Elliot Hospital: Ask the Pediatric Surgeon

Elliot Hospital
Dr. Elizabeth Soukup from Elliot Hospital in Manchester, NH

Dear Dr. Soukup, My 7 year old daughter has had a mole on her leg since birth that my pediatrician has been watching. Should this be biopsied? -Mandy D.

Dear Mandy, 

Freckles and moles are very common in children, and it may help to start out with some definitions. The fancy name for a simple mole is “nevus”. The brown color is called pigment and is made by cells in the skin called “melanocytes”. These pigment- producing cells may increase in number (often from sun exposure) and make more pigment, which causes brown spots in the skin. Most of these, like freckles and moles, are benign and no biopsy or treatment is necessary. Atypical moles are less common in children but are at higher risk for developing into a skin cancer and should be recognized and watched closely by your pediatrician or dermatologist. Melanoma in children is incredibly rare, but even that small risk is what prompts a biopsy when there are concerns. We use the mnemonic ABCDE to help identify moles that should be biopsied. A = Asymmetry (when half of the mole does not match the other half). B = Border (when the edges of the mole are irregular instead of smooth). C= Color (when the color varies throughout the mole). D = Diameter (if the size of the mole is larger than a pencil eraser or approximately 6 mm). E = Evolving (when the mole changes the way it looks).

Dermatologists and pediatricians are trained to recognize moles that should be biopsied or observed closely. Once a biopsy is recommended, I will see children and their families to discuss this procedure. A biopsy simply means removing part (or all) of a mole and having it reviewed by a pathologist for diagnosis. Some children can tolerate this type of procedure in the office, but many need a sedation or anesthesia to do this safely. This is a big reason why an appropriate decision for biopsy is so important in children. 

A final category of moles that I should mention are the “congenital” moles, which means they are present at birth. These can range in size from tiny to very large, covering the entire trunk or limb. They will also grow proportionately in size with the child. As long as they are followed closely by your pediatrician or dermatologist, they do not need to be biopsied unless there are changes or concerns. So remember your sun protection, especially in those hot summer days! Thanks for your question! 

-Dr. Soukup 

Elizabeth S. Soukup, M.D., M.M.Sc. Pediatric Surgeon Dr. Soukup is a Pediatric Surgeon at the Elliot Hospital and has an interest in educating families about pediatric health and wellness. Her mission is to provide expert specialty care for children of all ages in New Hampshire – newborns through teenagers – striving to keep them close to their families and communities. If you would like more information, call 603-663-8393 for an appointment, or visit our website at http://elliothospital.org/website/pediatric-surgery.php. Check out her previous articles at #askthepediatricsurgeon. 

Check out her previous articles at #askthepediatricsurgeon. 


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