What is a birthmark?
A birthmark is a localized proliferation of pigment cells of the skin (melanocytes) that appears as a dark spot. It is a benign skin change that is also known colloquially as a beauty spot or liver spot. The technical term for a birthmark is nevus (plural nevi). The number of moles increases with age. New moles can appear at a young age up to the age of forty. Pigment spots that appear at an advanced age are known as age spots.
The spots therefore increase with age. The appearance of benign changes in the skin is accompanied by reduced elasticity due to collagen loss. The humidity decreases. In addition, external factors (external influences) such as UV rays and an unhealthy or healthy diet play an important role in the appearance of your skin and can also promote dry skin. Depending on the interplay of factors, you may struggle with premature skin ageing and new or increasing skin changes.
An ordinary birthmark is usually smaller than about 5 millimeters in diameter. The spot is round or oval, light brown to dark brown. It has a smooth surface and is sharply demarcated from the surrounding skin. Moles are particularly common on areas of the body that have been exposed to the sun (actinic keratosis). Depending on hereditary predisposition, an adult Central European develops an average of 10 to 40 moles with a diameter of over two millimeters on the entire body over the course of time. From a number of 50 moles, there is a slightly increased risk of skin cancer 1 . The risk of a birthmark developing into skin cancer is low. Measured over a period of one year, the risk is between 1:200,000 and 1:33,000, depending on age 2 . In over 70 percent of cases, malignant melanoma develops in areas where there is no mole 3 .
What our patients say
What is a conspicuous skin mole (atypical or dysplastic nevus)?
The unusual appearance of atypical moles can be differentiated from birthmarks using the ABCDE rule. Changes can also be seen when looking at the individual cells under the microscope compared to normal moles. Atypical moles only appear during or after puberty. They are often larger than 6 millimeters in diameter, raised or irregularly patterned. People with a light complexion, red or blonde hair, blue or green eyes and freckles are particularly at risk. Sunburns, especially in childhood, increase the risk of developing atypical moles.
Atypical moles occur in around 10 percent of the population in Europe (range: 7-24 percent) 4 . It is assumed that the risk of developing skin cancer increases with the number of atypical moles 5 . The risk of developing malignant melanoma with conspicuous moles is estimated at around 1:30,000 to 1:40,000 6 .
It is therefore recommended to remove conspicuous moles without leaving any residue 7 .
Which birthmark is dangerous?
Skin cancer or precancerous lesions stand out due to certain characteristics. The ABCDE rule helps to recognize suspicious or dangerous moles and thus, if necessary, to detect them. early before the development of a malignant skin tumor. Each letter stands for a characteristic. If at least one of these characteristics is present, an examination by a dermatologist should be carried out.
- A = Asymmetry: uneven shape of the birthmark.
- B = Boundary: irregular or blurred edges, without clear demarcation to the healthy surrounding skin.
- C = Coloring: different coloring with light, dark or pink parts.
- D = diameter: the widest point has a diameter of more than 6 millimeters.
- E = development / elevation: changes in size, shape or color / growth above the skin level.
Moles on the sole of the foot or on the mucous membranes are often overlooked during self-examination. If the mole itches or bleeds, patients should also consult a dermatologist. If you are unsure whether the mark is benign, always contact a dermatologist to rule out the possibility of a malignant change.
How do birthmarks develop and how are they categorized?
The origin of this benign change in the outer skin layer can be traced back to the first weeks of the unborn child. Under the influence of messenger substances, the cells from the area of the future spinal cord (also known as the neural crest) develop into connective tissue cells, cartilage cells, nerve cells and pigment cells. Certain messenger substances initiate the development of precursor cells into pigment cells. UV light can change the genetic material in pigment cells. Certain genetic changes lead to a proliferation of pigment cells, which become visible as moles 8 .
Skin moles are categorized according to the age at which they form. Congenital birthmarks appear in the womb or in the first few weeks of life. Moles that develop in younger people in childhood and later are referred to as acquired moles. Age spots are pigmentation marks that develop on mature skin in older people after the age of 40 as a result of skin ageing.
Moles are also differentiated according to their location in the layers of the skin. A birthmark that appears at the boundary layer between the epidermis and dermis is called a junctional nevus. If pigment cells are found in both the epidermis and the dermis, this is referred to as a compound nevus. The technical term for a birthmark whose pigment cells are only found in the dermis is dermal nevus.
