Mole checks: when to worry

Most of us have moles, and the vast majority are completely harmless. But a change in a mole can occasionally be an early sign of skin cancer, including melanoma, and finding it early makes a real difference. As a plastic surgeon with a specialist interest in melanoma and skin cancer, I want to share simple, practical advice on what to look out for and when to get a mole checked.

What does a normal mole look like?

A typical, harmless mole is usually:

• round or oval, with a smooth, even edge
• one colour, often brown, tan or skin-coloured
• smaller than about 6mm across, roughly the size of a pencil eraser
• stable, staying the same size, shape and colour over months and years

The ABCDE checklist

When checking a mole, it helps to remember ABCDE:

• A for Asymmetry: the two halves of the mole look different.
• B for Border: the edge is irregular, ragged, notched or blurred.
• C for Colour: the colour is uneven, or there are several shades such as brown, black, red, white or blue.
• D for Diameter: it is larger than about 6mm across.
• E for Evolving: it is changing in size, shape, colour or height.

Of these, change is often the most important sign. A mole does not need to tick every box to be worth checking.

Other warning signs

• a new mole that appears in adulthood and keeps growing
• a mole that itches, bleeds, crusts or oozes without being injured
• a sore or spot that does not heal within a few weeks
• the “ugly duckling”: a mole that looks different from all your others
• a new dark streak under a fingernail or toenail that is not from an injury

Who is at higher risk?

Anyone can develop skin cancer, but your risk is higher if you:

• have fair skin that burns easily, light-coloured eyes, or red or fair hair
• have lots of moles, or large or unusual-looking moles
• have had sunburn, especially blistering sunburn as a child
• have used sunbeds
• have a personal or family history of skin cancer
• have a weakened immune system, for example after an organ transplant

How to check your skin at home

A quick self-check once a month is a good habit:

1. Use a full-length mirror and a hand mirror in good light.
2. Check everywhere, including your scalp, back, the backs of your legs, the soles of your feet, between your toes and under your nails.
3. Ask a partner or family member to help with areas you cannot see.
4. Take dated photos of any moles you want to keep an eye on, so changes are easier to spot.

When to get a mole checked

Get a mole checked if you notice any of the ABCDE signs, a new or changing mole, or anything else that worries you. If you are ever in doubt, it is always better to have it looked at. You can see your GP, who can refer you urgently if needed, or book a specialist mole check.

What happens at a mole check?

At a mole check I ask about your skin history and any changes you have noticed, then examine your skin, including any moles you are worried about. I use a dermatoscope, a special magnifying lens with a light, to see the structure of each mole in much more detail than the naked eye allows. If a mole looks suspicious, I may recommend removing it, or taking a small sample (biopsy), so it can be examined under a microscope.

What if a mole needs removing?

Mole removal is usually a quick procedure under local anaesthetic:

• Complete excision: the mole is removed with a small margin of normal skin and the wound is closed with stitches. This is used when there is any concern about the mole, so it can be fully examined.
• Shave excision: for moles that are clearly benign, the mole can be shaved flush with the skin. It heals with a small scab and often leaves an inconspicuous mark.

If a skin cancer is diagnosed, I will explain the results and the next steps clearly, including any further treatment you need. You can read more about mole removal and melanoma treatment.

Protecting your skin

• Use a broad-spectrum sunscreen of SPF 30 or higher with good UVA protection, and reapply regularly.
• Seek shade in the middle of the day, especially between 11am and 3pm in the UK summer.
• Wear a hat, sunglasses and clothing that covers your skin.
• Avoid sunbeds.

Frequently asked questions

How often should I check my moles?

Once a month at home is a good rule. If you have many moles or a history of skin cancer, a regular professional check may also be recommended.

Are most changing moles cancerous?

No. Most changes turn out to be harmless, but because some are not, any change is worth checking.

Will mole removal leave a scar?

Any removal leaves a mark, but it is usually small and fades over time. As a plastic surgeon, I plan the removal to leave as neat a scar as possible.

Can I use my health insurance for a mole check?

Many policies cover specialist assessment of a suspicious mole. Check with your insurer, who will need my full name, Mr Siva Kumar Veeramani, and my GMC number, 6114710. Self-pay consultations are £250.

Next steps

If you have a mole that worries you, please do not wait. Book a mole check at one of our clinics, or speak to your GP.