What should I do about a mole that has changed from being rounded to sunken?

Management of a Mole That Has Changed from Rounded to Sunken

A mole that has changed from being rounded to sunken should be urgently referred to a dermatologist or surgeon/plastic surgeon with expertise in pigmented lesions for evaluation within 2 weeks, as this change in appearance is concerning for possible melanoma. 1

Why This Change Is Concerning

Changes in the appearance of a mole are a key warning sign that requires prompt medical attention. Specifically:

• Any change in shape (from rounded to sunken) is a significant clinical feature that meets criteria for urgent evaluation 1
• Evolution or change in a mole is part of the ABCDE criteria for melanoma suspicion (Asymmetry, Border irregularity, Color heterogeneity, Diameter >6mm, and Evolution) 2
• The "ugly duckling" concept suggests that moles that look different from other moles on your body warrant special attention 3

Immediate Steps to Take

1. Document the change: Take clear photographs of the mole if possible
2. Avoid manipulation: Do not scratch, pick at, or attempt to remove the mole yourself
3. Seek urgent referral: Contact your primary care provider for an urgent referral to a specialist 1

What Will Happen at the Specialist Appointment

The specialist will:

1. Perform a full skin examination, including documentation of the site and size of the concerning mole 1
2. Possibly use dermoscopy (a specialized magnifying tool) to better visualize the mole 1
3. Likely recommend a complete excisional biopsy if melanoma is suspected 1, 2

Important Considerations About the Biopsy

If a biopsy is recommended:

• It should be a full-thickness excisional biopsy with 2-5mm margins of normal skin and a cuff of subdermal fat 1, 2
• Shave and punch biopsies are not recommended for suspicious pigmented lesions 1, 2
• The entire specimen should be sent for pathological examination 2, 4

Common Pitfalls to Avoid

1. Delay in seeking medical attention: Any change in a mole warrants prompt evaluation 1
2. Assuming benignity based on appearance alone: Even experienced clinicians cannot always distinguish benign from malignant lesions without biopsy 2
3. Incomplete removal: Partial removal can make accurate diagnosis and staging difficult 1, 2
4. Self-treatment: Never attempt to remove a suspicious mole yourself 4

Risk Factors to Be Aware Of

If you have any of these risk factors, be especially vigilant:

• Fair skin, light-colored eyes, or red/blond hair 1, 2
• History of sunburns, especially in childhood 1
• Family history of melanoma 1, 2
• Previous melanoma or multiple atypical moles 1, 2
• More than 50 moles on your body 3, 5

Remember that early detection of melanoma significantly improves outcomes. The change in your mole from rounded to sunken represents a concerning change that requires prompt professional evaluation.