Moles or naevi

Naevi, moles or birthmarks

Moles (naevi) are benign accumulations of pigment-forming cells in the skin. Moles are a normal phenomenon. The official medical term for these benign moles is naevus naevocellularis.

Almost everyone develops a number of naevi after puberty, some are even born with them. These are normally referred to as birthmarks (naevus congenitalis). Although usually limited in numbers, some people can develop many naevi. Most naevi are small, flat and evenly pigmented brown or black spots. Some naevi grow in the dermis, others are more elevated, clearly round or irregular. And although they can be quite different in size, shape or colour, their shape and pigmentation is always even. Agitated naevi (atypical naevi), however, are larger than 0.5 cm and have a colourful pigmentation with a blurred boundary. When a mole is showing different shades of brown and black, but also when there is a reddish dyschromia, it must be monitored because of a degeneration risk.

Malignant moles or melanomas

In addition to normal, benign moles, there are also agitated moles (dysplastic or atypical naevi) and malignant moles (melanomas). Although agitated moles are usually benign, they can sometimes be the forerunners of a melanoma. So, a melanoma can develop from an agitated mole, and even very rarely from a normal mole. A melanoma, however, can also spontaneously develop from normal skin.

Degeneration of moles into skin cancer or melanomas has increased in recent decades. This is because we are increasingly exposed to direct UV radiation by lying in the sun or under a sunbed. The risk of developing melanomas increases by overexposure to UV radiation, as such the skin shows more moles or naevi, also where there are agitated moles or atypical naevi, or if someone in the family has ever developed a melanoma. Birthmarks or congenital naevi also have an increased chance of degenerating into melanomas.

Can naevi be treated with the laser?

Until 1998, laser treatments of moles were performed only in a research setting. In these studies, in addition to the efficiency of the treatment, special attention was paid to ensure a laser treatment did not stimulate the degeneration process. The results proved to be reassuring.

However, these studies showed that after the laser treatment some small groups of non-pigmented naevus cells were usually still present in the depth of the skin. For this reason, it can never be guaranteed 100% that a degree of pigmentation will not recur after some time. In the case of re-pigmentation, of course, an additional laser treatment can be performed.

Because some naevus cells can remain in the skin, we can never guarantee that the risk of degeneration completely disappears after a laser treatment. Besides, non-pigmented naevus cells can also degenerate at any time.

Although the risk of degeneration of naevi is very small and, according to the current knowledge, does not increase with laser treatment, an annual check after the treatment is important. It is especially important to have a check done if ever a change (swelling, changed pigmentation, wound, etc.) should occur in the treated skin area. We must also point out that there is still no consensus regarding laser treatment of naevi. Some universities still advise against it, although, in our opinion, this is based on inconsistent reasoning.

Laser treatment of moles, birthmarks or naevi

For the treatment of moles, birthmarks or naevi, we use both the evaporating UltraPulse CO2 laser and the selective pigment laser. The pigment lasers produce a very powerful light wave of one particular wavelength that is selectively absorbed by the pigmented cells of the mole. Due to the high energy dose and the extremely short pulse duration, selective damaging of these cells is created. This is done in such a precise way that the surrounding normal tissues are hardly damaged.

Are evaporating or selective pigment laser treatments painful?

  • Treatment with an evaporating UltraPulse CO2 laser or with a selective pigment laser is well tolerated by most people.
  • Mild pain is usually experienced in the same way as if a rubber band was snapped against the skin.
  • Treatment under local anaesthesia is also possible for larger naevi. 

What to expect after the laser treatment?

  • After the laser treatment of a mole, a birthmark or naevus, slight swelling occurs (oedema) and sometimes a light blue dyschromia (purpura) also.
  • Sometimes there may also be some spots of point-sized bleeding and a certain degree of scab formation.
  • The risk of scarring is negligible.
  • Slight lightening of the skin texture is possible.
  • After treatment, we sometimes see some lightening of the skin (hypopigmentation) in the treated area in comparison with the surrounding skin colour. This usually disappears after a couple of months.

Aftercare following the removal of naevi through laser treatment

  • For comfort reasons, after the laser treatment, we suggest you apply Flamigel 1 to 2 x daily on the treated area. This ointment also reduces the risk of infection in the case of possible scab formation. You can continue to do this from a few days up to one week.
  • Afterwards, it is useful to use a moisturising or healing cream for several weeks. 
  • Rubbing or the use of soap on the treated area is advised against during the first few days after the laser treatment.
  • When washing the treated area, it is recommended to only lightly dab the skin with water.
  • Prior to, during and after the laser treatment, it is recommended to use maximum sun protection.

The expected results and frequency of laser treatments for naevi

  • The optimal result of one laser treatment for a mole, birthmark or naevus can be expected after about two months. After which point, a second treatment can be performed.
  • Usually, 3 to 6 treatments are necessary to obtain a maximum result.
  • Although in many cases, we can achieve a complete regression of pigmentation, we cannot guarantee this for all moles, birthmarks or naevi. But, we always succeed in achieving a significant fading to the area of the naevi.

What you also need to know

  • Agitated moles (atypical naevi) and pigmented skin lesions with an uncertain diagnosis (possibly melanoma) are not treated with the laser. This type of naevi are best surgically removed for microscopic (histological) examination.
  • During the treatment, the patient, the physician(s), staff and any attending family have to wear special glasses to protect their eyes from the laser light.

If you have any question about the removal of moles, birthmarks or naevi with laser treatment, do not hesitate to contact us.

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