Hi TheButterZone!
Thanks very much for submitting the first question to us! Following is sk1nd0c's (a derm specialist) response. Unfortunately sk1nd0c's clinic is not yet able to accept btc re you going to their clinic (we will definitely post if we find any btc-accepting derm clinics).
Would you mind if I cross-posted this on the forum at
btcdocs.net ? Any feedback would be appreciated if you have the time (eg if you do go into get some of these moles removed, was having any of the following information helpful?). Thank you again for the question.
-btcdocsDerm specialist response:It appears that you have what is called common intradermal nevi, which are benign raised "moles". Due the the image quality/resolution on some of the later photos, it was difficult for me to be certain 100% that they are benign (and honestly the only way to be completely sure is to perform a biopsy). There are other tumors that mimic intradermal nevi - blue nevi, spitz nevi, dermatofibromas, juvenile xanthogranuloma, and even malignant tumors like nodular basal cell carcinoma and melanoma. So with the image resolution lacking, it's difficult for me to appreciate the subtleties that would help me clinically distinguish these lesions and provide the reassurance you desire. Even if your photos had better resolution, moles are an example of a dermatological condition that is still best evaluated in person by a dermatologist (sometimes with the assistance of additional magnification). I wish I could be of more help in this regard, but I do not want to mislead you.
In determining benign versus malignant lesions, particularly with moles, I teach patients about the ABCD's of melanoma: A stands for asymmetry (we like to see nice round moles - as yours appear to be), B is for border (nice even, not jagged edges), C is color variability (same pigment throughout, without multiple shades of black, blue, pink, etc), D is for diameter greater than a pencil erasor (i'm not particularly fond of this one because some people just grow larger moles). The E was added - for evolving, and I think that is the most important component - a mole that begins to be symptomatic, is developing new colors within it or growing strange borders. It's estimated that 50% of melanomas arise in pre-existing lesions and the remainder arise as new lesions.
In regards to removal, I would hesitate to see any physician that offers to remove all of your moles at your first visit. I usually offer to remove one or two at the first visit, and the purpose of this is to see how patients scar at follow-up and to make sure the patient is satisfied with the cosmetic appearance of the scar before removing more lesions. I cannot predict how each individual patient will scar. Although I understand the desire to just get them off even if that means trading for a scar, scars can also be "ugly", symptomatic and worse than the original lesion. It sounds as though you have some experience with shave removal, which is where the skin is numbed and the mole shaved off flush with the surrounding skin, leaving a round scar. This does leave some possibility of recurrence if nevus is left at the base. Depending on site, size of the lesion, and proximity to skin lines, I may also offer a "punch" excision or regular elliptical (football-shaped) excision which require sutures and leave linear scars.
Again I wish I could be of more assistance to you, I hope the information I have provided has been helpful for you. Rashes like psoriasis, eczema, etc are fairly straightforward, but within dermatology moles are comparatively difficult to diagnose via photography alone (and sometimes, even clinically). To give you a sense, there was a recent article in a dermatology journal discussing the controversy of iphone apps which allowed users to submit photos of their moles to "determine" whether benign or malignant, and the frequency of wrong diagnosis was quite substantial.
-sk1nd0c16SqgezceSdf9weWxpC2UHG7jv1oh52Fut
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