Mole Checks: What You Need To Know & Where To Go

Post-Summer Is The Best Time (But Not The Only Time) To Get A Mole Check

“Most of us have had our highest dose of UV over the summer months and UV is the main modifiable driver of skin cancer. Sometimes a new mole appears or an existing one changes after a period of sun exposure, so autumn is a natural checkpoint to take stock. The evidence also suggests that it’s intermittent, intense exposure – such as getting sunburnt on a beach holiday – that matters most for melanoma, making the period after summer a logical point to take stock. That said, I'd never want anyone to think mole checks are seasonal – if something is changing or worrying you in the middle of winter, that still needs looking at promptly. Post-summer is a good prompt, not a deadline.” – Dr Sidra Khan, consultant dermatologist

Does Having Lots Of Moles Mean You’re More Likely To Get Skin Cancer?

“Yes. Having a high number of moles is an established risk factor for melanoma. The risk increases further in people who have multiple atypical moles, which tend to be larger and have more irregular shapes, borders or pigmentation. However, having lots of moles certainly does not mean that you will develop melanoma. We look at a person's overall risk profile rather than mole count in isolation.” – Professor Caitriona Ryan, consultant dermatologist, co-founder at Institute of Dermatologists, clinical professor at University College Dublin and co-founder of ID Formulas 

What Other Factors Increase Your Likelihood Of Skin Cancer?

“Other important risk factors include very fair skin, red or blonde hair, a tendency to burn rather than tan, freckles, a history of significant sunburn, a personal or family history of melanoma or other skin cancers, immunosuppression and any history of sunbed use. That last point is particularly important. Even if someone only used sunbeds when they were younger and has not touched one for 20 or 30 years, it is still relevant to their lifetime UV exposure and something I want to know when assessing their risk. There is no safe level of sunbed use.” – Professor Ryan

The Key Signs A Mole Isn’t ‘Normal’

“The most useful tool for the public is the ABCDE guide:

• A is for asymmetry – where one half doesn't match the other.
• B is for border – an irregular or blurred border.
• C is for colour – more than one colour or uneven colour.
• D is for diameter – generally larger than about 6mm.
• E is for evolving – I think this is the most important; any mole that's changing in size, shape, colour or how it feels. 

“I'd add the ‘ugly duckling’ sign to that: a mole that simply looks different from all your others is worth showing to a professional.” – Dr Khan

Other Mole Changes To Watch For

“Other warning signs include spontaneous bleeding, crusting, persistent itching, soreness or a change in sensation. However, melanoma is frequently completely asymptomatic, so you should never wait for something to hurt or itch before having it assessed.” – Professor Ryan

Most Skin Cancers Don’t Arise From Moles

“Most skin cancers aren't melanomas arising in moles. The commonest skin cancers are basal cell and squamous cell carcinomas, and they often show up as a pink or pale spot, lump or patch rather than a classic mole: something that bleeds easily, scabs and won't fully heal, a pearly or shiny bump, or a rough, scaly, tender area that keeps growing. In darker skin tones I'd particularly flag a new dark line or change under a fingernail or toenail, especially if the pigment extends onto the surrounding skin, or changes on the palms and soles, as these sites are easy to overlook.” – Dr Khan

Other Skin Symptoms To Look Out For

“Basal cell carcinoma and squamous cell carcinoma are extremely common and often look completely different from melanoma. I would want someone to have a lesion checked if they notice any of the following:

• A persistent pink or red patch.
• A new lump that is gradually enlarging.
• A tender, scaly or crusted nodule, particularly on chronically sun-exposed areas such as the face, ears, scalp, lips or backs of the hands.
• An area that resembles a scar when there has been no previous injury.

“As a useful rule of thumb, an unexplained skin lesion that is persisting, growing, bleeding or repeatedly scabbing for around four weeks deserves medical assessment.

