What is the significance of sudden redness around a mole and how should it be managed?

Acute Redness Around a Mole: Urgent Evaluation Required

Any sudden redness surrounding a mole requires prompt evaluation by a dermatologist, preferably within 2 weeks, as this represents a concerning change that could indicate malignant transformation, proliferative nodule formation, or other serious pathology. 1

Why This Matters

Acute redness around a mole is a red flag sign that demands immediate attention because:

• Concerning changes in moles include rapid growth, bleeding, pain, development of nodules, or ulceration—all of which should be promptly evaluated 1
• Patients with suspicious pigmented lesions should be referred urgently to a dermatologist or surgeon with expertise in pigmented lesions 1
• The British Association of Dermatologists explicitly recommends that specialists ensure patients with suspicious lesions are seen within 2 weeks of referral 1

What You Should Do Immediately

Refer Without Biopsy

• Do not attempt biopsy in primary care—even when melanoma is suspected, refer without performing any biopsy procedure 2
• There is no place for incisional or punch biopsy in primary care when melanoma is suspected 2
• Punch and shave biopsies make pathological staging impossible and prevent accurate measurement of tumor thickness 2

Urgent Referral Pathway

• Refer to a dermatologist or surgeon/plastic surgeon with expertise in pigmented lesions 1
• Ensure the patient is seen within 2 weeks 1
• Document the site, size, and characteristics of the lesion with clinical photographs if possible 1

What the Specialist Will Assess

The dermatologist will evaluate for:

• Visual inspection aided by dermoscopy and palpation of the lesion 1
• Regional lymph node examination for lymphadenopathy 1
• Assessment for proliferative nodules (benign melanocytic growths that can arise within larger moles and overlap clinically with melanoma) 1
• Full skin examination to document other pigmented lesions 1

Definitive Diagnosis

If biopsy is warranted, the specialist will perform:

• Full-thickness excisional biopsy including the entire lesion with a 2-5 mm clinical margin of normal skin and a cuff of subdermal fat 1
• This allows confirmation of diagnosis and accurate Breslow thickness measurement for staging 1
• Histopathologic examination should be performed by a dermatopathologist with expertise in pigmented lesions 1

Critical Pitfalls to Avoid

• Never perform partial sampling techniques (punch or shave biopsies) as they make pathological staging impossible 2
• Do not delay referral while "watching" a mole with acute changes 1
• Do not reassure patients that redness around a mole is benign without specialist evaluation 1
• Recognize that melanoma in congenital melanocytic nevi can present as deep nodules without overlying color change 1

Patient Education

Advise patients to monitor for additional concerning changes:

• Rapid or asymmetric growth 1
• Bleeding or ulceration 1
• Development of lumps or nodules 1
• Pain or significant symptoms 1