2015-07-24

New Vision for Advanced Pediatrics, Literally

New Vision for Advanced Pediatrics, Literally

We at Advanced Pediatrics are very, very pleased to announce that we have a new neighbor, the Western Reserve Vision Care center.

Led by Dr. Mary Jo Stiegemeier, the Western Reserve Vision Care (WRVC) is a truly unusual source of eye care for the whole family.  WRVC features a group of highly skilled optometrists, many of whom see mainly children and have extensive experience with infants as well.

Dr. Stiegemeier spent many years working with one of our region's top pediatric ophthalmologists, Dr. Andreas Marcotty, and remains a close collaborator of his.

With the WRVC next door to us now, we are so pleased that if any children in the practice have an eye injury of concern, we can arrange evaluation on an emergency basis very easily, simply by walking next door once we have determined that would be helpful.

The WRVC is also going to help us make sure if there are any questions about eye or visual function that we can have your infant, child, or adolescent seen promptly and deliver an extremely high quality and reliable evaluation.

Western Reserve Vision Care  also can provide eye exams and prescriptions for eyeglasses and contacts as well as the eyeglasses and contacts for the whole family.

We recently met with Dr. Stiegemeier and are so excited to have her office right next to ours.  Her approach to care is so congruent with our vision of care at Advanced Pediatrics.    She has been sought by many, but remains committed to independent practice where she can make the care her team offers as excellent as possible.

So we welcome Western Reserve Vision Care to our office suite, and are particularly excited that these excellent services are now so very easily accessible to all the families of Advanced Pediatrics.

To your health,
Dr. Arthur Lavin



*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2015-07-17

Fruits and Vegetables- Getting Closer to Know, Why are They Good for You?

Fruits and Vegetables-  
Getting Closer to Know, Why are They Good for You?
For a very long time, we have known that groups of people who eat lots of fruits and vegetables live significantly longer than groups that do not.

How much longer?  About seven years longer.   That is, one group's average life is 7 years longer than the other group's average.  That is a very dramatic difference.

Science has begun to uncover just what is it in fruits and vegetables that endows us with longer life.  And it isn't what you think.

For many, the answer has always been all those good things in fruits and vegetables, like vitamins and anti-oxidants.  Enough people were convinced of this explanation, that almost everyone is convinced that if you just take a load of vitamins and minerals, you can get all the extra life and health fruits and vegetables offer, without worrying if you eat enough fruits and vegetables.

That is essentially why half of all Americans take a vitamin pill every day.  Well, it doesn't work, at all.  In fact, groups that take vitamin pills often don't live as long as those who do not, in study after study.

So what about anti-oxidants?  The idea that the magic power of fruits and vegetables lies in blocking oxidation is still crazy popular, but again, groups that take anti-oxidant pills live no longer than people who do not.  

Taking vitamins, minerals, and/or anti-oxidants does nothing that eating fruits and vegetables does for you.

The first clues about what is it in fruits and vegetables that actually provides benefits was outlined in an article this spring in Scientific American.   The authors have spent many years finding out what this mystery set of chemicals is, and the answer is a big surprise.  One protective set of chemicals found in fruits and vegetables are actually plant toxins.   That's right, it's not the nutrients or things that are good for you that make people healthier who eat fruits and vegetables, it's the poisons in the plant!

It turns out that most plants make toxins to protect themselves from insects.  They do not need to kill the insect, just discourage it from eating it.  This strategy saves plants from having to produce high concentrations of complex toxins, just a bit will do.   How does a toxin make us healthy?  It appears that some of such plant toxins activate processes in our bodies, and our immune systems, that strengthen our defenses, in particular against damage from oxidation and inflammation.   Of course, too much of such a toxin could damage our tissues, but a bit seems to make them sit up and protect themselves, rendering less susceptible to harm over time.

At this point it should come as no surprise that for people, the amount of such toxins in fruits and vegetables is just the right amount to provoke protective actions by our tissues and not enough to cause any harm.

In a cruel twist of fate, it appears that the reason taking vitamins and anti-oxidants not only fails to help, but may hurt, is that when you take these compounds the body's tissue's sense the need to protect themselves is diminished and so the guard is let down, to the body's detriment.

