I have a particular interest in the diagnosis and treatment of skin cancer and I lead the melanoma MDT at Guy's and St Thomas' NHS Trust so not surprisingly I see a lot of patients for mole checks! Patients will generally come to me if they have a mole that they are concerned about or if they have lots of moles and are unsure whether they should be worried.
Moles are harmless growths of pigment cells (melanocytes). Melanocytes are present throughout the skin surface and are responsible for tanning and pigmentation of the skin. The medical name for moles is melanocytic naevi.
Occasionally, a melanocyte (pigment cell) may sustain mutations (like spelling mistakes) in the DNA which causes it to become cancerous - this is a melanoma.
Melanoma is the most serious form of skin cancer since it has the potential to spread elsewhere in the body. This risk is much lower if a melanoma is detected at an early stage and this is why it is important to identify melanomas as early as possible.
The following is a simple method to help you identify moles that may be of concern:
It is important to note that not all moles fulfilling one or more of the above criteria is a melanoma. Conversely, some (usually early) melanomas will not fulfill these criteria and may only be detected on microscope (dermatoscopic) examination of the mole.
I will begin by asking you questions about the mole(s) that you are concerned about. I will then ask you some more general questions about your health and to assess your risk of skin cancer.
The following factors can increase your risk of developing melanoma:
It is usually advisable to perform a full-body check of your moles, however if you prefer we can just focus on those that concern you. If you are female, a female nurse chaperone will be present should you need to undress. You are also welcome to request a chaperone if you are male.
I will perform a systematic examination of your skin - starting from the head and neck and working through all body areas. I will carefully examine any moles of concern with a dermatoscope. The diagnosis of melanoma can be very obvious, however in some cases early melanoma may only be apparent through subtle irregularities of the pattern of pigmentation that are apparent with the dermatoscope.
The principle of mole mapping is that harmless moles either do not change in appearance or change very slowly over years whereas melanomas usually will change significantly in appearance over a period of a few months.
If you have a large number of irregular moles I may advise that you have mole mapping photographs performed. This enables me to monitor for any change in your moles over time. Additionally, for any moles that I am concerned about, I will take digital dermatoscopic (microsope) photographs of the pigment pattern. This allows me to check for any subtle changes in the pigment pattern at a follow up appointment.
Even if you are having regular skin checks with a dermatologist it is important that you monitor your own moles at home. I generally advise patients to perform skin checks on a regular basis - so that you come to recognise what is normal for you and you will spot any changes at an early stage. Since it can be hard to keep track of your moles I also advise that you take photographs of all of your moles every few months - this helps you to identify any new moles or any subtle change in existing moles. When you are checking your skin, you should look for the features listed above that can help to identify cancerous moles.
If I am concerned about a mole then I may advise that it is removed. This is a minor surgical procedure that is performed under local anaesthetic. The mole is removed and then the wound is closed carefully with stitches to leave a straight-line scar. The mole is then sent for analysis by an experienced pathologist. I have advanced training in skin surgery and have performed thousands of skin surgeries. I always aim to minimize discomfort and scarring. In many cases I will use dissolvable subcutaneous (invisible) stitches that are beneath the skin surface and do not need to be removed.
I can also remove moles - such as lumpy moles - that are harmless but unsightly. These are often removed by shave excision to leave a small flat scar without the need for stitches.
My all-inclusive fee for an initial mole check consultation is £250 and for a follow up consultation in £200. I am recognised by all major UK medical insurance providers.