From the Guidelines
If a large nevus (mole) is bleeding, immediate medical attention is necessary as this could be a warning sign of melanoma or other skin cancers. The first step is to apply gentle pressure with a clean cloth to stop the bleeding. Once bleeding is controlled, the area should be cleaned with mild soap and water and covered with a sterile bandage. Do not attempt to remove or treat the nevus at home.
Next Steps
- Schedule an urgent appointment with a dermatologist who will likely perform a thorough examination and possibly a biopsy to determine if the nevus is benign or malignant, as recommended by the revised U.K. guidelines for the management of cutaneous melanoma 2010 1.
- Treatment typically involves complete surgical excision of the nevus with appropriate margins, which is done under local anesthesia in an outpatient setting.
- The tissue is then sent for pathological examination. If melanoma is confirmed, further treatment may be necessary depending on the stage, potentially including wider excision, sentinel lymph node biopsy, immunotherapy, or targeted therapy.
Considerations
- Bleeding in a nevus is concerning because it often indicates changes in blood vessel formation (angiogenesis) which can be associated with malignant transformation in the skin lesion.
- For large and giant congenital melanocytic nevi (CMN), surgical approaches include serial excision, tissue expansion, local flaps, and grafting with skin or artificial skin substrates, as discussed in the care of congenital melanocytic nevi in newborns and infants: review and management recommendations 1.
- The decision for procedural interventions or removal of a CMN is complicated by numerous factors, including family preference, the size and location of the nevus, patient age, overall health, and prognosis if neurocutaneous melanosis (NCM) or melanoma is present, as outlined in the care of congenital melanocytic nevi in newborns and infants: review and management recommendations 1.
From the Research
Treatment Options for Large Nevi with Bleeding
- Laser therapy has been used as an alternative treatment for nevi, with quality-switched lasers being preferred for the treatment of pigmented lesions 2.
- For congenital melanocytic nevi (CMN), laser treatment has been shown to improve the cosmetic appearance of some CMN and may be cautiously considered for lesions located in cosmetically sensitive areas 3.
- Surgical excision is often preferred for the treatment of CMN, but its safety and effectiveness remain unclear, with major wound-related complications and scar-related complications occurring more frequently with large/giant CMN 4.
Hemorrhage Control for Nevi with Bleeding
- Direct pressure remains the most effective "medical" intervention for initial hemorrhage control, with elevation and splinting of the bleeding extremity or body part as an adjunctive aid 5.
- Appropriate immediate hemorrhage control interventions for bleeding wounds include direct pressure, wound packing, hemostatic dressings, pressure bandage, and possibly tourniquet application 5.
Considerations for Treatment
- The risk of developing secondary intralesional neoplasms increases with age and nevus size, with younger patients being more likely to need general anesthesia for excision 6.
- Surgical excision of nevi is safe and has an acceptable risk profile, with the findings of one study supporting the practice of nevus excision before puberty to reduce the risk of developing secondary intralesional neoplasms 6.