What is happening inside my child’s body? A freckle is a small pigmentation, usually no bigger than an eraser head, caused by exposure to the sun. A mole is a bigger version of a freckle and results from a combination of genetic predisposition and sun exposure. They both come from skin cells (called melanocytes) that produce dark pigments. Whereas freckles usually show up in sun-exposed areas and in patches by the dozen, moles can appear anywhere on the body, ranging widely in shape and size. In medical terms, a mole is also known as a nevus.
Your doctor will examine any moles on your child’s skin. A mole should be watched over time to determine whether it is changing in shape, size, color, or appearance. The general rule about moles is as follows: A mole that is perfectly circular and that has consistent color and texture throughout is typically benign. A mole that has an unusual shape, that is partially raised and partially flat, or that has multiple colors throughout will be followed more closely or even removed. If your child has several moles, or if he has one mole that looks worrisome to you, you may want to take him to a dermatologist for evaluation.
What can I do?
There is nothing you need to do about freckles or moles, except to point out to your doctor any that are changing or worrisome. If you are not sure whether a mole is changing, it may help to take a picture every few months to document any changes.
To prevent freckles and moles, use sunscreen. Sunscreens are rated by SPF, or sun protection factor. This number can range from 0 to 50. Pediatric sunscreens are formulated with high SPFs (never use a sunscreen with an SPF less than 15) and other kid-specific features, such as fun colors, easy-to-apply dispensers, and waterproofing to minimize the need for reapplication. Sunscreen should be used on any sun-exposed area. This generally includes the face, ears, forearms, and lower legs, although a child wearing a bathing suit will need more areas covered. If your child will not wear a hat and has thin or fair hair, you should apply sunscreen to the scalp as well. And be sure to apply sunscreen to the tops of your child’s feet.
What are the treatments?
If a mole is determined to be worrisome by a pediatrician or dermatologist, it may need to be biopsied or removed. This is the only treatment. Medications, creams, or lasers are not used in lieu of removal.
What are the possible complications?
It is possible for a birthmark or mole to become malignant over time. About 1 percent of newborns are born with one or more moles, most of which are quite small. The risk of a small mole becoming malignant is very low, and this usually occurs only during or after puberty.
The bigger a nevus is, the greater the chances that melanoma will develop in the mole. For example, in moles bigger than about half an inch (1.5 cm), the risk of malignancy is about 5 percent. It is estimated that the risk of developing melanoma is about the same for people born with moles and people who acquire them later in life.