Monitoring of moles (nevi) in children

Heredity clearly determines the number and type of moles, but an important factor in their appearance and development is the sun exposure.

Congenital moles (nevi) are classified as small less than 1.5 cm in diameter, medium from 1.5 to 9.9 cm, large from 10 cm to 19.9 cm, and giant (>20 cm) and grow depending on the increase of the surface area that they cover. As the child grows, moles may become darker and acquire a warty surface. Large and giant congenital moles have a higher percentage of transformation into malignant melanoma than the small ones. It should be emphasized here that melanoma is very rare in childhood. However, if it occurs, it has a very poor prognosis.

The acquired moles are usually less than 1cm in diameter and remain unchanged in color and shape until puberty. An increased number of acquired moles is associated with sun exposure and is a high risk factor for melanoma.

For congenital moles, especially for the large and giant ones, we must consider the possibility of surgical removal for precautionary reasons, both to avoid the possibility of transformation into melanoma, but also for aesthetic reasons.

The main method of examination and control of moles in children is the clinical examination with dermoscopy and the mapping in case of multiple moles, dysplastic moles as well as in children with a family history of melanoma. The dermoscopy and mapping does not differ from the corresponding one for adults, but it is expected in the case of congenital moles and the increase in their size according to the child’ s growth.

In the vast majority of cases, we simply monitor the moles and mark new and dysplastic moles if they are present. With the term ‘dysplastic moles’ we mean that on dermoscopy they appear some characteristics that show us that the specific mole could develop into a malignant one in the future and we monitor them, while after the age of 12 we can remove them surgically.

There are also some types of moles that must be removed, such as Spitz’s mole. This is usually a mole that grows suddenly and its color varies from pink to dark brown and appears in the 2/3 of cases under the age of 20 and in fact in the 1/3 of the cases under the age of 10.

As UV radiation is a risk factor for melanoma and acts cumulatively from childhood, the primary concern of parents should be to effectively protect their children from the sun from the first day of life. The necessity of avoiding the unnecessary sun exposure and the effective sun protection is emphasized and pointed out by all experts, as children’s ability to repair the mutations caused by the sun in their skin is ineffective compared to adults. Childhood sunburns is the #1 predisposing factor for melanoma later in life.

Especially for light-skinned children, for children with many moles or children with a family history of melanoma, sun protection is vital.