“The nails are another area people often forget. A new dark streak beneath a nail, particularly if it is widening, changing or the pigmentation begins to extend onto the surrounding skin, should be assessed.

“Melanoma is not always brown or black either. Some melanomas contain very little pigment and may be pink or red. Melanoma can also occur on the palms, soles of the feet and beneath the nails. These sites are particularly important when examining darker skin tones.” – Professor Ryan

What Does A Mole Check Involve

“A proper mole check begins with taking a history. I want to know about previous skin cancers, family history, sun exposure, sunburn, sunbed use, whether the patient has noticed anything new or changing, and whether there are particular lesions they are concerned about.

“I then perform a systematic examination of the skin. It is important not just to look at the obvious places. Depending on the examination, this can include the scalp, ears, back, backs of the legs, hands, feet, between the toes and the nails. I use a dermatoscope, which is a small handheld instrument that combines magnification with specialised light. It allows us to see pigment structures, colours, patterns and blood vessels below the surface of the skin that simply cannot be appreciated properly with the naked eye. In trained hands, dermoscopy gives us significantly more information about whether a lesion is reassuring or requires further investigation.” – Professor Ryan

For People With Lots Of Moles, Digital Mapping Can Help

“For people with large numbers of moles or atypical moles, digital photography and mole mapping can also be extremely useful. Total body photographs provide a baseline map of the skin, while individual lesions can be photographed dermoscopically and compared over time. The real power of this technology is change detection. We can see whether an existing lesion has subtly evolved or whether an entirely new lesion has appeared. It can also help us avoid unnecessary surgery because a lesion that is slightly unusual but remains completely stable can sometimes be monitored rather than immediately removed.

“Technology is a very useful adjunct, but it does not replace an experienced clinician. I would be cautious about any machine or app being presented as a stand-alone test that can definitively tell you whether a mole is melanoma.” – Professor Ryan

How Is A Mole Removed?

“It depends entirely on why it's being removed. If there's any suspicion of skin cancer, the mole is removed properly under local anaesthetic and sent for histology, so we know exactly what we're dealing with – you'd usually have a few stitches and a small scar. If a mole is genuinely benign and someone wants it removed for comfort or cosmetic reasons, there are options like a shave excision, but, even then, it needs a proper clinical assessment by a qualified healthcare professional. The point I feel strongly about is that pigmented lesions should never be destroyed without a diagnosis. That means no removal at a salon and no lasering or freezing off a mole, because those methods leave nothing to send to the laboratory. My own position is that anything pigmented I remove goes for histology regardless of how confident I am – occasionally the report surprises you, and that's precisely the point of doing it. A melanoma treated as a cosmetic blemish is the scenario we're all trying to avoid.” – Dr Khan

One Of The Best Tools Is Your Own Eyes And Intuition

“In my opinion, the most useful thing people can do is become familiar with their own skin. You do not need to become an expert in melanoma and you should not feel that you have to diagnose skin cancer yourself. You simply need to know what is normal for you and recognise when something has changed. Look at the areas we tend to forget: the scalp, behind the ears, the back, the backs of the legs, between the toes, the soles of the feet and the nails.” – Professor Ryan

Prevention, As Always, Is Best

“Protecting the skin from excessive UV exposure, using a high factor broad spectrum sunscreen as part of an overall sun protection strategy, and avoiding sunbeds entirely are among the most important things we can do for the long-term health of our skin.” – Professor Ryan

And Acting Early Is Key

“Caught early, skin cancer is very often highly treatable – the problems come from waiting. If in doubt, get it checked; that's genuinely what we're here for.” – Dr Khan

Institute of Dermatologists, Dublin

Dr Sidra Khan, Glasgow

The Mole Clinic, Harley Street, London

Montrose Clinic, London

Dr Alexis Granite at Skinesis, London

Welbeck Clinic, London

Follow @Dr.Sidra.K & @CaitrionaRyanDermatology

DISCLAIMER: Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.