Moles are common skin growths resulting from clusters of pigment-producing cells called melanocytes. Nearly every child will develop them, and most moles that appear during childhood are benign and harmless. These growths can be present at birth or appear later, causing parents to worry about which ones require medical attention. Understanding the normal appearance and behavior of a child’s moles helps identify the few that need professional evaluation.
Understanding Common Moles in Children
There are two main types of moles seen in pediatric patients: congenital and acquired. Congenital nevi are those present at birth or appearing shortly after, occurring in about one percent of newborns. Acquired moles, which are far more numerous, typically begin to appear during early childhood and adolescence, often in areas exposed to the sun.
A common mole exhibits symmetry, a regular border, and uniform color. They are usually round or oval-shaped and remain smaller than six millimeters in diameter. It is normal for these moles to grow proportionally as the child grows, and they may become slightly raised over several years.
Changes in color, such as a mole getting slightly darker or lighter, can be a normal part of development, particularly during hormonal shifts like puberty. However, the color must remain consistent across the entire mole, presenting as a single, uniform shade of tan or brown.
Key Warning Signs: When to Seek Evaluation
While most moles are harmless, certain features indicate a potential risk of melanoma. These concerning signs are summarized by the ABCDE criteria, which helps identify atypical lesions.
“A” stands for Asymmetry, meaning one half of the mole does not mirror the other half. “B” refers to an irregular Border, where the edges are blurred, notched, or poorly defined. “C” is for Color variation, particularly if the mole displays multiple shades of brown, black, white, red, or blue.
“D” for Diameter refers to moles larger than six millimeters, but smaller lesions showing other signs should not be ignored. The most significant and predictive warning sign in both children and adults is “E” for Evolving, meaning any noticeable change in the size, shape, color, or elevation of a mole warrants immediate evaluation. New symptoms like bleeding, crusting, non-healing sores, tenderness, or persistent itching are strong indicators of a problem.
A helpful concept is the “ugly duckling” sign, which suggests looking for any mole that stands out or looks distinctly different from the child’s other moles. This is especially important because pediatric melanomas sometimes present unusually, appearing as a fast-growing, single-colored, raised pink or red bump that may not meet the classic ABCD criteria.
Moles Unique to Pediatric Patients
Some moles have characteristics that can look alarming but are often benign. The Spitz nevus is one such lesion, commonly presenting in childhood as a solitary, dome-shaped papule that can be pink, red, or reddish-brown. It may grow rapidly for a few months, reaching up to one or two centimeters.
Despite their worrisome appearance and fast growth, Spitz nevi are generally harmless, though they can sometimes mimic the microscopic features of melanoma. The Halo nevus is a mole surrounded by a white ring of skin. This white ring results from the body’s immune system attacking the mole cells, causing depigmentation.
Large or giant congenital nevi, those present at birth, require close, long-term monitoring because they carry a slightly increased lifetime risk of developing into melanoma. The risk level is directly related to the final projected adult size of the birthmark. Any focal change within a congenital nevus, such as a new bump or area of darkening, should prompt a consultation.
What Happens at the Pediatric Dermatologist
A pediatric dermatologist begins the evaluation with a visual examination of the child’s entire skin surface. The specialist uses a handheld device called a dermoscope, which provides a magnified, illuminated view of the mole’s internal structures. This painless procedure helps differentiate between benign patterns and features characteristic of melanoma.
For moles deemed low-risk, the dermatologist recommends “watchful waiting,” involving photographic documentation and re-evaluation at regular intervals, such as every six to twelve months. This monitoring allows the doctor to track subtle changes over time.
If a mole displays atypical dermoscopic features, shows rapid changes, or if the diagnosis is uncertain, a biopsy may be recommended. A biopsy involves surgically removing all or part of the lesion so it can be examined by a pathologist under a microscope. Regardless of the diagnosis, proactive sun protection remains a preventative measure for all children.