Suspicious Moles with images

[alex35736]

Hi there!

My Dr noticed two suspicious moles that i had and I wanted to see if they could be more closely examined. The pictures I have taken are pretty high quality. Both of these moles are located where the sun don't shine if ya know what I mean - probably not due to UV radiation.

The one in the top right is only about 3-4mm in diameter but it wasn't there 3-4 months ago. I think its been growing at a pretty slow rate, but it doesn't look like the other moles I have because its slightly lighter in color (light brown/pink). It also feels a little harder than normal moles and a little more raised up.

The one in the middle of the picture is much bigger, maybe 10mm in diameter. I have had it for most of my life. I dont look at it much but from what I remember (couple years ago), it used to be round and darker. Now it is VERY asymmetrical and has redish growths on it. It feels pretty soft and it doesnt hurt at all. I have a bad feeling about this one.

Questions:
1. Are these moles clearly cancerous/melanoma? Or is the only way to tell is to have a biopsy?
2. Lets say they are cancerous/melanoma, for the big one and from the physical aspects of it, does it pose any risk  to my survival at this point? I know that the bigger the tumor growth, the higher chance it will spread.
3. What kind of Dr should I see, a dermatologist? Would they have to biopsy it first?
4. If I need to get it removed, how will the surgery procedure go down? Is it a one man job? How long will it take?

Anything else I should probably know?
Thanks!
Your response would be GREATLY appreciated!

[vedadhar]

Thank you for the update and good to know that you got the wart leveled out,guess that is the one your penis.Appreciate your understanding and follow up with me. :).You also mentioned swollen prostrate gland,please talk to your Doctor and undergo recommended examination to evaluate its pathology (Severe HPV infection may have association with Prostrate cancer-similar to cervical cancer)

Please take healthy diet to keep your immune system in condition and seek medical help in time as indicated.Please do practice safe sex so as not get a new infection or transmit current infection which may put you at risk because chances of recurrence are high.Though warts may regress with/without treatment.

All The Best and God Bless!

[alex35736]

Thanks again vedadhar,

I have a degree in molecular biology so I'm pretty familiar with viruses. I went to the doctor today and he used liquid N2 to get rid of the HPV wart. He told me everything you have told me and said to just make sure to treat the warts if I get anymore and that is all I can do at this point. My immune system should take care of the rest. As for the other mole, he referred me to a dermatologist so hopefully I can get that checked out as well next week.

I'll keep you updated!
thanks!

[vedadhar]

Pathological conditions of HPV infection depends on the type of viral strains which are divided into High risk strains-16, 18, 31, 45 (genital cancers),High risk groups in cases of warts-6, 11, 42, 44 (ano genital warts-condyloma accuminata),moderate risk strains for simple warts-2, 7,Plantar warts-1, 2, 4, 63 (condyloma),Flat warts-3, 10, 8(papilloma) and so on.

The risk of transmission from one person to another depends on which type of strain being the culprit.

Generally,any viral infection is not totally cleared from the body by immune mechanisms,since the virus replicates (DNA and RNA)with different mode unlike bacteria which are cleared by phagocytosis (engulfing and removal).Bacterial genetics have little or no role in phagocytosis,so makes them easier to manage.But viral infections stays within the body in inactivated genome strands,which will be reactivated when immune system is compromised.So there are more chances of recurrence (since virus undergoes transduction and acts as Bacteriophage where as bacteria divides by binary fission/resistance to cell wall).In case of bacteria there will re infection with more resistant species but virus are different from that.

So hopefully,as you said your infection was two years ago,may be your immune system has deactivated potent virulent adaptations of previous pathogens entry,and might have protecting you.It may recur depending on the state of your immune system or mutation that might occur in virus DNA (HPV-DNA virus not RNA virus). Understand the facts of virology.Basing on this fact,viral infections have longer incubation periods when compared to bacterial infections.Undergo a viral DNA analysis (if HPV virus infection is confirmed and isolate type of strain to estimate risk of malignancy)

The tissue may be biopsied to check if it is malignant or benign,and be confirmed only after histological analysis.Basing on inspection/palpation,it is rather difficult to confirm such,but these practices may give a clue.So biopsy is mandatory.

All the best.Please update me about your confirmatory diagnosis because not only that I am learning but also a question to my intellect and analysis.

[alex35736]

Dear Vedadhar,

Thank you for your informative response. I read somewhere that the type of HPV that causes warts is not the one that causes cervical cancer. Hopefully its also the one that doesn't cause prostate cancer.

I also read that this type of HPV should be rid of by my immune system within 2 years. Is this true? It has been about 2 years already so hopefully it will leave my body soon.

