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Moles(nevi) are collections of nevus cells derived from the pigment- producing melanocytes. Almost everyone has at least one nevus, which can be flesh-colored, brown or bluish-black. Some are flat (Junctional), some slightly elevated (compound), and some dome-shaped (dermal). Nevi occur in about one percent of all newborn babies; the number of nevi increases in childhood. The size and pigmentation may increase throughout life, especially during puberty, pregnancy, with oral estrogens such as the Pill, and after sun exposure. Although some women such as Elizabeth Taylor are known for their distinctive “beauty marks”, many moles are unattractive or irritating, and others may change in appearance. These should be removed for microscopic examination.

Lentigines(singular: lentigo) are small, uniformly-colored, tan or brown, flat spots which are often difficult to distinguish from nevi. There are two types: lentigo simplex and solar lentigo. Lentigo simplex usually appears in childhood but can occur at any age, anywhere on the body, often on people with red or blonde hair. There is no connection with the sun. Solar lentigines (misnamed “liver spots”, though they have nothing to do with the liver) are light brown spots mostly on the backs of the hands, chest, upper back, shoulders, and face. Although these are considered to be tell-tale signs of age, they are actually an unattractive result of sun-exposure. Lentigines do not become skin cancers. They can easily be removed using prescription bleaching agents or by cryosurgery.

Dysplastic neviare melanocytic nevi which are potentially dangerous since they have abnormal cells. The tendency to develop dysplastic nevi is hereditary, and there is usually a family history of melanoma. Some dysplastic nevi actually evolve into melanomas; even more significantly, people with dysplastic nevi have at least a ten times greater probability of developing a melanoma in their lifetimes than people who do not have any. Dysplastic nevi are recognized by their poorly defined border, irregularity in shape, and variegated, uneven color. Individuals with more than one hundred moles on their bodies almost always have several dysplastic nevi. Any mole which changes or which appears dysplastic should be biopsied for microscopic examination. Removing a mole does not in any way increase the risk of its spreading or changing.

Basal cell carcinomais by far the most common type of skin cancer. This usually appears as either a small, translucent lump (almost like a pimple that does not heal) on the face, ear, neck or hands, or as a reddish patch with a raised border, on the back or chest or hand. Basal cell carcinomas grow slowly but if left untreated they will begin to bleed, forming a grainy crust in the center as they enlarge at the edge. This type of cancer rarely spreads to other parts of the body, but it can spread locally below the skin, even to the bone. If treated early enough, there is only a minimal (and sometimes no) scar. If left untreated for a long period, the damage can be more extensive, and the scar that remains after removal will be larger.

Squameouscell carcinoma is the second most common form of skin cancer. It appears most often on sun-exposed areas such as the face, ears, upper chest and back, arms, and back of the hands. Pipe smokers often get squameous cell carcinomas on their lips or inside the mouth from having held their pipe between their teeth for long periods. These cancers at first appear simply as scaly patches that do not heal, growing to become ulcerated, red patches. They tend to grow faster than basal cell carcinomas. They invade not only locally, but they can also occasionally spread through the body, particularly if they were initially on the head and neck (especially the mouth, lips or scalp).

Malignant melanomais the deadliest form of skin cancer. There are four characteristic warning signs of melanoma — the “ABCD’s”: A for “asymmetry” such that one side of the mole is not round, but rather quite irregular; B for “border irregularity” with ragged, notched, blurred edges; C for “color not uniform” with shades of tan, brown, blue and black or red, mottled areas; and D for “diameter” larger than 6mm (¹/4in) (the size of a pencil eraser). A melanoma can appear anywhere on the body, not just in areas that have been exposed to the sun. Some melanomas develop from pre-existing dysplastic nevi; but some just seem to come from nowhere. Melanomas can be completely removed if they are caught in the initial stages, but they can spread rapidly throughout the body if they enlarge, so early diagnosis and prompt treatment are absolutely essential.

Seborrheic keratosesare slightly elevated, rough, scaly growths that appear “stuck” onto the surface of the skin. They are usually brown but can be skin-colored. They are often nicknamed “barnacles” or “stucco keratoses“. Seborrheic keratoses are very common; almost everyone has at least one, and some individuals have more than one hundred! They can be found almost anywhere on the body, most prevalently on sun- exposed areas. Not only are seborrheic keratoses unsightly, but frequently they are itchy. Fortunately, they are benign and never become serious skin tumors. They are easily removed by curettage or by cryotherapy. These keratoses are superficial, so there is no residual scar. A biopsy is sometimes required to rule out a more serious skin tumor.

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