The arrangement of the pigment cells in the skin can be checked with a special magnifying glass (dermatoscope). The arrangement of the cells can be divided into patterns such as fine lines, floes, circles or dots. Moles on the palm of the hand or the soles of the feet show parallel lines in the furrows of the skin 9 . Other characteristics that serve to differentiate pigment spots are, for example, color, size and the part of the body where the birthmark is located (e.g. face).
Birthmark, skin cancer or a completely different diagnosis?
In a consultation with the doctor, he or she will explain to you whether it is a birthmark, a wart, a fibroma, a nipple or another skin change. On our page about skin cancer, you will learn everything about the distinction between benign skin tumors, seborrheic keratoses and benign tumors as opposed to malignant skin tumors, malignant growths and any other malignant tumors of the skin. As part of a skin cancer screening, white and black skin cancer is examined. We will check what symptoms you have and whether there are any nodules. The doctor may recommend an appropriate treatment that makes sense from a medical point of view. If there are medical reasons, the examination and treatment or removal are covered by statutory health insurance. If you have any further questions that are not answered on our website, please feel free to arrange a personal consultation.
What is a congenital birthmark?
Congenital birthmarks are skin spots that are present at birth or skin changes that form and become visible within the first few weeks of life. Congenital skin moles are dark and occasionally hairy. In some cases, there may be slightly raised skin lesions. They can also come in a variety of colors, from light brown to black. Congenital birthmarks grow over time in proportion to a person’s growth in size as they age. They consist of densely packed pigment cells. The technical term for this is congenital melanocytic nevus. Congenital birthmarks occur in 1 in 100 newborns. They occur slightly more frequently in women than in men (ratio of 3:2). In congenital birthmarks, the pigment cells are located in the dermis.
Moles are categorized according to their size:
- Small: less than 1.5 centimeters.
- Medium: 1.5 to 20 centimeters.
- Large: 20 to 40 centimeters.
- Huge: larger than 40 centimeters.
The larger the congenital birthmark, the greater the risk of degeneration into skin cancer 10 . The risk of small congenital moles developing skin cancer in the course of a lifetime is around one percent 11 . The risk of developing malignant skin cancer in the general population in Europe over the course of a lifetime is 0.3 to 1.6 percent 12 . In addition to black skin cancer, there is also light or white skin cancer. This occurs most frequently on areas of the body without hair that are particularly exposed to the sun (face, neck, ears, upper arms, etc.). UV radiation is considered to be the most common cause of both forms of cancer. For this reason, it is recommended to always use appropriate sun creams with sufficient UV protection against UV radiation to prevent the development of malignant skin changes. Take precautions and make sure you take good care of your skin, for example with anti-ageing products or an anti-ageing treatment, so that it always receives enough moisture. This also has the positive side effect of preventing wrinkles and deeper wrinkles for future mature skin. You should also have skin changes examined or checked regularly.
Birthmark removal
Removing moles without surgery
Birthmarks can be removed in various ways. In certain cases, a birthmark can be lasered away. The laser is used to transfer high-energy light to the skin. The tissue is heated to a high temperature over fractions of a second. Individual tissue layers or cells vaporize or char.
Some lasers emit energy to chemical compounds with a specific color (hemoglobin, melanin, water). This allows the targeted destruction of pigment cells while sparing the surrounding tissue. However, these lasers have a limited penetration depth, so that only the upper skin layer can be treated as well as possible. Pigment cells in deeper layers of the skin can remain and multiply again. This is particularly dangerous if black skin cancer (malignant melanoma) has not been ruled out with absolute certainty in advance. Lasering also carries the risk of developing light skin spots if all the pigment cells are destroyed. Other lasers, such as the CO2 laser or the YAG laser, destroy the most superficial layer of tissue without differentiating between color pigments. Scars occur in 25 to 50 percent of cases, and in up to 18 percent of cases the wounds can become infected 13 .
The result of a laser treatment depends on the type of birthmark, the patient’s skin characteristics, the properties of the laser and the experience of the operator. Experts agree that moles must be carefully selected for laser treatment. If a suspected cancer cannot be ruled out, the doctor must have a tissue sample examined histologically (recommendation of the Radiation Protection Commission, February 2016).
