Moles: when should I worry?

Moles are small growths on your skin and most of the time, they’re harmless. However, they can sometimes develop into cancer. So, a new mole, or one that changes in appearance should be checked out. Moles can be the same colour as your skin tone, brown or black, and either flat or raised. They can also be smooth or rough to the touch.

Make sure you pay close attention to what your moles normally look like and check them every month. This will help you spot any changes so you can see a doctor sooner rather than later. 

Some people find it helpful to take photos of their moles so they can easily compare them month by month. Although it can be worrying if you notice a mole has changed, remember that most changes do not lead to skin cancer. However, it’s still important to get a mole checked by a doctor if you do notice a change. 

What are the different types of moles?

Moles come in many different shapes, colours and sizes. There are three main categories:

• Acquired moles — these develop after birth; they are small in size and have an even border and pigmentation 
• Atypical moles — these can be hereditary and are asymmetrical, which means they have characteristics that aren’t uniform; they have irregular borders and are often uneven in their pigmentation  
• Congenital moles — these are present at birth and can be small, medium or large, smooth or rough, flat or raised 

When to see a doctor about your mole

Although most changes in moles are generally harmless, it’s important to see your doctor to rule out skin cancer. The earlier skin cancer is detected, the easier it is to treat. If you have a family history of skin cancer or atypical moles, or if you have a large number of moles, your doctor may refer you to a dermatologist (skin specialist) for regular check-ups.

If you notice any of the below changes in your moles, it could be a sign of skin cancer and you should see your GP:

• Change in size or shape
• Itching, pain or bleeding
• Poorly defined border around your mole
• Asymmetrical surface to your mole, where one part looks and feels different to the other part
• Changes in colour

After examining your mole, your GP may refer you to a dermatologist who will assess your mole and surrounding skin. If your dermatologist thinks you are at risk of developing skin cancer (melanoma), they may recommend removing the mole. After removal, the mole tissue will be sent to a laboratory to determine whether or not it contains cancerous cells.

What is melanoma?

Melanoma is a type of skin cancer that can spread to other parts of the body if it isn’t caught and treated early. It can develop anywhere on the skin but tends to occur in moles that are on the neck and face, as well as on the legs for women and on the chest and back for men. 

Risk factors for melanoma

Understanding what causes melanoma can help you prevent it from developing or help detect it earlier. 

Risk factors include:

• Excessive UV exposure — if you spend a lot of time in the sun without sun protection 
• Genetics — melanoma can run in families, especially if other family members were affected at a young age
• Having a high number of moles
• Having fair skin — melanoma occurs more frequently in people with fair skin as it is more easily damaged by the sun’s ultraviolet (UV) rays
• Sunbed use 
• Weakened immune system ie if you have a compromised immune system due to a medical condition or taking certain medication

If you’re at a higher risk of melanoma, take extra care to protect yourself. Avoid direct sunlight at the hottest time of the day (between 11am and 3pm) and protect your skin from the sun. Wear a hat if you have moles on your face and apply sunscreen all year round to protect your skin from the sun’s UV rays. 

Mole removal treatment

If your mole has changed and your doctor is concerned that you’re at a risk of developing melanoma, your mole will likely need to be removed. You may also wish to have a mole removed, even if it hasn’t changed, as a preventive measure against melanoma. 

However, there are also other instances where you may want a mole removed, even if you aren’t at an increased risk of developing melanoma eg if your mole is painful, restricting your movement or for cosmetic reasons. 

Mole removal is usually carried out under local anaesthetic, so you will not be in any pain but may experience some mild discomfort. You can go home the same day as you have your procedure. 

The technique used to remove your mole will depend on its size and location. It will usually either be shaved or cut off with a scalpel. The wound may then need a few stitches to close it and will be covered with a temporary dressing. 

Treatment for melanoma

If changes in your mole have already progressed into melanoma, you will be referred to an oncologist (a doctor specialising in treating cancer). Your treatment options will depend on the stage and location of the melanoma and if it has spread to other areas of your body. 

In addition to being cared for by an oncologist, your specialist team will include a dermatologist, a plastic surgeon, a radiologist and a specialist nurse.

In the early stages where your melanoma hasn’t spread, it is usually treated with surgery to remove it and some surrounding skin tissue. If your melanoma is more advanced, you may need additional treatments, such as

• Chemotherapy — chemicals that destroy cells that are rapidly growing, including cancer cells
• Immunotherapy — stimulates your immune system to destroy cancer cells
• Radiotherapy — radiation waves directed at the area where your cancer is located to destroy the cancer cells
• Targeted therapy — drugs that specifically target and destroy cancer cells

Your doctor will discuss the most appropriate treatment plan in your particular case, taking into consideration the stage of your cancer and your general health.

Make sure you ask your doctor any questions you have about your treatment options, recovery and expected outcomes so you can make an informed decision about your treatment plan.