All parents should note, the protection offered by eating fruits and vegetables is the same in fruits and in vegetables.  Kids who eat lots of fruits and no vegetables do just as well as those who eat only vegetables.

Eating fruits and vegetables are not the only action that acts by provoking protection.  It appears two other actions excite the same mechanisms:  exercise and intermittent fasting.  Exercise is an irritant on the system that provokes protective mechanisms being turned on.  And, strangely, so does fasting very other day!

BOTTOM LINES
1.   There is no doubt, eating fruits and vegetables can prolong your life.   We know this happens at a level of 2 ounces of fruits OR vegetables about 5 times a day.
2.    Fruits and vegetables  DO NOT offer this good health via their vitamins, minerals, or any other such helpful nutrient.
3.    Fruits and vegetables help us live longer through small amounts of plant toxins that provoke our cells to protect themselves.
4.    Exercise and intermittent fasting provide the same health benefit via the same mechanism.
5.    So, throw away your vitamin and mineral supplements, and get some great summer fruits, they will help you live longer, the pills will not.  And enjoy a good walk, and feel free to skip a meal every now and then.

To your health,
Dr. Arthur Lavin  

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2015-07-12

Primum Non Nocere- Time to Revisit a Foundation of Medical Practice

Primum Non Nocere
What it really means

Anyone who knows those of us at Advanced Pediatrics knows that we love what we do — helping families get and stay well.

Over the years we have been in practice, we have come to better appreciate this principle taught to every medical student in the United States: primum non nocere —first, do no harm.

While we spend much of our time helping cure a child's illness, easing someone's discomfort or suffering, preventing a problem from occurring, and offering counsel that helps, many possibilities exist today that could cause a degree of harm — even if slight. Thus we make a real effort to follow the dictum of primum non nocere.

So it came as a real shock to read the report released this week (in mid-July of 2015) by the American Psychological Association (APA) into their own investigation of a pattern of behavior by senior officials of the APA — past presidents, and the head of their ethics division. The report describes that these leading American psychologists gave official APA sanction for the use of “…harsh and abusive techniques…” on prisoners, in an effort to secure and maintain lucrative contracts from the Department of Defense and CIA.

Here is a link to the actual APA report:

The use of harsh and abusive techniques on prisoners of war may be controversial to some, but the notion that some of our country's top mental health professionals would essentially sell out their professional for money is not. The most troubling aspect of this situation is that it is not surprising.

For many years, we have heard of hospitals making decisions that favor profits over good practice; and of doctors taking drug money in exchange for studies with, recommendations of, and prescriptions for profitable medicines. The new motto of the day seems to be primum pecuniam, first money, rather than primum non nocere, first do no harm.

The good news is that this fundamental violation of what it means to be a health care professional was investigated and reported by the same organization whose leadership created the breach, the American Psychological Association (APA). Sadly, I remain skeptical.
While it is unlikely this particular breach will happen again, I doubt that past presidents of the APA and past chairs of their ethics committees will go on record and admit their role in this insult to our healthcare creed.

As a family member of Advanced Pediatrics, you can remain secure in the knowledge that we honor first do no harm. And that we will continue to pursue policies that attempt to keep the marketplace as far from any medical decision making as possible. This is why we when we opened, we created the self-regulating guideline of accepting no items from any pharmaceutical company. And why we try to base all our information on direct readings of the scientific literature, and not through the lens of any particular organization. This is also why we offer direct on-call access to Dr. Hertzer and me, and will not sign up for distant nurse call centers.

We are pleased that the APA has issued this report, but dismayed that leaders of such high stature could have missed so thoroughly the obvious obligation that being a healthcare professional entails. Advanced Pediatrics is an infinitesimal part of the medical professional landscape, but within our small arena, we will continue to make the obvious choices the right ones, namely, that the care of your family comes first.

In these times when trust is questioned so often, we are all the more grateful for the trust you have given to us.

To your health,


2015-07-07

On the Best Timing to get Tested for Strep Throat

On the Best Timing to get Tested for Strep Throat

Just today, a parent in the practice asked, "When is the best time in the course of a sore throat to get tested for strep?"   And then added, "You should make this the topic of your next email."

