When To Worry About A Mole

There has been a dramatic rise in the number of cases of skin-cancer in over-50s. For the first time ever 10,000 people a year aged 55 and over are being diagnosed with skin melanoma, up from just over 3000 people a year in the mid to late 90s. The shickingly steep rise in cases of skin cancer is being blamed on the rise of package holidays in the 1960s.

Cancer Research UK have said that the ‘sun, sea and sangria' generation were paying the cost of decades of cheap package holidays, and the desire for deep tans.

The idea that something as innocuous as a mole might be a
dangerous cancer is terrifying, but is it really practical to see a GP
every time you are worried? The answer is yes, according to our experts:

Dr Noor Almaani, consultant dermatologist at King Edward VII NHS Hospital in Windsor and The Private Clinic in Harley Street, London.

Dr Joanna Gach, a consultant dermatologist at University Hospital Coventry and NHS Trust and BMI Meridien Hospital in Coventry.

Nina Goad, spokesperson for the British Association of Dermatologists.

Dr Sean Lanigan, consultant dermatologist at Birmingham City Hospital and medical director of Sk:n Clinics.

First, the good news. By the time we turn 40 most of us will have around 35-40 moles, lumps and bumps on our bodies. But while they're more common in mid-life, according to Dr Jeremy Halfhide, a practising GP specialising in skin cancer, over 99 per cent of moles and bumps seen in patients in his GP practice turn out to be benign, once they're been checked by a dermatologist for malignancies. Even more comfortingly, he estimates that around 90-95 per cent of moles referred to hospital dermatologists to be checked for skin cancer also turn out to be benign. Well, phew is all we can say!

That doesn't mean you shouldn't get your moles checked though, and here's why you need to be vigilant. Over 13,000 people are year are diagnosed with skin cancer - almost 7000 of those are women - and rates of malignant melanoma, the most dangerous form of skin cancer, are rising in Britain faster than any other cancer.

Most of us know about the importance of slathering on high factor sunscreen but leading skin cancer experts are now encouraging us to be skin aware in the same way as we're breast aware. That means watching the things that go bump on our skin - that's everything from moles and fleshy growths to weird lumps - for changes and reporting them to our doctors. 

Like most cancers, early detection is everything for melanoma. In fact, of all the cancers, it's the most treatable: when they are diagnosed and treated quickly, some 9 in 10 women and 8 in 10 men survive it for at least ten years.  

By your 40th birthday, along with a few extra wrinkles, your body will feature 10-40 moles (35-40 is average) lumps and bumps. Though highly unlikely to be cancerous, it's important to report changes in the appearance or feel of these to your GP.


What am I looking for?

Skin cancer doesn't always show itself as a mole, so also look for skin changes such as crusty, sore or scabby patches that develop out of the blue and don't seem to heal. If you have had very few or no moles in early life and suddenly develop one in your 40s it's worth getting it looked at, although it is most likely to be innocent. Never ignore red flags such as itching, pain, discharge, bleeding or a sudden change in colour, texture or size.

These are the key signs to check:

Asymmetry - when two halves of your mole don't look the same.
Border - the edges are blurred, jagged or irregular.
Colour
- there's more than one shade in your mole.
Diameter - a mole wider than six millimetres (about the size of a pencil eraser).
Skin - scabs or sores - especially if they occasionally bleed or itch - scaly or crusty patches along any lumps getting bigger.

Are there several types of skin cancer?

Yes, they divide into these three categories:

Basal cell carcinoma (BCC) The most common cancer affecting 75 in 100 cases, in 99.99 per cent of cases they're limited to the skin. A dermatologist can scrape, freeze or cut them out but there is usually no urgency in treating these.

Squamous cell carcinoma (SCC)  About 20 per cent of skin cancers are SCCs and while they don't often spread, they should still be treated urgently.

Malignant melanoma This the rare but serious from, affecting over 13,000 Britons a year - 6,853 women and 6,495 men. They are most commonly found on the legs for women and the torso on men.

Who should I see?

Your first stop is your GP. As well as changes and new moles they'll want to know any family history of skin cancer and sunburn, especially in childhood as it takes about 15 years on average for a sunburn to result in a cancerous mole. If your doctor has any suspicions, they should refer you to a specialist urgently - within two weeks, according to NICE guidelines - for biopsy or removal and testing. Unfortunately, the British Association of Dermatologists say a chronic shortage of NHS dermatologists across Britain can lead to delayed diagnosis, but bear in mind there will also be a delay if your case isn't deemed urgent. Going private for a check-up may put your mind at ease and skin clinics charge anywhere from £100 to £600 for a check up. On the less pricey end, Sk:n Clinics has branches across the country offering full body mole screenings from £99 (sknclinics.co.uk). Removal starts from £155 and you can have up to three moles checked for malignancies for £115.

How is skin cancer diagnosed and treated?

Specialists use a ‘dermatoscope', a hand held magnifier, to see what's really going on. If they suspect cancer, the offending area will be removed under local anaesthetic, sent away and examined for cancerous cells. If a cancer diagnosis is made, you may need another op to remove a little more skin around the original mole or lesion to ensure they got all the cancer cells out. The area that is removed will be sent to the laboratory each time until the specialists are satisfied that no cancer cells remain. 

What about other lumps and bumps?

The NHS only treats growths suspected of being malignant,  so you need to see a dermatologist privately for cosmetic treatment. Costs vary, but expect it to be somewhere between £300 and £600 depending on the treatment required, the dermatologist's expertise and the area you live in.


Benign moles
: These can be cut out and stitched, usually leaving a straight-line scar. You might also be able to opt for laser removal, which is quick and usually scar-free.


Seborrheic keratoses:
Complicated name, incredibly common problem - especially for the over 30s.  These wart-like brown spots tend to look like they're stuck on the skin. The brown crater-like growths most often appear on trunks, faces, scalps and faces, though they can turn up anywhere. A procedure called Curettage uses a metal loop to scrape the bumpy bits off the skin. Cauterising stops the bleeding, meaning there is no need for stitches.


Skin tags: Almost all of us will develop a skin tag at some point. These flesh-coloured or brown growths are most common in clusters around the neck or armpits and occur most frequently during pregnancy. They can be snipped off with small surgical scissors under a local anaesthetic, and are unlikely to leave scars.

Continued below...


Lipomas:
Round lumps of fatty deposits under the skin sometimes the size of a cherry or larger, these can appear anywhere but are often on the scalp. Though usually harmless, lipomas can get infected and become painful and hot. They may burst and smell, so it's best to have them checked out, especially if they're growing. If you have symptoms such as pain or discharge your GP can arrange for surgical removal. If you don't, a private dermatologist can cut out the growth surgically using a local anaesthetic.

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