What does a speckled mole mean?

Moles are common growths on the skin that are usually harmless. However, some moles may be cause for concern. Speckled moles, also known as dysplastic nevi, are moles that are larger than average and have an irregular shape and color variation. While most speckled moles are benign, some may develop into melanoma, which is the most serious form of skin cancer. In this article, we will discuss what a speckled mole is, what it may signify, and when to see a doctor about a suspicious mole.

What is a speckled mole?

A speckled mole, also known as a dysplastic nevus, is a type of mole that contains a variety of colors, from tan to dark brown. Speckled moles are often larger than average moles, around 6 millimeters or larger. They tend to have irregular and indistinct borders. The variations in color as well as asymmetry are what causes the “speckled” appearance of this type of mole.

Speckled moles result from abnormal melanocytes, which are the cells that produce pigment in the skin. Normal moles have an organized growth pattern, while dysplastic nevi exhibit disorganized growth under a microscope. This abnormal development leads to the variegated color and border irregularity.

While speckled moles are present at birth, they typically become more noticeable in the teenage years and early 20s. Individuals with dysplastic nevi usually have between 10-50 such moles. There is also a hereditary component, so people with a family history of dysplastic nevi are more likely to have numerous speckled moles themselves.

What causes speckled moles?

Speckled moles are caused by genetic mutations that affect melanocytes, leading to abnormal structure and growth patterns. People inherit a tendency to develop dysplastic nevi from their parents. Those with a family history of dysplastic nevi or melanoma are at an increased risk.

One of the main genetic mutations implicated in speckled moles is the BRAF gene mutation. The BRAF gene helps regulate cell growth, but when mutated, it can cause cells to multiply uncontrollably. Around 80% of dysplastic nevi have the BRAF mutation.

Exposure to ultraviolet radiation from sunlight or tanning beds may also contribute to development of speckled moles in those with a genetic predisposition. UV radiation causes damage to melanocytes, promoting abnormal growths.

Are speckled moles dangerous?

Most speckled moles are benign. However, some features may make them more concerning for melanoma:

  • Larger size, usually greater than 6 mm
  • Irregular, faded borders
  • Color variation, such as brown, black, pink, red, blue, and/or white
  • New symptoms like itching, burning, or bleeding
  • Rapid growth or changes in the mole

Individuals with dysplastic nevi have an increased lifetime risk of developing melanoma. It is estimated that around 10% of those with multiple dysplastic nevi will develop melanoma over their lifetime.

The more speckled moles present, the greater the risk of melanoma. People with 10-15 dysplastic nevi have a 12 times higher melanoma risk compared to the general population. For those with 15 or more speckled moles, the melanoma risk is 50 times higher.

Melanoma warning signs

While most speckled moles will remain harmless, it is important to monitor them for any changes that may signal a malignancy like melanoma. Use the ABCDE screening guideline to identify moles that may be concerning:

  • Asymmetry – One half does not match the other half
  • Border – Irregular, blurred, or ragged edges
  • Color – Variation in color with shades of brown, black, red, blue, and/or white
  • Diameter – Larger than 6mm or continuing to grow
  • Evolving – Changes in the mole’s appearance like growth, itching, or bleeding

If you notice any of the ABCDE signs in a mole, it is prudent to get it evaluated by a dermatologist. Caught early, melanoma has a very high cure rate.

When to see a doctor

See your doctor if you notice any of the following:

  • New speckled mole appearing after age 40
  • Speckled mole that is growing or changing
  • Speckled mole that is itchy, painful, or bleeding
  • Speckled mole with irregular borders or unusual colors like blue, white, or red
  • Sore that does not heal, especially if located on a mole

Individuals with a personal or family history of melanoma or multiple dysplastic nevi should have a full body skin exam by a dermatologist once a year. This allows early detection and removal of any moles that may be precancerous before they turn into melanoma.

Dermatologist examination

During a full body skin check, the dermatologist will examine all your moles carefully, including speckled moles. They will note the ABCDE features of each mole and look for any worrisome or changing lesions.

The dermatologist may use a dermatoscope, which is a special magnifying tool, to evaluate the borders, colors, and patterns of pigmentation in each mole. This helps determine if biopsies are needed of any suspicious lesions.

Photography of the moles may be done to monitor for changes at future appointments. Comparison to past images allows the dermatologist to detect subtle enlargement or irregularities that may not be appreciated on visual inspection alone.

The dermatologist may also recommend removing select moles as a precaution. Dysplastic nevi that exhibit abnormal features under the dermatoscope are often excised to rule out melanoma.

Biopsy of speckled moles

If the dermatologist identifies any speckled moles that appear concerning, they will take a biopsy to determine if skin cancer is present. A biopsy involves numbing the area with local anesthesia and using a punch tool, shave blade, or surgical excision to remove all or part of the mole.

The biopsy sample is then examined under a microscope by a pathologist. They will determine if the mole is benign or malignant. Specific characteristics like abnormal pigment cells, rapid growth, and invasion into the deeper skin layers help differentiate between an unusual mole versus melanoma.

Types of biopsies

  • Punch biopsy – Small circular core removed using a punch tool
  • Shave biopsy – Shaving off the top layers using a blade
  • Excisional biopsy – Cutting out the entire mole and some surrounding normal skin via elliptical excision

An excisional biopsy that removes the entire lesion is preferred for speckled moles to diagnose melanoma. Punch and shave biopsies may not provide adequate depth for pathological examination.

Can speckled moles turn into melanoma?