And since you said the bigger mole doesn't pose a threat of malignancy, or spreading, I am very much relieved. thank you.

I have a dermatologist appointment next week so I will definitely keep you updated if you are curious with the results.

Thanks!

[vedadhar]

If your history suggests,a sexual intercourse (un protective penetrative sex episodes),HPV can be transmitted from your partner to you.Although there are situations where infection is possible via non penetrable sex,making it more likely in people who may not have such history.This condition can be medically known as Condyloma Accuminata (Genital warts) or condyloma (simple warts) where differentials remain same as mentioned in last post.The types of HPV that cause warts are highly transmissible. Roughly three out of four unaffected partners of patients with warts develop them within eight months.

Unattented cases may progress into warts growing more in number and size,which indicates either presence of new infection(new growths), or recurrence from previous infection (number).Chances are high due to latency period and types of strains infecting.

Diagnosis is made visually or by punched biopsy,which is confirmatory diagnosis if (ABCDE)does not eliminate other differentials (mollscun contagiosum,Verrucae etc).Fresh warts can be estimated with local application of Acetic acid,to determine sub clinical growths. Because genital warts are caused by low-risk HPV types, DNA tests cannot be used for diagnosis of genital warts or other low-risk HPV infections.

There is no cure for confirmed HPV.Current management include-Surgical excision with biopsy/Liquid nitroge cryosurgery/Electrocauterisation(Loop Electrical)/Laser ablation/depending on expertise and skill of doctor and facilities available,reducing the risk of scarring and reaching areas that cannot be reached by general measures (inside anus/prepuce needs attention).You did not mention the location of small growth (though said on penis),where most common are on skin attachment of penis to prepuce and surrounding shaft.,which needs attention in planning treatment due to risk of recurrence/transmission as penis is a vital organ for sexual intercourse.In males they are frequently found on or around the head of the penis.

Medical therapy remains with Podophyllotoxin (0.15%-0.5%) /Imiquimod (Aldara)/Polyphenon E (green tea extract)/TCA (less effective)/Interferon (expensive) making every practice challenging due to their pros and cons.

So meet your dermatologist who has expertise in surgery (complete evaluation with therapy)/venereal disease specialist (medicinal Therapy)/cosmetic surgeon (both therapeutic/diagnosis but expensive) depending on things like fees/higher center/facility/distance/personal choice etc.Hope you understand the limitations in management of such conditions.

Keep commenting including more questions if you have any.

[alex35736]

First of all THANK YOU, for your quick and detailed response. I greatly appreciate it.

The smaller mole is located on my penis and the larger one is about 2 inches to the right of the anus. Hopefully that doesn't hinder surgical procedures.

The HPV diagnose makes sense because my girlfriend of 2 years was initially diagnosed with HPV a long time ago. I also had a swollen prostate a couple months ago, I'm wondering if the two are connected.

Thanks again for your evaluation, I will let you know what the dermatologist recomments, however I feel as if you are spot on with your evaluation :)

Thanks vedadhar

[vedadhar]

Areas where sun may not shine are armpits,groins,genital area,pubic region,waist(trunk),etc ,so please mention exact location if possible scientifically or in general terms,you do not have to feel embarrassed or feel shy about it.

[vedadhar]

The appearance refers to a Papillomatous growth may be referred to as Squamous cell Papilloms which is Benign condition which needs further evaluation, namely erythematous papillomas which may happen due to proliferation of keratinocytes.These may happen due to HPV infection,such as warts.

Since the surrounding area around the growth seems to be of normal contour,it suggests no invasion into surroundings which makes it malignant less likely.However a biopsy is recommended with excision.Since you have mentioned these growths as slowly progressing,a biopsy is recommended.

Dermatologist with surgical expertise or a cosmetic surgeon would be the person of choice.The excision and biopsy would be done by the same person,but pathological analysis would be done by pathologist who evaluates the histological features of these growths.

Since these growths are small and show no invasion(spread) into surrounding areas,it can be removed by one man with no complications of scars or tension(you have not mentioned the location of both these growths), with suitable suture technique.The bigger mass may need a excision but the smaller one may be punched out with cryotherapy (only after complete evaluation with results of biopsy)The procedure may not take long time since the area of mass is 1x0.5 cm.

The things that needs to be evaluated are if its a premalignant /malignant/benign growth that may/may not recur in time.This can be sorted out by biposy pathological study.First consult a dermatologist or cosmetic surgeon and undergo tactile (ABCDE)evaluation and let the Doctor guide you.

Keep me updated about the details of consultation with the Doctor.All the best.

P.S.-Correct me if I am wrong at any point.