Why does a mole hurt?

Black moles may be really common in our lives. Pigmented moles are benign proliferation of melanocytes, but in areas that are frequently rubbed, long-term stimulation may cause them to become malignant, especially moles that show signs of growth. It is recommended to go to the plastic surgery department of the hospital for excision. If you are not sure, you can do a tissue pathology examination after excision to rule out the possibility of malignancy. Moreover, we must be more careful with these black moles to prevent greater harm, so let us understand why black moles hurt!

1. Mole

Pigmented nevus, also known as pigmented nevus, nevus or black nevus[1], is the most common benign skin tumor composed of normal pigmented nevus cells, occasionally found on the surface of mucous membranes. There are various types of clinical manifestations. The colors are mostly dark brown or ink-black, and there are also colorless moles without any color.

2. Disease Overview

Pigmented nevus, also known as pigmented nevus, spotted nevus or black nevus, is the most common benign skin tumor composed of normal pigmented nevus cells, occasionally seen on the surface of mucous membranes. There are various types of clinical manifestations. The colors are mostly dark brown or ink-black, and there are also colorless moles without any color. Such as intradermal nevus, junctional nevus, mixed nevus, giant nevus, blue nevus, juvenile melanoma, etc. Some types may become malignant under certain conditions, which deserves attention. Pigmented nevi often occur on the face, neck, back and other parts of the body and can be seen on any normal human body. It may be present at birth or develop gradually in the early years of life. Most grow slowly or remain unchanged for many years, but spontaneous degeneration rarely occurs. Both surgical and nonsurgical treatments are available. The therapeutic effect is good. Pigmented nevus are congenital benign tumors composed of pigment cells, most of which are benign; some may become malignant in the later stage. Once a pigmented nevus becomes malignant, its malignancy is extremely high, the metastasis rate is also the fastest, and the treatment effect is not ideal. The disease can be seen everywhere on the skin, with the face, neck, chest and back being the most common sites. A few occur in mucous membranes, such as the mouth, labia, and conjunctiva. Pigmented nevi in ​​certain junctional nevus-prone areas and pigmented nevi with symptoms of malignant transformation should be removed promptly.

3. Symptoms and Signs

Junctional nevus are light brown or dark brown macules, papules or nodules, which are generally small, with a smooth, hairless surface, flat or slightly above the epidermis. Generally no subjective symptoms occur. Junctional moles protruding from the skin surface are easily affected by washing, shaving, friction and injury, and may thus develop symptoms of malignant transformation: such as mild local itching, burning and pain; rapid increase in the size of the mole; darkening of color; infection, ulceration, bleeding on the surface, or the appearance of satellite dots, radiating black lines, melanin rings on the skin; and enlarged lymph nodes in the drainage area where the mole is located. Malignant melanoma often arises from junctional nevi. It is generally believed that hairy nevus and freckle-like pigmented nevus are both intradermal nevi or compound nevi. This type of mole rarely becomes malignant, and if it does, it is usually from the junctional mole.

4. Diagnostic Basis

1. The location, size, color and shape of the mole, and whether there is hair, hyperplasia or ulcer on the surface.

2. Pay attention to the time of onset, speed of development, and the severity of the disease.

3. Pathological section examination can distinguish intradermal nevus, junctional nevus, mixed nevus, verrucous nevus, etc.

5. Causes of Disease

1. Intradermal nevus is differentiated from large nevus cells, which are more mature small nevus cells and enter the dermis and surrounding connective tissue.

2. Junctional nevus: nevus cells are located at the junction of the epidermis and dermis, in the form of multiple nests with clear boundaries and uniform distribution distances; the upper half of each nest is in the bottom layer of the epidermis, and the lower half is in the superficial layer of the dermis. These nevus cells are large and darkly pigmented.

3. In the process of nevus cells entering the dermis, compound nevus often has both intradermal nevus and residual junctional nevus, which is a mixed form of the above-mentioned vehicle-type nevus.

6. Pathological changes

1. Junctional nevus: Localized nests of nevus cells are located at the junction of the dermis and epidermis.

2. Intradermal nevus: Nevus cell nests are located in the dermis, in which multinucleated nevus cells can be seen.

3. Compound nevus: Nevus cell nests are found at the junction of the dermis and epidermis and the upper part of the dermis. The dermal nevus cells are cubic. The nevus cells at this junction are small and contain very little pigment.

7. Principles of treatment

Most benign melanocytic tumors do not require treatment. The general principle is to treat them thoroughly if possible.

1. Ordinary acquired pigmented nevus and common blue nevus do not require treatment. If they occur in areas prone to friction and damage, it is best to perform surgical excision. Small skin lesions can also be treated with ultra-pulsed CO2 laser and (or) Q-switched laser. It is difficult to control the depth of ordinary CO2 laser, freezing, ultra-high frequency electricity, chemical peeling, etc., and they are prone to leave scars or incomplete treatment.

2. Try to have surgical removal. Since malignancy usually occurs after the age of 30, the removal can be performed after adulthood.

3. Treatment of congenital giant nevus: Since the rate of malignant transformation is high and half of the malignant transformation occurs before the age of 5, it should be removed as soon as possible after birth.

4. If malignancy is suspected, surgical treatment should be adopted. All the moles removed should be subjected to pathological examination. If malignancy is found, the resection should be expanded and treated as appropriate.

8. Treatment measures

No treatment is usually required. Pay attention to pigmented nevi on the soles of the feet and nail beds. Do not stimulate them casually or apply corrosive drugs indiscriminately to avoid inducing or irritating their malignant transformation. If a mole rapidly increases in size within a short period of time, its color deepens and turns black, its edges become red and irregular, it bleeds or is damaged on the surface, and satellite lesions appear around it, it indicates that the mole has signs of malignancy and should be surgically removed and sent for pathological examination.

IX. Treatment Plan

For larger moles on the face with no evidence of malignant transformation, staged partial excision can be considered, which can better preserve both appearance and function, but it is not suitable for those with a tendency to malignant transformation. Total excision, adjacent skin flap transfer or free skin grafting can also be used. If malignancy is suspected, a complete excision biopsy should be performed using a shell surgery; the incision should be made outside the boundaries of the mole on normal skin. After the removal of a small mole, the skin wound edges can be peeled off secretly and then sutured directly.

10. Efficacy Evaluation

1. Cure: The treatment achieves the expected effect, the wound heals, and the morphology is better.

2. Improvement : The treatment has basically achieved the expected results and the wound has healed well.

3. Not healed: The expected effect is not achieved and the wound heals poorly.

11. Expert Tips

Everyone has pigmented moles. According to statistics, after careful physical examination, a normal individual may have as many as 50 pills, and the average is 15-20. Because it is common, people often treat it carelessly and casually, which teaches us many lessons. Some people believe in the nonsense of fortune tellers and randomly mark their moles on the street in order to "drive away evil, bring in good fortune and make money"; some people do not know the consequences and use corrosive substances to mark their moles at random; some people scratch and dig at will, and the consequences may leave scars and deformities at the least, or even death at the worst! Therefore, popularizing relevant medical knowledge, enabling patients to understand medical principles, and accept regular treatment from doctors is the truly feasible way.

The vast majority of moles are benign and have no impact on your health. Many people worry about pigmented moles turning malignant, and it is not groundless. First, some pigmented nevi are easily confused with some skin malignancies and are often misdiagnosed. Second, some pigmented nevi do have a certain relationship with melanoma, so melanoma should be given due attention and a dermatologist should be consulted for identification when necessary.