Treatment of a Mole That Has Grown or Spread Over Time

Step 1 - Recognize the Warning Signs (ABCDE Rule)

Step 2 - Diagnostic Evaluation First

• Dermoscopy - A dermatologist uses a magnifying tool to examine pigment patterns, helping distinguish benign from malignant features.
• Photographic surveillance - Serial photography to track the rate and pattern of change over time.
• Excisional biopsy - If the mole has worrisome features, the entire lesion is surgically removed and sent for histopathology. This is both diagnostic AND potentially curative.
• Incisional biopsy - Used for very large lesions that cannot be fully excised in one step, to obtain a tissue diagnosis first.

Step 3 - Treatment Options Based on Diagnosis

A. Benign but Growing Nevus (Dysplastic/Atypical Nevus)

• Surgical excision is the treatment of choice - the mole is cut out with clear margins.
• Partial removal is NOT recommended because it can lead to repigmentation, regrowth, and confusion with recurrence or melanoma.
• Destructive methods (cryotherapy, laser, electrodesiccation, dermabrasion) should be avoided - they destroy tissue without providing a sample for pathology, making it impossible to confirm the lesion was benign.
• After removal, continued periodic surveillance for life is recommended if the patient has multiple dysplastic nevi or a personal/family history of melanoma.

B. Melanoma (if confirmed by biopsy)

C. Cosmetic Removal of Confirmed Benign Moles

• Shave excision - For smaller, raised moles; no stitches needed.
• Excisional surgery - For larger or flat moles; stitches required.

Step 4 - Prevention After Treatment

• Minimize midday sun exposure (especially 10 AM - 2 PM).
• Use broad-spectrum SPF 30+ sunscreen daily.
• Wear protective clothing (hats, long sleeves) during sun exposure.
• Consider vitamin D supplementation if avoiding sun strictly.
• Schedule annual full-body skin checks with a dermatologist.
• Perform a self-skin exam every 6 months.

Important Disclaimer

Do not attempt to remove a growing mole at home. A mole that has grown or changed needs professional evaluation first. What looks like a harmless mole could be early melanoma, which is highly treatable when caught early but dangerous if ignored or improperly treated.

• Fitzpatrick's Dermatology, 9th Edition, pp. 1985-1987 (Nevus Management & Treatment)
• Cummings Otolaryngology Head and Neck Surgery (Benign Nevus section)

Most Likely Diagnosis: Becker's Nevus (Nevus of Becker)

• Large, flat (macular), dark brown hyperpigmented patch
• Irregular, ill-defined borders with a speckled/reticulated pattern
• Hypertrichosis (coarse, dark hair growth within the lesion)
• Located on the thigh/lower body (less common site but well-documented)

What is Becker's Nevus?

• A benign, acquired epidermal hamartoma (overgrowth of skin cells, melanin, and hair follicles)
• Androgen-dependent - often first appears or darkens during puberty/adolescence
• May darken further after sun exposure or during pregnancy
• Not cancerous and does not transform into melanoma
• Persists throughout life without spontaneous resolution

Treatment Options

1. Laser Therapy (Most Common Approach)

Note from Fitzpatrick's Dermatology: "Long-pulsed and picosecond alexandrite laser, as well as quality-switched Nd:YAG, have been cited as useful in some studies, but the current evidence lacks statistical power and has inconsistent findings." (p. 1405)

2. Topical Treatments

• Topical flutamide (anti-androgen cream) - has shown satisfactory reduction in hyperpigmentation in case reports
• Topical retinoids and depigmenting agents (hydroquinone) - limited evidence, may provide modest lightening
• Sunscreen (SPF 30+) - keeping the area out of the sun prevents further darkening; this is the most consistent advice

3. Surgical Excision

• Only practical for small lesions
• Not recommended for large patches (like the one in the image) due to the high risk of scarring and poor cosmetic outcome

4. Destructive Methods (Avoid)

• Cryotherapy, CO2 laser ablation, argon laser, dermabrasion - all carry a high risk of scarring and dyspigmentation and are no longer recommended

5. Cosmetic Camouflage

• Medical-grade camouflage makeup can effectively conceal the lesion
• Useful when other treatments fail or between sessions

6. Hair Management

• Laser hair removal (diode or alexandrite) is safe and effective for the hypertrichosis
• Waxing, shaving, threading, and depilatory creams are all safe and will NOT worsen hair growth

Key Points to Know

This is a benign condition with no risk of cancer.

1. Sun protection is the single most important daily measure to prevent further darkening.
2. Laser treatments can lighten the patch and reduce hair, but complete removal is rarely achieved.
3. A dermatologist consultation is recommended to confirm the diagnosis (dermoscopy or biopsy if uncertain) and to plan a laser treatment series suited to the skin type.
4. Results vary significantly - realistic expectations are important before starting treatment.

• Fitzpatrick's Dermatology, 9th Edition, pp. 1404-1405 (Nevus of Becker: Clinical Features, Management)
• DermNet NZ - Becker Naevus
• Journal of Clinical and Aesthetic Dermatology - Becker Nevus Syndrome