Melanoma. This form of skin cancer lacks the dark pigment typically seen in most melanomas. Since the usual color warning sign is absent, monitoring these spots requires focusing on other characteristics of change. The standard ABCDE rule must be adapted, as the ‘C’ (Color) is not a reliable indicator.
Attention must be paid to Evolution, the ‘E’ in the rule, which encompasses any change over time. Warning signs include a rapid increase in size, a change in shape, or a change in surface texture. A lesion that begins to bleed, itch, or become tender without injury warrants immediate professional evaluation.
The Ugly Duckling Sign is particularly helpful with these colorless lesions, referring to any spot that looks distinctly different from all other moles on the body. Physicians also use the “3 R’s” to look for lesions that are Red, Raised, and showing Recent change. Any flesh-colored spot that is asymmetrical, has an irregular border, or is actively evolving should be examined by a dermatologist.