I agree.  So here it is.

The problem is one faced by many, many families.   You have a child with a sore throat and fever, when is it best to bring them in for a throat swab and strep test?

Two errors can be made.  The first is getting tested for strep if you don't have it.
The second is not getting tested for strep if you do have strep.

Now, the actual question put to me was, when in the course of a sore throat is it best to be tested?  This implies that one is more likely to be subject to either error if you come in too early or too late in the course of the sore throat.

For example, if it was true that it took 2-3 days of being sick with strep throat before a strep test would reliably be positive, then coming in for a strep test on the 2nd day of being ill would cause the test to say you did not have strep, when you did.

But, it turns out it is not true that it takes 2-3 days of strep illness before the strep test turns positive.

The way it does work is as follows:
  1. You are not infected with strep until the strep germ lands on your throat and begins to infect your throat.
  2. From the moment the strep germ lands on and infects your throat, you have strep throat.  From that moment on, a swab of your throat will yield a positive strep test.
  3. It does take some time for the germ, once landed and infected, to cause symptoms, usually something on the order of 1-2 days.  But even during this time, a throat swab could detect the presence of strep.
  4. Once the first 24-48 hours are passed, symptoms begin to appear, and may include headache, stomach ache, neck ache, sore throat, fever, and even a fine red dotted rash.  The rapid strep test stays positive throughout the duration of the illness.
  5. After a few days or a week, even if untreated, the infection begins to fade away.  The rapid strep test stays positive through the decline of the illness as well.
Bottom Lines
1.  The rapid strep test for the infection of strep throat can be done reliably at any point along the course of a strep throat infection.   Getting tested on the first day or a week later yields the same answer.
2.  If a family is wondering if their child has strep throat, it is OK to wait a day or two to see if the symptoms go away, as long as your child is not too ill or uncomfortable.
3.  Strep throat itself is fairly harmless, aside from the discomfort it causes.  The vast majority of strep throat infections do not even cause a sore throat, are missed, and never treated.  So the main reason to get tested is that if you have it, we can treat it and reduce the fever and pain.  That can be done at essentially any point along the course of the illness.
4.  The only timing issue that counts is that if strep is treated prior to 10 days of illness, a rare complication, rheumatic fever, is prevented.  So if strep is suspected, you have plenty of days to weight whether to get tested, but not more than 10 days.

To your health,
Dr. Arthur Lavin



*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2015-07-06

Fidget to Learn- Some Children need to Fidget to Learn Better

Fidget to Learn- 
Some Children need to Fidget to Learn Better

Perhaps one of the most challenging aspect of our school-age years, is that everyone is obligated to do the same thing.  Everyone must sit in a classroom, everyone must study language, math, and science, and other subjects as well.  Everyone has the same homework.

This is so different than the rest of our lives, one could talk about three parts of the modern person's life- their life before they enroll in school, the school years, and their life after they leave school.

The life before entering the world of school is the one in which learning is the most geared to the particular child.  Toddlers and pre-schoolers get to do pretty much what interests them at the moment.  A roomful of 20 three year olds will often show a room of 20 different activities going on.

Much the same is true of us adults once out of school.  Some of us become teachers, or painters, or lawyers, even doctors.   But the point is a randomly sampled group of 20 adults will likely yield a wide range of what constitutes their daily activity.

Not so school.  There all children are asked to do what the school requires, not what they are interested in.

This fact has created a rather huge amount of trouble for kids across the country, so it was quite interesting to read that two studies published recently seem to suggest that some children's minds actually think better when they fidget.

Two of these studies were reviewed in the Wall Street Journal and New York Times (http://well.blogs.nytimes.com/2015/06/24/fidgeting-may-benefit-children-with-a-d-h-d/).

The findings were actually very straighforward:  if you take kids with ADHD and let them move or fidget during school work, their ability to think is actually improved.   If you have kids who do not have ADHD fidget, it offers no benefit to their thinking.

