- Often self-diagnosable
- Symptoms: Small elevated lesion
- Color: Typically flesh-colored or slightly brown
- Location: Anywhere on the skin
- Treatment: No treatment necessary; dermal electrosurgical shave excision
An intradermal nevus is a classic type of mole or birthmark, with the same degree of pigmentation as the surrounding skin. It appears as an elevated, dome-shaped bump on the surface of the skin.
Intradermal means that the nevi cells are localized in the dermis (below the most external layer of skin). This is why the melanocytes (the cells that produce dark brown to black pigment) are not visible in the lesion.
This skin condition occurs mostly after adolescence. It is a benign skin growth and are caused by the sun, immune status or genetic factors. For example:
- People with many moles tend to have family members that also have many moles, and their moles may have a similar appearance.
- New moles may erupt following the use of BRAF inhibitor drugs (vemurafenib, dabrafenib).
- People living in Australia and New Zealand have many more moles than their relatives residing in Northern Europe.
- Immunosuppressive treatment leads to an increase in numbers of moles.
- Fair-skinned people tend to have more moles than darker skinned people.
- Moles that are acquired later in childhood or adult life often follow sun exposure.
How do they develop?
Melanocytes divide faster than normal and produce a cell mass, which pushes the overlying skin outwards, forming a bump like structure, which we call a mole. Even though melanocytes are black or brown colored cells, the mole appears skin colored or only slightly brown because the melanocytes are in the dermis and covered by the outer layer of skin.
All nevi formed in the discussed manner are melanocytic nevi. Melanocytes migrate from outer layers of skin towards inner layers, namely, from epidermis to dermis. Depending on where the cell mass is, melanocytic nevi are 3 types. As it descends from superficial to deep, they are named junctional nevi, compound nevi and intradermal nevi respectively. As they migrate down, melanocytes produce less melanin, which is the pigment responsible for skin color. That is another reason why intradermal nevi are usually flesh colored.
Intradermal nevi are usually flesh-colored, but can also appear to be slightly brown. It may also contain brown flecks or small dilated blood vessels. It can appear anywhere on the skin, especially on the face, head, scalp, neck, trunk or extremities, and often has a smooth surface.
These small lesions (5mm-1cm) elevate from the surface of the skin. They are presented in rounded, dome-shaped, pedunculated or warty appearance, and are also associated with hair growth. They are well-defined and have a soft, rubbery texture.
Sometimes the mole may have a small collection of a protein called keratin at its tip, in which case it is given the name ‘pseudo-horn cysts’. Older intradermal nevi in trunk and flexures commonly elongate to form peduncles, ultimately taking the appearance of a skin tag. In addition, as we age, our moles can migrate down through layers of skin.
Itchy intradermal nevus
Should I seek medical care?
While they are benign moles, they resemble early basal cell carcinoma and malignant melanoma, which are types of skin cancer. Keep track of the mole’s growth. If your mole changes in size, shape, or color, you should get it checked out to rule out skin cancer. In this case, you should seek medical care immediately, where a dermatologist can perform excision biopsy to determine if the mole is malignant. There have been cases where moles suspected as intradermal nevi, without any change in color or shape for years, later got identified as basal cell cancers after dermoscopic examination.4 This shows the importance of using proper technical methods to examine, rather than inspecting the moles only with the naked eye.
No treatment is necessary in most cases. But sometimes, the mole has to be removed because of different reasons. If the mole is present at birth, which is called congenital intradermal nevus, there is a slight possibility it might become cancerous with time. So, congenital melanocytic nevi are often treated.
Even though most of them are harmless, intradermal nevi can cause discomfort to people. Especially if located on the face or other exposed parts of the body, they can be cosmetically disturbing, and it is only natural to be self-conscious about the mole. Sometimes your clothes or shaving might irritate the mole frequently. If you are facing any of these issues because of intradermal nevi, do not worry. There are several treatment options you can try out to get rid of the mole.
Since the aim of the treatment is to make you look better, the cosmetic outcome and the minimum recurrence rate are the two main objectives that should be achieved from it. Nowadays, surgery or laser treatment are the popular methods that are being used to treat intradermal nevi.
Surgical removal of the mole can be done in two ways. One is excision of the full thickness of skin, named elliptical excision. This method involves sutures or stitches and a comparatively longer healing time. Also, you are likely to be left with a scar that can be roughly three times as big as the original mole.6 But the possibility of the mole reappearing is minimum.
The other method is called shave excision. Here the skin lesion is removed superficially. This method has both pros and cons. The benefits are the use of simple and easy surgical techniques, the ability to use the removed mole for further histopathological examination purposes and acceptable cosmetic outcome. However, it is impossible to undergo this procedure without a scar. The good news is, the scar will be less noticeable than the mole you had, possibly because of the retraction of the healing skin tissue.
