Urgent Dermatology Evaluation Required
You need immediate evaluation by a dermatologist within 2 weeks, as a rapidly growing, itchy mole that spontaneously fell off is a concerning presentation that could represent melanoma or another malignant process. 1, 2
Why This Is Urgent
- Rapid growth, itching, and spontaneous loss of a pigmented lesion are warning signs that require urgent specialist assessment, as these features can indicate malignant transformation, particularly melanoma. 3, 1
- The fact that "nothing really" remains underneath does not exclude melanoma—the lesion may have been superficial, or deeper tissue involvement may not be clinically apparent without proper examination. 1, 2
- Melanoma can present with evolution in size/appearance (the "E" in ABCDE criteria), and any persistent or changing pigmented lesion warrants immediate evaluation. 1, 2
What You Should Do Now
Immediate Actions
- Schedule an urgent dermatology appointment within 2 weeks—do not delay, as early detection dramatically affects prognosis. 1, 2
- Try to locate any remnants of the fallen-off lesion and bring them to your appointment if possible, as pathological examination is critical for diagnosis. 4, 2
- Photograph the site where the mole was located to document the current appearance. 3
What the Dermatologist Will Do
- Complete skin examination including the site where the mole was, all other skin surfaces, and regional lymph node palpation to assess for metastatic spread. 1, 2
- Biopsy of the site if any residual tissue remains—this must be a full-thickness excisional biopsy with 2-5 mm margins and subcutaneous fat to allow accurate pathological staging. 4, 1, 2
- Assessment for concerning features including asymmetry, border irregularity, color heterogeneity, and any nodules or ulceration. 1, 2
Critical Warning Signs to Monitor
Between now and your appointment, seek immediate evaluation if you develop:
- A lump or nodule at the site where the mole was located 3
- Bleeding, pain, or ulceration at the site 3
- Enlarged lymph nodes in the region (neck, armpit, or groin depending on where the mole was) 3, 1
- Any new pigmented lesions appearing rapidly 3, 2
Why Pathological Examination Is Essential
- Without histopathological examination, it is impossible to determine if this was melanoma, and if so, the Breslow thickness (depth), which determines prognosis and treatment. 4, 2, 5
- If melanoma is confirmed, Breslow thickness dictates surgical margins: lesions <1 mm require 1 cm margins, 1-2 mm require 1-2 cm margins, and >2 mm require 2 cm margins. 3, 1, 5
- The pathology report must include ulceration status, mitotic rate, and margin assessment—all critical for staging and determining if sentinel lymph node biopsy is needed. 4, 2, 5
Common Pitfall to Avoid
Do not assume that because the lesion fell off, the problem is resolved. 3 Spontaneous loss of a pigmented lesion after rapid growth and itching is not a normal process and requires investigation to exclude malignancy. 1, 2 Even if nothing appears to remain, microscopic disease may be present, and without proper evaluation, you risk missing a potentially life-threatening diagnosis. 4, 1, 2