Question(s) regarding dark specks in a cauliflower mole...

[bmw1]

Hello, I have a question about a mole on my lower abdomen. (Yes, I am planning to have my dermatologist look at this week, but until then I was hoping to get some further input/advice/opinions as I tend to be a worrier!)

I have had this mole my whole life as far as I can recall (I am male, 42 years old, good health). It is about 4 inches below and three inches to the left of my navel.

It's characteristics are as follows (I wish I could post a photo):

- NO changes in mole (size, itching, bleeding)
- round
- symmetrical
- 6mm diameter (1/4 inch)
- sharp, even border
- cauliflower surface
- 'on a stalk', meaning it is broader on the top (6mm) than at the base, kind of like a 'mushroom cloud'. The overall depth of the mole from skin surface to top of mole is about 3mm.
- very even mid-brown coloration, EXCEPT:

I noticed on very close inspection that within the dimples of the cauliflower surface there are three darker specks (not quite black). They looked to me like lint in the dimples, though further investigation with tweezers revealed they were not. One was protruding slightly, and with a slight tweeze, I extracted it. Upon extraction it appeared to me to be just like a blackhead, and there was extremely slight bleeding from where it was extracted (just like with some blackheads).

The reason I started looking closely at this mole was because my wife was just diagnosed with a patch of BCC. This is the largest mole on my body, so I've started to be more vigilant (and more worried since her diagnosis).

I have no history of extensive sun exposure (grew up in a very northern latitude) and no family history of melanoma. I've had a couple of smaller moles on stalks before (under arm, on shoulder) that actually just fell off on their own.

I don't have many moles, and the ones I have are quite small on the arms and legs. I've had two moles removed in my life. Both were benign, but the one removed from my lower leg a couple of years ago exhibited some 'atypical cells'. It was removed with clear margins and the doc told me it was nothing to worry about. That one was tiny, about 2mm. I have follicultitis and it looked to me like the coincidence of a small pimple and the mole, hence it itched, so I had it looked at.

Questions are as follows:

1) does this description sound like cause for concern? These specks may have been there forever for all I know.

2) can blackheads form inside a cauliflower shaped mole? Are there follicles in moles?

3) I realize that of the ABCD's of melanoma, I suppose I have 'C' and that on it's own is reason enough for a trip to the dermatologist?

4) what percentage of melanomas arise out of moles like this (cauliflower, stalk shaped) vs. arising in flat, previously unpigmented skin.

5) do moles on stalks with a cauliflower appearance have a medical name? When I search the web for "cauliflower and moles" I get a lot of pages about rodent pests and vegetables!


Thanks in advance for any input/advice/opinions.

- b

[Alan Rockoff, MD]

Although you are clearly wise to see a doctor about this, I'm confident that you have nothing to worry about.  The black specks may well be blackheads, which can form part of some moles.  Moles can have cauliflower-like projections and some are on stalks--these characteristics don't merit specific names and don't have particular implications (though having a stalk makes moles easier to remove.)  Raised moles rarely lead to cancerous change, especially when as in your case they've been there for a long time.

Best.

Dr. Rockoff

[bmw1]

I wanted to add this information I found about seborrheic keratosis, because it accurately describes the 'appearance' of this particular mole:

"Stuck on - They are classically described as looking like someone took clay or a blob of dirt and "stuck" it on the skin. The edge of the seborrheic keratosis is not attached to the underlying skin making it appear that it could be removed by picking it off with your fingernail. This is because seborrheic keratoses arise from the epidermis, or top layer of skin. They don't extend deep into the skin like warts. What you see is what you get."

I understand, however, that SK develops later in life? I know I have had this mole since at least my late teens/early 20s. (20+ years).

[Alan Rockoff, MD]

Seborrheic keratoses often occur later in life, but I've seen lots of younger folks with a single one.  You may well be right, and if so, then it's still nothing to worry about.

Dr. Rockoff