Scary looking mole, but harmless
A middle aged white person presented with a story of a mole on an arm that had been changing and growing over 6 months. In the absence of a photograph, we have no objective way of being certain whether, and how much, a lesion has changed, so have to go on people’s stories. Here is the plain view.
And a close up
Not that worrying, but there is the history to consider and it is the largest mole. Dermoscopy.
Irregular globules can be seen, varying in size and mainly a greyish-blue in colour. Given the history of change, this was considered to be adequate grounds for excision. Note also the pale circles associated with hair shafts, these are of no concern and are termed perifollicular hypopigmentation.
Histology was of a benign dermal naevus.
On reflection, did this mole really need excising? I showed the picture to colleagues, some said yes, others said that photography and monitoring would be acceptable. This is a debate that will continue-we must not miss melanomas but should avoid excising excessive numbers of benign lesions. Sharing images like this where histology has been obtained should perhaps over time help us to be more confident in deciding to monitor-but many experts say, if there is doubt about a changing/suspicious solitary lesion then remove the doubt by getting histology. I am sure we will get to know better as time goes on PROVIDED that we photograph lesions before surgery and then learn from the photos when the histology report comes back. And we all need to audit our ‘hit rate’.