Skin moles can range from harmless to life-threatening but do you know the difference? Editor Anna Magee gets one of her moles checked out and finds out what to look for in skin moles and how to treat them
Some things are part of who we are, like fixed earlobes or square nails. That’s how I’d always seen the mole on the back of my left thigh.
15 years ago it was a neat, round, slightly raised brown dot, like something you’d make with the tip of a marker pen. When a dermatologist examined it in 2001, I couldn’t even remember when it formed, so long had it been there. ‘It’s nothing,’ she said, sending me on my way.
But in the last couple of years it’s been changing. The border now has jagged asymmetrical edges and it’s grown in size fourfold, its surface turned scaly. Instead of an even brown, its pigment is now darker in parts. I knew these weren’t good signs and that my history of sunburns as a child – I grew up in Australia – put me at increased risk, even with my olive skin.
Almost all normal adults will have around 10-40 moles of varied shapes, colours and textures on their bodies by their 40th birthdays
And yet, my GP didn’t look worried at all when she examined it at the beginning of last year. ‘It looks like a benign mole to me,’ she said. As a fully paid-up member of the vain hypochondriacs club I asked if I could have a referral to a dermatologist to have it doubled-checked and perhaps removed because it made me feel self-conscious in my bikini. She nodded vaguely.
I never did get that referral letter and instead, recently opted for a second opinion with leading dermatologist Dr Noor Almaani, who specialises in moles, both malignant and benign. She works at King Edward VII NHS Hospital in Windsor and The Private Clinic in Harley Street, London where I stood in her surgery in my knickers while she looked at every mole on my body with a ‘dermatoscope’. This is a hand held magnifier that doctors place over moles to see what’s really going on in the deeper layers of the skin.
almost all normal adults will have around 10-40 moles of varied shapes, colours and textures on their bodies by their 40th birthdays
While Dr Almaani is almost certain the mole on my leg is a harmless ‘serborrheic keratosis’, she thinks it’s best cut out and checked out. ‘The fact that it has doubled in size in the last year, is asymmetrical and that you only have one like it on your whole body is enough reason to have it removed and tested.’
Though they might look unsightly, benign moles, lumps, and bumps on the skin are not something the NHS will pay to have removed, unless a GP suspects they may be malignant, who will then refer you. But, as almost all normal adults will have around 10-40 moles of varied shapes, colours and textures on their bodies by their 40th birthdays (bumps and moles on the skin are more common in middle age) – very few of which turn out to be cancerous – what can be done about them? More importantly, how can we know that what we have really doesn’t need to be checked by a specialist for skin cancer?
Things that go bump
There’s a vast array of benign lumps, bumps and growths that can develop on skin with age – here are four of the most common and expert help on what to do
1. Benign Moles
What are they?
Small coloured spots on the skin that can be flat or raised, smooth or rough and may have hair growing from them. ‘Benign moles are incredibly common,’ says Dr Almaani. ‘The vast majority we see are what we call ‘typical moles’ so their borders are smooth and they’re symmetrical in shape and almost the same colour all over – this is normal’.
What can be done?
The NHS won’t remove benign moles, unless there are symptoms such as itching, pain, a recent change in colour and size, asymmetry, a family history of skin cancer, a history of sunburn or sunbed use, inflammation or bleeding that could signal cancer.
You need to keep checking [your moles], as it’s possible for benign moles to turn cancerous later in life
‘But you need to keep checking, as it’s possible for benign moles to turn cancerous later in life,’ says Dr Almaani. Privately, benign moles can be removed. ‘If the mole is raised it can be surgically shaved off in a procedure done under a local anaesthetic that takes about half an hour,’ she says. ‘This might leave a small scar a bit lighter than the skin surrounding it.’
If the mole is flat, there’s little that can be done except cutting it out, also a quick procedure under local anaesthetic by a dermatologist who cuts into the skin around the mole and removes it, then stitches the skin together again, leaving a scar that’s usually a straight line, explains Dr Almaani. ‘The only reason you can get a mole removed on the NHS is if your doctor suspects a malignancy and refers you for treatment, in which case it will usually be biopsied or removed and sent for testing.’
Cost for removal: Around £600
2. Seborrheic Keratoses
What are they?
These wart-like brown spots, common in middle age, tend to look like they’re stuck on the skin, says Dr Joanna Gach, a consultant dermatologist at University Hospital Coventry and NHS Trust and BMI Meridien Hospital in Coventry. ‘Most people tend to get these in different shapes or sizes,’ she explains.
These wart-like brown spots, common in middle age, tend to look like they’re stuck on the skin
They can be light brown or almost black, flat or warty, sometimes like a cauliflower in texture and tend to commonly appear on people’s trunks, scalps and faces, though they can turn up anywhere, she says. The cause? ‘Simply the way the skin is maturing – we tend to see them appearing from around 30 and they’re no cause for concern, though they can get itchy and irritated and catch on things.’
What can be done?
‘If they’re small, we can use cryotherapy in which liquid nitrogen is applied to quickly freeze them off,’ says Dr Gach. ‘But this can not only lead to them coming back quicker, it can also leave unsightly white scars.’
Using another procedure, curettage, a dermatologist under a local anaesthetic uses a metal loop to scrape the bumpy bits off the skin and then uses cautery to stop the bleeding. ‘This leaves a small scab that heals well and quickly and gives a great cosmetic result that patients love as there are no stitches.’