One of the papers' authors was Dr. Julie Schweitzer of the MIND Institute of University of California at Davis.  She notes that children with the primary form of ADHD (that is, their inattention is not due to some other problem other than being unable to attend), often have evidence of less brain activity in the cognitive parts of the brain, such as the prefrontal cortex.   But these children, even at rest, have higher levels of activity in parts of the brain that run muscle action, such as the cerebellum and basal ganglia.

I found this work fascinating for a number of reasons.

First, it presents science based evidence for what we have all known all along.  People learn the same facts in quite different ways from person to person.  In this example, clearly some kids need to move to learn, and for some kids moving offers not help at all.

Secondly, there is a fascinating connection between thinking and moving.   The basal ganglia are a set of structures of neurons deep inside the brain that are known to be very important in making sure our muscle motions are smooth, well-planned, and effective.   They do a lot of programming of motion, like walking, picking up items, catching things, etc.   But it turns out the basal ganglia are also the centers of dopamine-run nerve networks that are the source of much of our senses of pleasure.  We also know these same dopamine networks are involved in effective thinking.  So the nerves that make pleasure happen also coordinate our muscles so that we get tasks done, like writing this post.

We tend, culturally, to split great athletic prowess and bright thinking.   But the brain does both, and in many instances, using the same pathways.  This is yet another reason exercise is so good for you, purposeful, well-executed motion, helps the mind create purposeful, well-executed thoughts.

Bottom Lines
1.  The chief take away point is that every person learns in their own way.  School typically offers only one approach to learning.  This works for many, but not many others.
2.  So, the ideal school, the school of tomorrow that will be based on good neuroscience, will know how every student learns, and use the right approach for each student.
3.  In the meantime, we now know that some subset of kids really do learn subjects better if they can fidget and move.   Just think of how many of our children actually get in trouble for moving in class, and how many of them would have been much better students had they been allowed to.

To your health,
Dr. Arthur Lavin



*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2015-07-02

Moles: What are They? When to Worry?

Moles:  
What are They?  When to Worry?

Everyone has them, increasingly people are worried about them.

So, what is a mole, why do we worry about them, when should we worry about them.

Some mole basics
The word mole comes a very old root from which other words meaning spot, or stain, or blemish arise.    And in common use today, the word refers to small, typically dark brown or black, spots or blemishes on the skin.

Nearly everyone has moles, and they are made up of the same type of cells, the melanocytes (muh-LAN-o-sites).

Melanocytes are cells with a unique function, they make a chemical called melanin, the key pigment of human skin.   The way it works is that each melanocyte has a network of little tubes, one tube going to from the melanocyte to a skin cell.  Typically each melanocyte is connected to about 50 skin cells.   As the melanocyte make their yellow pigment melanin, it is delivered through these 50 tiny tubes to 50 skin cells.

Nearly everyone has the same number of melanocytes, distributed in an even blanket across the skin, feeding nearly every skin cell with its melanin.   People with dark pigmentation have no more melanocytes than those of very little pigmentation.  The only difference is how much melanin is pumped out from one's melanocytes.  A very little bit or almost none will yield a person with very pale unpigmented skin.  More leads to olive or even slightly yellowish hues.  As melanin production increases, skin color tends towards the various shades of brown.

Almost everyone has a group of melanocytes accumulate somewhere on their skin, not the even sheet distributed across the skin described above, but a little ball of melanocytes.   This is a mole.

The average number is about 10-20.  It is thought the number of moles a person will develop, and where they will appear, is determined prior to birth in one's genes.

The number and place of moles is determined once one's genes are set, but these little balls of melanocytes, the moles tend to take many years to form. That's why most moles are not present at birth.  Many tend to develop during infancy and childhood and even appear during adulthood.
The little clumps or balls of melanocytes grow over time and so they may start flat and then grow to have some vertical elevation relative to the flat plane of the skin.

Moles tend to be some shade of brown.  They can be without any pigment, just flesh-colored, or very light brown,  Or, they can be darker brown, even to the point of looking black.  Some have a reddish hue as well.  Some have a little halo of decreased pigment or lighter skin surrounding them.

An enduring question about moles is, why do we have them?  No one has ever answered this question, so it remains in place.   My own sense is that they are present either because this a by-product of having a vast network of melanocytes across nearly all of our skin and sometimes they gather into clumps at random.  Or, they serve some function that we don't know about yet.