Removing a birthmark yourself at home is strongly discouraged. In the worst case scenario, this can delay the diagnosis of skin cancer.
Surgical removal of moles
The method of choice for the reliable assessment of skin changes suspected of being cancerous is three-dimensional, micrographically controlled removal. The methods of shaving, scraping or punching out have limited significance for histological examination. With gentle treatment of the tissue and a tension-free fine skin suture, a fine line-shaped scar usually remains. If the operation is planned from an aesthetic point of view, the scar is aligned so that it is barely visible. Larger congenital moles are removed in several procedures for cosmetic reasons so that the skin suture can heal without tension and in a cosmetically appealing way. Plastic surgeons refer to this type of surgical removal as a serial excision.
1 . dividing lines of facial regions 2. tension lines of the skin
A detailed knowledge of the anatomy is essential in facial surgery, as is knowledge of the aesthetic units and tension lines of the skin. Scars generally heal quite inconspicuously if the skin incisions are made along the dividing lines or small wrinkles. Outside these lines, zigzag irregular scars are less obvious. The “broken line” surgical technique is used here.
Removing moles on the face
Experienced plastic surgeons work with fine instruments and magnifying glasses in order to achieve the best possible aesthetic result. The minor surgical procedure to remove birthmarks is painless to painless, as it is performed under local anesthesia.
At the beginning of the procedure, the doctor injects the anesthetic for local anesthesia using a very fine cannula. The addition of adrenaline to the medication reduces the risk of a bruise being visible after the operation. The doctor performs the surgical removal of the skin change using a scalpel. The procedure rarely takes longer than fifteen minutes. Experience with microsurgical techniques and plastic surgery methods ensure barely visible scars. The doctor and specialist in aesthetic surgery closes the smallest wounds along the skin tension lines. Under these circumstances, the wound can heal without tension and the stitches can be removed by the doctor after a few days.
What types of pigmentation spots are there?
The most common pigment spots include:
- Freckles (ephelides).
- Liver spot (lentigo simplex, age spot: lentigo solaris).
- Acquired birthmark (junctional type nevus, compound type nevus or dermal nevus).
- Congenital birthmark (congenital nevus cell nevus).
- Cafe au Lait spot (nevus pigmentosus).
The rare special forms include
- Blue nevus (Naevus caeruleus).
- Halo or Sutton nevus.
- Spitz nevus (spindle cell and epithelioid cell nevus).
- Reed nevus (spindle cell nevus).
- Nevus spilus.
- Becker nevus.
- Large congenital mole on the face (nevus ota).
- Large congenital mole on the shoulder (nevus Ito).
Regular checks are recommended for skin changes.
FAQ – Frequently asked questions
The wound should be cooled slightly on the first day after the procedure. Showering is usually possible on the first day after treatment. Nevertheless, prolonged bathing or swimming should be avoided during the first 2 weeks. A sick note is usually not necessary. The skin threads are removed after 5 to 7 days. Wound healing is usually completed after 7 to 10 days. Cigarette smoking delays wound healing and increases the risk of inflammation. After two to three weeks, scar healing can be supported by frequent application of cream. Pay attention to this care. For a particularly inconspicuous scar, it is advisable to use UV protection in the first few months.
Health insurance covers the removal of moles if there is a medical necessity. There are medical reasons if there is a suspicion of cancer. Disturbing moles can also be removed if you do not like them for aesthetic reasons. Patients are often unhappy with moles and wish to have them removed for beautiful skin without marks, which they may try to cover up with make-up. The price for the removal of benign moles depends on the size, position and number of moles to be removed.
AUTHOR
Dr. Stéphane Stahl
We provide you with extensive expert knowledge in order to select the best possible treatment path together with you.
Privatdozent Dr. med. Stéphane Stahl is the former Director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at Lüdenscheid Hospital. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin.
He passed the European specialist examination for plastic and aesthetic surgery in 2011 and the German specialist examination in 2012. This was followed by further specialist qualifications and additional qualifications (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officer, hand surgery) as well as prizes and awards.
In 2015, he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, sought-after expert witness and regular speaker at specialist congresses. Following a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery.
His authorship includes numerous articles in prestigious peer review journals and standard surgical textbooks.
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