In this article we cover moles, what changes to look for in moles, melanoma skin cancer and reducing your risk of developing melanoma. It is important to understand that recreational and occupational exposure to ultraviolet (UV) radiation from the sun increases your risk of getting melanoma, primarily in terms of episodic but also cumulative sun exposure, therefore safe sun exposure should be practised at all ages.
Pigmented moles are referred to as ‘Melanocytic naevi’ by Dermatologists. The word ‘melanocytic’ means that they are made up of the cells (melanocytes) which produce the dark pigment (melanin) that gives the skin its colour. Melanocytes clustered together form ‘naevi’ or moles.
Some moles are present at birth or appear within the first two years of life. Most develop during childhood and early adult life. The number of moles increases up to the age of 30-40. Thereafter, the number of moles tend to decrease. New moles appearing in adulthood need to be monitored and checked if growing or changing. Moles can be found anywhere on the skin, including on the hands and feet, genitals, eyes and scalp.
There is some risk of melanoma growing from an individual mole. However, there is a strong link between excessive or recurrent sun exposure and developing a melanoma from a normal looking skin.
It’s important to get a new or existing mole checked out if it:
– changes shape or looks uneven
– changes colour, gets darker or has more than 2 colours
– starts itching, crusting, flaking or bleeding
– gets larger or more raised from the skin
These changes can happen over weeks or months, these changes are sometimes a sign that the mole is developing into melanoma skin cancer. The British Association of Dermatologists recommends that you tell your GP about any changes to a mole or patch of skin as soon as you notice these changes. If your GP is concerned about your skin, your GP will refer you for a review with a Consultant Dermatologist at your local NHS hospital to be seen within 2 weeks.
Early detection of melanoma involves the following :
regular self-examination: Stand naked in front of a mirror. Look for any new or seemingly changing moles. Look for the ‘ugly duckling’, the mole that stands out. Don’t forget to look at your scalp, between the fingers and toes and soles of the feet.
take photographs of your moles for comparison between skin checks.
monitor your moles for changes in size, shape, colour: the ABCD rule (Asymmetry, Border, Colour, Diameter (>6mm). Asymmetric moles with uneven borders, multiple colours, and more than 6mm and are changing, need to be checked.
get suspicious moles checked urgently by your GP.
Melanoma is a word derived from the Greek melas “dark or black” and oma “tumor”, literally black tumour. Melanoma is a type of skin cancer, which arises from the pigment cells (melanocytes) in the skin.
It is estimated that 1 in 3 cancers diagnosed is a skin cancer. Cancer Research UK states that Melanoma skin cancer is the 5th most common cancer in the UK, accounting for 4% of all cancers and that there are 16,200 new melanoma cases in the UK each year.
Each year more than a quarter (28%) of all new melanoma skin cancer cases in the UK are diagnosed in people aged 75 and over.
Most melanoma skin cancers occur commonly in the trunk or legs, they are uncommon in areas that are protected from sun exposure.
Melanoma is considered to be the most serious type of skin cancer. This is because it is more likely to spread (metastasise) from the skin to other parts of the body than other types of skin cancer. If melanoma has spread to other parts of the body, those deposits are known as secondary melanoma (secondaries/metastases). Although a diagnosis of melanoma can be serious, most melanomas are diagnosed at an early stage and surgically excised and so do not cause any further problems. People who have had a melanoma at this earliest stage removed may need another operation, to ensure a wider margin and reduce the chance of the melanoma coming back at the original site. This is called a wide local excision. During the operation, some healthy skin will be removed from around the original scar to make absolutely sure that all of the melanoma has been taken away, and this makes the scar larger than before. Occasionally a skin graft will be needed.
Top sun safety tips – reducing your risk of developing melanoma
Melanoma arises as a result of complex interactions between individual genetic factors and environmental risk factors, the majority of which seem to be connected with exposure to the sun and having a history of sunburn. Although we can’t change our skin type, number of moles we have or our genetic makeup, that predisposes us to the development of melanoma, we can change our behaviour to sun exposure.
Protect your skin with adequate clothing, wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses. Choose sun protective clothing (with permanently sun-protective fabric, widely available for adults and children) if you have fair skin or many moles.
Spend time in the shade between 11am and 3pm when it’s sunny. Step out of the sun before your skin has a chance to redden or burn.
When choosing a sunscreen look for a high protection SPF (current recommendations are SPR 50 or 50+) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA. Apply plenty of sunscreen 15 to 30 minutes before going out in the sun, and reapply every two hours and straight after swimming and towel-drying.
Keep babies and young children out of direct sunlight. Rash vests, hats and sunglasses are mandatory in young children.
Sunscreens are not an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.
The skin is the largest body organ. Always protect it from sun damage, never let it burn. And remember that skin cancer is treatable if caught early. For more information visit: www.bad.org.uk
Dr Eirini Merika MBBS, BSc, FRCP. Consultant Adult & Paediatric Dermatologist, Chelsea & Westminster Hospital, Head of the Local Dermatology Training Programme.
Dr Raj Chandok FRCGP FRSA MSc MBBS DC DRCOG DFFP D Med Ed. General Practitioner Principal, Dr G Singh & Partners.
Content used for this article and illustration are courtesy of the British Association of Dermatologists.