The main point about moles though, is that they are a normal part of the human body.  Nearly everyone has them, and unless they change in some radical way, they are 100%, completely harmless.

Why worry about moles?
If moles are a normal part of the body, why is there so much worry about them?

It should come as no surprise, but moles are like many other normal parts of our body, their cells can turn cancerous.   Not all parts of the body can create cancers, heart cells and nerve cells cannot turn cancerous.  But many other parts of the body can, like other parts of the skin, lungs, pancreas, kidneys, white blood cells, the gut cells.

Of course, cancer is a scary property of our bodies, one of the scariest, so it makes sense for us to be worried about whether our bodies, and especially our children's bodies, will every turn to cancer.

But moles have a special place in our world of worry.  We don't tend to worry much, when feeling fine, about our lungs, or gut.  In fact, if pushed to think about the insides of our body, most of us tend to be very grateful our lungs and gut, and other parts are doing their job.

But since moles have no known job to perform, they seem to sit there as a constant reminder of what might go wrong.  Moles, more than any other normal part of the body tend to make us think of cancer.   No wonder we worry more about our moles than any other part of our body.

What is melanoma?
Every cancer comes from a normal cell.  Most cancers are named for their cell of origin.  Lung cells are the cell of origin for lung cancer, and colon cells are the cell of origin of colon cancer.  But some cancers have their own name, usually tied to the cell of origin by some Latin or Greek translation.
White blood cells, for example, are the cell of origin of leukemia.  The ancient Greek word for white is leukos, and the ancient Greek word for blood is haima.  So leukemia is a rough Greek translation of the phrase white blood, referring to the white blood cell.
Melanoma comes from the Greek word for black (melos) and tumor or mass (oma), so it means black tumor.   But the cell of origin for melanoma is always a melanocyte.
Now, interestingly enough, most melanomas come from those melanocytes evenly distributed around the skin, not from moles.  In fact, about 75% of melanomas do not come from moles.  Of course that means about 25% of melanomas come from moles.
Melanoma is an unusual cancer since when it occurs, it makes itself visible via changes in the skin.
And so it has the very wonderful property that if the change is seen early enough, and it is removed before it goes even 1mm deep into the skin, it is cured.  No spread, no recurrence, cured.
Sadly, if it is missed, and goes very deep, it spreads better than most cancers and can be very deadly.

When is a mole worth our concern?
Of course, the only reason to worry about a mole is if its melanocytes convert to cancerous melanoma cells.  No melanoma no worries.  Thankfully, moles, like other parts of the body do not tend to convert, they stay normal our entire lives.   And, if a mole stays a mole, there is truly nothing to worry about.

So, the only reason to worry about a mole is if it is turning from a mole into a melanoma.   The key signs of that happening all have to do with change.  No mole starts off as a melanoma, so to become worrisome, a mole must change.

But it is is very important to keep in mind there is one change in a mole that is always fine, and always expected- they grow with you.   A mole on your belly at age 3 grows as the 3 year old grows, and maintains roughly the same proportion of area on the belly when you are 20 as when you were 3.

The changes of concern are easy to remember, as easy as A-B-C:
Area-  as noted, moles grow as a person grows, so they do increase in area normally, but if the mole grows beyond it usual proportion of area, that is of concern.   Moles smaller than the diameter of the eraser on a pencil are considered a normal, small size.
Border-  the border of a mole should not change.  Typically the border is very sharp, if the usually sharp border gets fuzzy or zig-zagged, that is of concern.
Color- moles come in all colors, but once a mole has appeared, its color should not change.  So if a mole gets darker, or develops more than one color, that is of concern.

The Gray Zone of Dysplasia
We have noted that moles either are simply moles, harmless clumps of melanocytes that don't do anything; or, are melanomas.

There is one other way moles can be, they can be dysplastic.  When we look at a mole under a microscope, we can see the melanocytes arranged in very orderly patterns, all looking exactly alike.  That's the normal mole.  Or we can see cells transformed into wild out-of-control clumps of growing chaotic looking cells.  That's melanoma.