Lots of studies have been conducted to assess the satisfaction of the patients who went through the procedure. One study reported patients declaring “the scar looked better than the original mole”.5 Same study reported 99% of people were satisfied with the shave excision method and would undergo the same process again.
Another study compared the shave excision and elliptical excision, and the results show great patient satisfaction with both methods, with a lower recurrence rate in the latter.7 It is up to you to decide which surgery option is better for you, mainly based on the location of the mole. If you don’t mind the scar, why not play it safe and go for full skin thickness removal?
If you are reluctant to go for surgery, you can try out laser treatment. There are different types of laser treatments available, including carbon dioxide laser (10,600 nm) and ruby laser (694 nm).8 They are pigment specific lasers, which means it targets and removes certain colored structures from skin that match with the wavelength of the laser.
It is effective, and cosmetically very good. One study shows a successful laser treatment, where the patient was left with only a grayish hue where the mole was, after ten sessions of monthly laser treatment.9 However, in the laser method lifelong follow-up is needed, even though the mole disappears completely. It is best to choose the laser method only if the mole is located in a place where you cannot afford to have a scar.
One major disadvantage of this method is, inability to get a sample to check if the mole is cancerous. If the mole is cancerous and removed without checking for malignancy, it can reappear later and it would be too late to save the life because now the cancer is in late stage. In contrast, if it was identified as malignant earlier, the life would’ve been saved. So, you need to think twice before opting for laser treatment.
What can I do?
If you are fair skinned, excessive exposure to sun might trigger intradermal nevi. Because of that, it is important to prevent skin damage from sun exposure, in order to limit the growth of moles. There are some home remedies you can try, including garlic, baking soda, lemon juice, tea tree oil, potatoes, banana peels, honey, aloe vera and coconut oil. However, these are not scientifically tested for their ability to remove moles. It is extremely important not to attempt surgical removal of a mole at home.
Bottomline, intradermal nevi are often harmless moles. If it causes irritation or cosmetic problems, you can consider removing it. There are several options you can go for, each one with its own pros and cons. You can choose what’s best for you based on your priorities.
- Patient. Intradermal and Compound Naevi. Available at: https://patient.info/doctor/intradermal-and-compound-naevi
- Dermnet. Moles Intradermal Nevi. Available at: http://www.dermnet.com/videos/nevi-melanoma/melanocytic-nevi/moles-intradermal-nevi/
- Cleveland Clinic. Common Benign Growths. Available at: https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/common-benign-growths/
- Salerni, G. (2022). Basal Cell Carcinoma Disguised Among Intradermal Nevi. Dermatology Practical & Conceptual, 12(1). https://doi.org/10.5826/DPC.1201A28
- FERRANDIZ, L., MORENO-RAMIREZ, D., & CAMACHO, F. M. (2005). Shave excision of common acquired melanocytic nevi: cosmetic outcome, recurrences, and complications. Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.], 31(9 Pt 1), 1112–1115. https://doi.org/10.1097/00042728-200509000-00005
- Burns T, Breathnach S, Cox N, Griffiths C. Rook’s Textbook of Dermatology. 8th ed. Oxford: Wiley-Blackwell; 2010.
- Santos Soares, A., Paula Dornelles Manzoni, A., Daniele Amorim de Souza, C., Blessmann Weber, M., Watanabe, T., Camini, L., & Santos Soares Ogê, A. R. (2016). Comparative analysis between sutured elliptical excision and shaving of intradermal melanocytic nevi: a Randomized Clinical Trial. Surg Cosmet Dermatol, 8(4), 316–336. https://doi.org/10.5935/scd1984-8773.201684902
- Bray, F. N., Shah, V., & Nouri, K. (2016). Laser treatment of congenital melanocytic nevi: a review of the literature. Lasers in Medical Science, 31(1), 197–204. https://doi.org/10.1007/S10103-015-1833-3
- Lee, J. M., Kim, I. H., Rhyu, I. J., & Ryu, H. J. (2015). Combined intense pulsed light and Er:YAG laser treatment of congenital melanocytic nevus. Journal of Cosmetic and Laser Therapy : Official Publication of the European Society for Laser Dermatology, 17(3), 162–164. https://doi.org/10.3109/14764172.2014.1003244
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The Specialist doctor from the University Hospital in Gothenburg, alumnus UC Berkeley. My doctoral dissertation is about Digital Health and I have published 5 scientific articles in teledermatology and artificial intelligence and others.