Cost for removal: Around £600 for surgical removal, around £300 for cryotherapy.
3. Skin Tags
Almost all of us will develop a skin tag at some point
What are they?
Almost all of us will develop a skin tag at some point. These are flesh-coloured or brown growths that hang off the skin, usually in clusters around the neck or the armpits, says Dr Gach. ‘Some women tend to get more in pregnancy and they tend to run in families,’ she explains. ‘Though harmless – and not treatable on the NHS – they don’t look nice and may catch on things and get sore, which upsets patients who often decide to have them removed privately.’
What can be done?
‘We can use cryotherapy to remove them’ Dr Gach explains (see above). ‘But a better result cosmetically often comes from snipping them off with small surgical scissors under a local anaesthetic, which is less likely to leave the tell tale white scars that cryotherapy can often results in.’
Costs for removal: Around £600 for surgical removal, around £300 for cryotherapy.
What are they?
Round lumps that form under the skin caused by fatty deposits. ‘The overlying skin looks normal, but beneath it is a lump sometimes the size of a cherry or larger,’ says Dr Gach. ‘Though they can appear anywhere, they’re often on the scalp. ‘Sometimes, they can get infected and become painful and hot and may burst and smell, so it’s best to have them checked out, especially if they’re growing.’
What can be done?
If you have symptoms such a pain or discharge or it’s getting red, hot or smelly, see your GP who can arrange for treatment that may involve surgical removal
If you have symptoms such as pain or discharge or it’s getting red, hot or smelly, see your GP who can arrange for treatment that may involve surgical removal. ‘Though it varies from trust to trust, some trusts will also remove asymptomatic lipomas if they’re over one centimetre in diameter on the face or over two centimetres on the body,’ says Dr Gach. Lipomas are removed by a dermatologist who can cut out the growth surgically using a local anaesthetic.
Cost for removal: £3-600
Is it skin cancer?
Although over 13,000 people a year are diagnosed with skin cancer – almost 7000 of them women – and rates of malignant melanoma have risen in Britain faster than any other cancer, there is good news. Some nine in ten women (and eight in ten men) will survive for at least ten years thanks to early detection and treatment.
What am I looking for?
‘You’re looking for change,’ says Dr Almaani. Check your whole body regularly and know where you have moles so you can be aware of any changes as you age (remember it’s normal to have between 10 and 40 moles by age 40), she advises.
You’re looking for change. Check your whole body regularly and know where you have moles so you can be aware of any changes as you age
‘If you have always had moles and one or some of them start to change, report that. But likewise, if you have never had moles and develop one in your 40s, tell your doctor.’ Never ignore red flags such as itching, pain, discharge, bleeding or a change in colour, texture or size, she explains.
Also, be aware of the ABCDs of skin cancer, from Cancer Research UK – having even one of the following warrants getting checked:
Asymmetry – this is when the two halves of your mole don’t look the same
Border – the edges of your mole are blurred, jagged or irregular
Colour – there’s more than one shade present in your mole
Diameter – your mole is wider than six millimetres (about the size of a pencil eraser)
Skin Cancer Types
Though the differences aren’t always obvious to the naked eye, a specialist can identify the type of skin cancer to determine the treatment you need
Basal cell carcinoma (BCC)
From left to right: morphoeic basal cell carcinoma, nodular basal cell cancer, pigmented basal cell cancer
‘By far the most common cancer in the body affecting 75 in 100 cases, this is a mild type of skin cancer and in 99.99 per cent of cases is limited to the skin’, says Dr Almaani. ‘A dermatologist can scrape, freeze or cut them out but there is usually no urgency in treating these’.
Squamous cell carcinoma (SCC)
Squamous cell carcinoma close-up, on scalp, and on ear. Common locations for this type of cancer.
This makes up about 20 per cent of skin cancers and while it doesn’t often spread, according to cancer research UK, it still should be treated urgently.
From left to right: melanoma with irregular border, melanoma with irregular shape and color, spreading melanoma
This is a rare type of skin cancer and in the UK, most are found and treated at an early stage. Under guidelines from the National Institute for Clinic Excellence, if a GP suspects either squamous cell carcinoma or malignant melanoma, you should be seen by a specialist within two weeks on the NHS, says Dr Almaani. A biopsy might be taken, or the whole thing might be surgically removed. ‘We usually prefer to take out the whole mole to assess the depth of the cancer. We might also take a biopsy of the lymph nodes to check the cancer hasn’t spread.’
I can’t stress enough how good survival is for skin cancer so see your doctor early if any mole changes
For most, surgery will be enough because the cancer will not have spread. ‘If it was a deep cancer, we will usually follow the patient every two months for about three years to ensure it doesn’t come back. If the cancer has spread, chemotherapy and radiotherapy along with medication will be prescribed. ‘I can’t stress enough how good survival is for skin cancer so see your doctor early if any mole changes,’ says Dr Almaani.
What to do:
Ask for a referral if you’re in any doubt. According to NICE guidelines, if your doctor has any suspicions or isn’t sure, he/she should refer you to a specialist urgently (within two weeks) for biopsy or removal and testing.
For more information log on to Cancer Research UK’s Skin Cancer section
MORE FROM HEALTHISTA: