Should Large Birthmark on Baby (Congenital Nevus) Be Removed?


Should Large Birthmark on Baby (Congenital Nevus) Be Removed? Dermatologist Dr. Joshua Fox Gives Advice About Removal of Large Birthmark on Baby

Sep 18, 2011

Does your baby (or toddler) have one or more large birthmarks (also called congenital nevi)? “Nevus” is another name for mole, and the plural is nevi (rhymes with Levi). “Congenital” means present at birth. For this article I consulted with dermatologist Dr. Joshua Fox, founder and director of New York and New Jersey-based Advanced Dermatology P.C.

Since I already knew that large birthmarks are more likely to become melanoma than are smaller moles, and since the general advice from dermatologists is to have moles, that are bigger than the size of a pencil eraser, electively removed, I wondered:

Should very large moles on a baby be electively removed?

I wasn’t thinking in terms of cosmetic reasons, but in terms of eliminating that increased risk of melanoma. I have seen toddlers and children with huge nevi – they didn’t even look like typical birthmarks or moles – they were giant, erratically shaped patches of dark purplish-brown. And whenever I see this, I think as a layperson, “Get that thing removed! It can become melanoma!”

Dr. Fox explains, “About 5 percent of the large congenital nevi have a risk of turning into melanoma.” To me, 5 percent sounds alarming enough to have a baby’s large birthmark removed. Otherwise, the parent might be facing indefinite anxiety. And so might the baby once he or she grows up and learns that very large birthmarks have a heightened chance for transformation into melanoma.

But Dr. Fox continues, “These nevi must be observed” for possible signs of melanoma. Signs are: a change in appearance over time; jagged, uneven edges (though the bigger a nevus, the more irregular its border will be); red spots in the lesion; different colors like grey or black; and bleeding without having been scratched.

This sounds scary, but should a parent arrange to have a baby’s large birthmarks surgically removed?

Dr. Fox explains, “However, it is not required to excise all large congenital nevi which do not possess the characteristics to become melanoma. Also, many excisions will leave a scar behind which is not very pleasing to many patients due to cosmetic reasons. There are institutions and some pediatric dermatologists who have advocated for removal of larger dysplastic nevi both to decrease anxiety, lower malpractice risk, and potentially help patients. This is not my approach or the accepted standard for many reasons.” The term “dysplastic” refers to atypical in appearance.

Removal of large birthmarks on a baby may be impractical.

If a baby has many huge dysplastic nevi or birthmarks, this can present a problem as far as removal, versus if the baby has only one large birthmark. Remember, only 5 percent can become melanoma, so what parents need to do is monitor large birthmarks in their baby via monthly visual inspections, and a baseline photo should be taken; just keep track of your baby’s birthmarks and they may never need to be removed.

Are the Big Moles on My Child Dangerous?


Are the Big Moles on My Child Dangerous? Leading Dermatologist Dr. Joshua Fox Discusses Moles in Children, Including Big Ones on Their Backs

Sep 18, 2011

Are you worried about all those big moles on your child’s back? Most people are born without “birth marks.” A recent study shows that every beach vacation gives rise to a 5 percent increase in the appearance of small moles on a child.

Dr. Joshua Fox says, “The development of new moles is of concern, because the higher the number, and the more irregular moles, the greater the risk for developing melanoma, the most dangerous of the skin cancers.”

What about big moles on my child’s back?

Dr. Fox is founder and director of New York and New Jersey-based Advanced Dermatology P.C. I asked him (for purposes of this article) specifically about large moles all over a child’s back: Does this reflect excessive sun exposure? My teen nephew has many big, funny-looking moles all over his back, and he is almost always shirtless on summer lake vacations and tropical vacations.

Dermatologists call moles “nevi” (rhymes with Levi, as in Levi jeans), and the singular form of nevi is “nevus.” Odd looking or atypical nevi are called dysplastic nevi, and they can resemble melanoma. Having dysplastic nevi is a risk factor for melanoma.

Dr. Fox says that most nevi are not worrisome, but as a parent you should monitor your child’s skin for any changes in nevi or new nevi. This will be challenging if your child has a lot of spots, like my nephew. If your child has a lot of moles on his back or elsewhere, it would be very smart to pursue serial digital dermoscopy as a way of tracking all the nevi.

