(Mole; Pigmentary mole)
Definition. – A circumscribed pigmentation of the skin, usually congenital, with or without hypertrophy of other cutaneous structures.
Symptoms – Moles are subdivided according to the prominence of one or more features into several groups, but in general they may be said to be varied in size, smooth or rough, elevated or non-elevated and yellowish-brown or black in color. They may be single or multiple and are more often found on the face, scalp and neck, less frequently on the trunk and extremities. Most moles are congenital or appear shortly after birth but identical lesions have developed in later life. According to the predominance of one or more features, moles are described in the following manner:
Nevus spilus is a simple smooth, flat, pigmented spot, pea- to bean-sized or much larger and devoid of hair.
Nevus pilosus is similar to the above except that it shows an abnormal growth of hair, usually coarse and of unusual length. The hairs may be light or dark in color and few or many in number.
Nevus verrucosus presents an irregular, finely corrugated or warty surface; the marked hypertrophy of the papillae causing the furrowed and uneven appearance.
Nevus lipomatodes exhibits excessive fat and connective tissue hypertrophy, hence is elevated with a smooth and soft, irregular and warty or rarely a furrowed appearance. This type sometimes involves an extensive area and may show hair growth.
FIG. 100 – Nevus pilosus, appearing as an upward extension of the right eyebrow. All normal and abnormal hair growth is black, stiff and coarse. The lesions of lentigo (freckles) are plainly noted on the face.
FIG. 101. – Showing the cure of the nevus and attendant hair growth by three applications of solidified carbon dioxide.
Nevus linearis is a hard warty variety which develops in line, streaks or bands, frequently following the course of nerves. If not congenital it usually develops during youth. When unilateral it is called nevus unis lateris.
Etiology and Pathology – The former is obscure. Both sexes are afflicted. Hairy moles are usually congenital while the non-hairy may be acquired. There is probably a trophoneurotic influence present in all cases. Anatomically they are two types; the first with an increased.
FIG. 102. – Nevus pigmentosus, congenital and of extensive distribution. This case combines the features of nevus lipomatodes and nevus verrucosus. The lesions on the left shoulder have been partially removed by solidified carbon dioxide.
Pigment deposit in the rete and in the corium; the second having besides the above a hypertrophy of papillae, glands, vessels and follicles.
Prognosis and Treatment. – These growths are permanent and for the most part benign. Occasionally they increase in size and may become, from irritation, the starting point of malignant degenerations. While these growths have been removed by excision, electrolysis, caustics, Unna’s microburner, phototherapy and the X-rays, the best results may be expected from solidified carbon dioxide, especially if other agents are used as adjuvants. Hairs present in these growths should first be removed by electrolysis or the X-rays and then refrigeration applied. Liquid air is more difficult to obtain and preserve and presents no advantages over the solid article. If the moles are numerous and very small, I invariably prefer mild fulguration. When moles show a tendency to multiply an indicated remedy may be given; see Calcarea carb., Condurango., Fluor. acid., Lycopodium, Nit. acid and Petroleum.