A mole, or nevus, is a common skin growth that develops when pigment cells (melanocytes) grow in clusters. While moles are typically harmless, changes in their appearance can suggest a potential health risk, such as melanoma. The primary purpose of a dermatologist appointment is to screen these spots for irregularities, allowing for the detection of abnormal growths in their earliest, most treatable stages.
Preparing for Your Mole Check
To improve the thoroughness of the examination, arrive prepared to share a detailed medical history, including any personal or family history of skin cancer, as well as a current list of all medications and supplements.
Dermatologists require a clear view of the skin’s surface for effective visual inspection. Avoid using makeup, self-tanners, and heavy body lotions before your visit, as these obscure subtle changes. It is also recommended to remove all nail polish, as melanoma can develop beneath the nail unit, preventing necessary examination.
The Comprehensive Skin Examination
The examination usually involves a careful, head-to-toe inspection of the entire skin surface. The dermatologist closely examines all moles, freckles, and pigmented lesions, including areas difficult for the patient to see, such as the scalp and back. Wearing hair loosely facilitates a complete examination of the scalp.
To evaluate a lesion more closely, the dermatologist uses a handheld dermatoscope. This specialized tool provides magnification and illumination, allowing the physician to visualize deeper patterns and structures not visible to the naked eye. This technique, known as dermoscopy, is a standard of care for assessing pigmented lesions and increases diagnostic accuracy.
The physician uses a systematic framework to assess the moles, commonly referred to as the ABCDE method.
- A stands for Asymmetry, meaning one half of the mole does not match the other half.
- B is for Border irregularity, where the edges appear ragged, notched, or blurred.
- C represents Color variation, indicating the presence of multiple shades of brown, black, red, or white within the same lesion.
- D is for Diameter, as lesions larger than 6 millimeters (roughly the size of a pencil eraser) warrant closer attention.
- E stands for Evolving, referring to any change in the mole’s size, shape, color, or elevation over time.
When a Mole Needs Further Evaluation
If a mole displays concerning features based on ABCDE criteria or dermoscopic evaluation, the dermatologist may recommend a biopsy for a definitive diagnosis. This quick, in-office procedure typically takes about 15 minutes. The area is cleaned and numbed using a local anesthetic injection, which may cause a brief stinging sensation.
The choice of biopsy technique depends on the lesion’s size, location, and suspected condition.
Shave Biopsy
A shave biopsy uses a sharp blade to remove the superficial layers of the skin, including the lesion. This method is suitable for growths confined to the surface, such as benign lesions, and usually does not require stitches.
Punch Biopsy
For lesions that may extend deeper, such as suspected melanoma, a punch biopsy obtains a full-thickness sample of skin. This technique uses a circular instrument (often 2 to 6 millimeters in diameter) to remove a small core of tissue, typically requiring one or two stitches to close the wound.
Excisional Biopsy
When there is a high suspicion of melanoma, an excisional biopsy removes the entire lesion along with a small, surrounding margin of healthy tissue. This ensures the pathologist can accurately determine the depth and margins of the growth.
Understanding Results and Follow-Up Care
After the tissue sample is collected, it is sent to a pathology laboratory for analysis. A pathologist prepares the sample by preserving, processing, and staining it for microscopic examination. The pathologist then examines the cell structure to determine whether the lesion is benign, atypical, or cancerous.
Results typically arrive within three to five business days, though complex samples requiring special stains or a second opinion may take up to 10 to 14 working days. Your dermatologist will contact you to communicate the findings and explain any next steps, which may include further treatment if cancer is detected.
Following the procedure, you will receive specific instructions for wound care to prevent infection and promote healing. This typically involves keeping the site clean and applying an antibiotic ointment and a bandage. If stitches were used, you will return to the office for their removal. Finally, surveillance is scheduled, which may be an annual full-body check or more frequent screenings depending on your personal risk factors.