Dysplasia is a state where the cells aren't as uniform, tidily arranged, and orderly as in a normal mole. But they aren't as wild and out-of-control, and oddly shaped as melanoma cells.   Dysplastic moles have melanocytes that are a bit disorganized, a bit non-uniform.  These are not cancers.   

Dyplasia means that the cells of the mole are a bit disorganized, but not that they are cancers.  It doesn't even mean they will become cancers.   If a mole turned dysplastic, but never turned to melanoma, it could stay on the body your whole life and never cause any harm.

The problem when it comes to the cancer melanoma is that any melanocyte can turn into melanoma, whether in the normal skin, in a normal mole, or a dysplastic moles.  Dysplastic moles turn into melanoma more often than normal moles, but the vast majority of dysplastic moles never do change, and most melanomas do not even come from moles.

The Current Craze to Remove and Biopsy
Now we come to current habits of how we all respond to the moles we all seem to have.

As noted above, we live in an era in which moles are far more scary than other parts of our body, even though so many parts of our bodies can turn into cancer.  It seems as though the fear of cancer, which is a very reasonable thing to dread, comes to the surface when it comes to moles.

Most would agree that any mole that poses a serious risk of being a melanoma needs to be removed and studied to see if it is.

The more interesting question is what about removing normal looking moles?  How to decide whether to worry about one, remove it and study it.

The answer turns out to be quite different for kids and older adults.   That is because the usual melanoma takes many, many years to transform its once normal melanocyte cells into melanoma cells.

To put this into some perspective, consider the how many people get diagnosed with melanoma a year.  For kids 0-14 years of age, that number is 1-3 out of every million kids.  For adults that number is 216 out of every million adults, about 200 times more common!!

This leads to perhaps the most interesting number I have come across when it comes to what happens to all the moles removed from kids.   This number is astounding, and was presented to me at a conference on pediatric dermatology not long ago.  The dermatologist stated that currently only 1 in every 100,000 moles removed in children turns out to be actual melanoma.  

That means that under current rates of mole removal, there are 100,000 moles removed that are perfectly harmless for every one that is.   There are no other procedures in medicine I know of where so many surgeries are done to that many people with no problem, for every one that is.

Which moles should be removed in childhood

There are a set of very unusual moles called large congenital nevus.  This is a very large mole, typically over 8 inches across, and present at birth.   These convert to melanoma at a higher rate than any other mole at any age, and need to be removed.

Otherwise, if a mole is present in childhood, is small, uniform in color, with sharp borders, has no spontaneous bleeding, the only reason to remove it is if it changes in those characteristics.  Removal for any other reason would be for appearance.

That means the typical mole should be removed for these reasons:
1.  Change in color
2.  Getting larger than expected with normal growth proportionate to the child's health
3.  Developing a fuzzy border,
4.  Changing in shape.

A good set of pictures contrasting typical, harmless moles, with worrisome moles is at
http://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/do-you-know-your-abcdes#panel1-5

BOTTOM LINES
1.  Moles are a normal part of the normal human body, almost everyone has some, often as many as 100.
2.  Like other parts of the body, moles can become the cell source for cancers, in their case, melanoma.
3.  Even if everyone got all their moles removed, about 75% of melanomas would still occur, since most melanocytes are distributed across all our normal skin.
4.  The risk of melanoma developing from a melanocyte goes up with age, melanoma is quite rare in childhood.
5.  Well beyond the vast majority of moles removed in childhood turn out to be harmless, not cancerous.   If you took 100,000 moles removed from children, on average only one of them would turn out to be dangerous.
6.  A dysplastic mole in childhood is not a cancerous mole.   There is no direct way to know if a specific dysplastic mole will ever convert to a melanoma, just as there is no direct way to know if any spot of skin will at some time.
7.  Putting it all together, aside from the very rare instance of a large congential nevus (a mole >8inches across), the only clear medical reason to remove a mole from a child is if the area, symmetry, color, border, are worrisome as a result of it being too big, too asymmetric, changing, or bleeding.  Simple appearing moles that don't change or bleed or erode are very, very likely to be safe to leave alone.

To your health,
Dr. Arthur Lavin








*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.