What's the Difference Between a Mole and a Skin Tag and How Do I Get Rid of Them?

It is not always easy to tell apart skin tags, moles, and keratoses (“barnacles”). All three can range in color from tan to brown/black, gray to pink, or match your skin color exactly. Some moles are even a blue/black color. Moles are well-organized collections of skin cells that are specialized in making the melanin pigment that protects skin from the harmful ultraviolet effects of the sun. Tags and most keratoses, however, are made up of the more common skin cell types.

Moles, or “nevi,” can also have many shapes and sizes, and can appear almost anywhere on the body, including palms and soles, scalp, face and genital areas. Keratoses are usually very superficial with no underlying “roots,” almost like warts. Some keratoses are caused by sun damage and they are considered pre-cancers.  Skin tags (“acrochordons”) are usually small, but can grow steadily and tend to occur in skin folds. The most common areas for skin tags include:

If tags, moles or keratoses get in the way, snag on your clothes or jewelry, or you are otherwise unhappy with their appearance, they can be removed safely by a professional dermatologist like Jennifer Baron, MD, FAAD, FACMS in San Jose. You will reduce the chances of bleeding, infection, recurrence and scarring by allowing Dr. Baron to remove them for you.

The differences between moles, freckles, skin tags and keratoses

Your baseline skin color is the result of pigment production and distribution to your skin by specialized “melanocytes.” The melanin pigment is normally spread evenly in your skin, but with moles, they group together in round or oval shapes, sometimes flat and sometimes raised like mounds above the skin. Some people have very few moles and some have more than 50. While there are exceptions, having a lot of moles is usually inherited and most people stop getting new moles after the age of 30.

True freckles are different from moles in many ways, but the most noticeable is that freckles are usually lighter tan or brown and are always flat. Also, freckles tend to be on the face, shoulders, chest, and arms, and sometimes disappear with age. Freckles do not become skin cancer.

It is very rare that a mole turns into a skin cancer (i.e. melanoma), but, it is not unusual for actual skin cancers to look very similar to a regular mole when it first appears on your skin. For that reason, it is very important to get a full skin examination by a dermatologist if you have moles, there is skin cancer or melanoma in your family, or you’ve noticed some of your moles changing color, size or shape faster than others. Your dermatologist can perform a biopsy right away if there is any suspicion for skin cancer.

Skin tags often look like a soft “pouch” of skin that is attached by a fine “stalk.” Because of this, they can twist and turn black and fall off, or they can be torn off and bleed. Some moles can look tag-like, so it is not advisable to try to snip or twist off any growth of the skin without visiting your dermatologist to assess first. Skin tags are not cancerous, but some growths that appear to be tags or moles may actually be early skin cancers.

Keratoses are usually rough like sandpaper or waxy in texture. They are so superficial, they may seem like they can be easily scratched off. They also tend to get irritated easily and can be very itchy, especially around the chest, neck and back. The pre-cancerous keratoses are almost always located in sun-exposed skin, like the scalp, ears, face, hands and arms.

Removing moles, freckles, skin tags, and keratoses

These growths can be removed by your dermatologist in the office. The best removal options depend on the size, location, and depth of the growth. Also, the dermatologist will almost always confirm with the pathology lab that a mole was non-cancerous by submitting it as a biopsy.

“Burning” or Fine Needle Hyfrecation

A specialized instrument that delivers a spark of electricity to the most superficial layers of the skin is used to effectively remove small tags and keratoses. The heat from the spark seals off any bleeding during this procedure. This treatment is used often in locations or skin types that may not tolerate freezing (see below).

LASER or Broadband Light (BBL)

Freckles and flat sun spots can be successfully lightened and/or removed safely and completely with BBL treatment.

Shaving, Snipping or “Cutting”

Dr. Baron may use a scalpel to remove raised moles or surgical scissors to snip off tag-like moles or skin tags. If a mole extends more deeply under the skin, she may recommend an excision which will prevent a mole from growing back. An excision is a bit more complicated and may require numbing (with a small needle injection) in the area, followed by stitches to improve healing and reduce the chance of a scar.

Freezing (Cryotherapy)

Liquid nitrogen is often used to freeze skin tags and keratoses. In some areas, this can form a blister which usually heals without a scar over the course of days to weeks, depending on size and location. For darker skin types, freezing may not be a good option since it can cause semi-permanent disruptions in the surrounding skin color (see Fine Needle Hyfrecation, above).

Leaving the removal of these common growths to a skilled dermatologist will give you the best chance for a great result, allow for careful evaluation (biopsy if needed) and will avoid complications like scars and pigment irregularity. Contact Jennifer Baron, MD, FAAD, FACMS when you need skin growths evaluated or removed. Call the San Jose office at 408-329-6056 to schedule your appointment.

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