Relationship between moles on child’s back and sun exposure

“Many dysplastic nevi seem to occur in areas in which the child received severe sunburn on one or more occasions,” says Dr. Fox. “It often matches the clothing distribution. In addition, there is a genetic relationship to melanoma. Only about 1 percent of infants are born with a mole. For those children who have many nevi, we encourage parents to check their child’s moles monthly to detect changes.”
If you notice a new “birth mark” on your child, keep visual track of it. “Normal looking new moles are not suspicious,” says Dr. Fox. About one-third of melanomas arise in a pre-existing nevus.

“By the time most people reach adulthood, they have between 10 and 40 moles,” says Dr. Fox. A lot of sun is another risk factor for melanoma, and maybe as a parent you’re not overly concerned about your child developing melanoma since this is extremely rare in kids.

However, older age is a risk factor for melanoma, and childhood sun exposure can lay the groundwork for melanoma risk decades later! In other words, parents should see the big picture: Their child’s risk of melanoma when their “kid” is 40 years old!

If you’re inspecting your child’s back moles (or elsewhere) for the first time and notice that some look funny, this doesn’t mean melanoma. Get familiar with the nevi so that you can detect a changing or evolving nevus. Follow your gut feeling and make an appointment with a dermatologist if your child has a suspicious looking skin lesion.

Concerning signs include irregular shape, jagged edges, red portions within the nevus or varying colors, larger than a pencil eraser, and of course . . . changing.

How often should I check the moles on my child’s back?

Every month, and inspect any area exposed to sun including the scalp and behind ears. Draw a mole map and take photos and compare every month. If this is overwhelming, pursue serial digital dermoscopy, which is ideal for kids and adults who have many moles on their back.

Keep it simple when it comes to skin care


Keep it simple when it comes to skin care

Sep 12, 2011 at 1:27PM

The array is dizzying. Dozens of face-washing “enhancers” are being touted in the fall fashion mags as vital for the nightly cleaning ritual: pre-wash makeup removers, post-wash scrubbing pads, exfoliating gels, toners to restore pH balance and on and on.

What’s a woman to do?

Just find yourself a good gentle face soap, dermatologists say. If you have reasonably normal skin, use the product twice a day, apply moisturizer after you’ve washed (one with sunscreen in the mornings) and ignore all those other things, they say.

“You don’t need 25 products to have good, clean skin,” says dermatologist Karen Nern of Vail Dermatology in Edwards and Basalt, Colo. “Cleansing your face is not complicated.”

Indeed, the avalanche of pre- and post-face-washing products entering the post-summer marketplace sometimes troubles dermatologists.

Most are a waste of money for relatively normal skin, and some people “can do too much with too many products and irritate their skin,” Nern says.

“It’s really best, for skin, to keep it simple,” says dermatologist Meryl Blecker Joerg of Advanced Dermatology and the Center for Laser and Cosmetic Surgery, with locations in New York and New Jersey.

The terms “soap” and “cleanser” are used interchangeably, but some “cleansers” contain things docs don’t like, and some soaps aren’t right, either.

Face-cleaning products dermatologists prefer range from bars (they love Dove, Purpose and Cetaphil) to gels to liquids. Whatever the form, the products must be formulated for the face, not the body, and shouldn’t contain deodorant, antiseptics or, ideally, fragrance. They shouldn’t have scrubbing grains/grit or other popular additives.

Good non-bar options are foaming and non-foaming; neither is necessarily superior (though non-foaming is regarded as milder and may be easier on especially sensitive skin, Joerg says).

There’s no need for post-wash toners because “they tend to remove the natural oils that should remain on the skin,” Joerg says. In fact, any product promising to return skin to proper pH after washing is unnecessary, because unlike in decades past, “most cleansers today are at normal pH,” Nern says.

Increasingly, dermatologists contend with fads. Two now promoted on the Internet — wash your face with bleach, or wash your face with hydrogen peroxide — are horrifying to Nern. “Way too harsh,” she declares.

As for green teas being promoted as face soap? “Tea isn’t a good cleanser,” Nern says. “It can kill bacteria, and it can feel soothing, but it won’t get skin clean.”