Although most dysplastic nevi will never become melanoma, some speckled moles do have malignant potential. It is estimated that around 5-10% of speckled moles will eventually transform into melanoma.

Some features that make a speckled mole more likely to progress to melanoma include:

  • Larger size, over 8-9 mm
  • Presence of multiple colors like brown, black, red, blue, and/or white
  • Irregular, fuzzy borders
  • New growth or changes in the mole
  • Older age, over 50 years old
  • Location on the trunk in men or lower legs in women

Speckled moles with these high-risk characteristics are more likely to contain advanced genetic mutations and abnormal melanocytes. They have a greater risk of demonstrating atypical changes over time or developing into melanoma.

Can dysplastic nevi be removed?

Yes, dysplastic nevi or speckled moles can be removed by surgical excision if they exhibit suspicious features. Some reasons a dermatologist may recommend removing speckled moles include:

  • Significant abnormal features under dermatoscopy like variability in color or borders
  • Dramatic growth or changes in the mole
  • Presence of concerning symptoms like bleeding, itching, or crusting
  • Biopsy showing severe dysplasia coming close to melanoma
  • Patient anxiety or desire for preventative removal

Removing dysplastic nevi can be considered for high-risk patients even if signs of melanoma are not yet evident. This may prevent progression to melanoma in some cases.

Excision procedure

To remove a speckled mole, the dermatologist will numb the area with a local anesthetic. They will then use a scalpel or surgical scissors to fully excise the mole along with a border of normal looking skin.

The wound is closed with sutures, which are typically absorbed by the body over time. A biopsy of the mole is done to confirm complete removal and to check for any cancerous changes.

After excision of dysplastic nevi, patients need to continue mole monitoring and annual skin checks to detect any new abnormal lesions.

Are there medications to treat speckled moles?

Currently, there are no specific medical treatments to eliminate dysplastic nevi or prevent their progression to melanoma. However, research is ongoing into targeted therapies.

Because the BRAF mutation is implicated in up to 80% of dysplastic nevi, drugs that target this mutation are being studied both for treatment of speckled moles and prevention of melanoma. However, more research is needed before any drugs are approved for this purpose.

One promising medication is vemurafenib (Zelboraf). In melanoma patients with the BRAF mutation, this drug helps inhibit tumor growth. Similar medications are also being investigated for use in high-risk precancerous moles.

Can you remove speckled moles at home?

It is not advised to try removing speckled moles at home. Attempting mole removal without medical supervision can lead to incomplete removal, infection, scarring, or recurrence of the mole.

Over-the-counter mole removal products that contain acids like salicylic acid to burn off moles are also not recommended. These can cause irritation and damage the skin without fully getting rid of the lesion.

Trying to cut or shave off a mole also often fails to remove the entire growth down to the deeper roots. This may actually increase the risk of transformation into skin cancer over time.

Dermatologists have specialized tools and training to properly excise moles and minimize the risk of complications. Leaving dysplastic nevi removal to professionals helps ensure complete extraction and allows for pathological examination.

Risk factors for speckled moles

Factors that increase the likelihood of developing dysplastic nevi include:

  • Family history – Having a first-degree relative with dysplastic nevi or melanoma
  • Fair skin – Especially those with blond/red hair and light eye color
  • Sun exposure – History of sunburns, life in sunny climate, indoor tanning
  • High nevus count – More than 50 common moles on the body
  • Genetics – Mutations in genes controlling pigment like CDKN2A, BRAF, TERT

Individuals with several of these risk factors have the highest predisposition for developing numerous dysplastic nevi and should take precautions to prevent melanoma.

Protecting your skin

Those with dysplastic nevi require extra diligence with sun protection and skin cancer screening to lower melanoma risk. Some preventive tips include:

  • Avoiding peak sun 10am-4pm
  • Seeking shade and wearing protective clothing like hats
  • Applying broadspectrum SPF 30+ sunscreen daily
  • Not using tanning beds
  • Performing monthly self-checks of all moles
  • Getting a full body skin exam by a dermatologist every year

Protecting your skin from further sun damage can help minimize formation of new dysplastic nevi and changes in existing moles.

What does a changing speckled mole mean?

A changing speckled mole can signal a problem. Any shifts in the characteristics of a dysplastic nevus deserve medical evaluation. Concerning changes to look out for include:

  • Increase in size, especially rapid growth
  • Darkening color or new black, brown, red, blue, or white shades
  • New symptoms like itching, tenderness, or bleeding
  • More irregular, fuzzy, or faded borders
  • Appearance of swelling, lumps, or ulcers

Changing moles should be seen urgently by a dermatologist. A biopsy is typically needed to determine if melanoma is present. Early detection and treatment provides the best outlook if a dysplastic nevus has transformed into melanoma.

Takeaway points

  • Speckled moles result from abnormal melanocytes and tend to be larger with varied colors.
  • Dysplastic nevi have some risk of becoming melanoma, so monitoring is needed.
  • See a dermatologist about any speckled moles that are growing, changing, or symptomatic.
  • Have a full body skin check annually if you have numerous dysplastic nevi.
  • Use sun protection diligently to prevent formation of new abnormal moles.

The bottom line

Speckled moles are abnormal growths that may signal an increased melanoma risk, especially if changes are observed. Routinely inspect all your moles and talk to a dermatologist about excision if any speckled moles become symptomatic or look concerning. Catching dysplastic nevi early provides the best opportunity for prevention and cure of this dangerous skin cancer.

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