The Importance of Mole Checks

Panos Vasiloudes, MD, PhD, FAAP, FAAD; Dermatologist, Academic Alliance in Dermatology, Tampa, Fla.

Skin cancer affects over 2 million people each year, making it the most common form of cancer. Accordingly, every patient should make mole checks a priority at least once a year. A mole can be more than just an aesthetic nuisance: Though often benign in nature, moles are a very specific type of lesion that may require medical assessment.

The term “mole” is used generically to describe many types of spots on the skin—freckles, beauty marks, sunspots and birthmarks, to name a few. Clinically speaking, a mole is a lesion comprised of melanocyte cells (the cells responsible for producing skin pigment). When these cells multiply, benign moles known as secondary nevi may form. When the growth and division of the cells becomes uncontrolled, a mole becomes melanoma.

By far the most aggressive and dangerous form of skin cancer, melanoma is characterized by a family history of the disease, severe sunburns or excessive sun exposure over time, and the presence of multiple moles, among other factors. The greater a patient’s number of moles, the greater their risk of developing melanoma.

Those with fair complexions are also at a greater risk for melanoma. The skin is classified into six types, with type one being very fair skin that always burns and never tans. If you have type one skin—typically accompanied by red or blonde hair and blue eyes—you may require more frequent dermatologic surveillance for melanoma.

Fortunately, in most cases melanoma is treatable when found early. The challenge is to detect a melanoma in its early stages before it becomes invasive. Many melanomas can be discovered during a routine skin check; in fact, the most important factors in detecting early melanomas are a patient’s instinct during self-examination, along with the physician’s intuition and experience.

As a general rule, patients should see a doctor annually for a thorough skin examination; however, those patients with a personal or family history of melanoma or high-risk behavior of moles should see their doctor every three to six months.

In addition to annual office visits, I suggest that patients perform monthly skin exams at home—a simple and costless way to identify any moles that may require additional attention. By conducting monthly exams, you can increase your chances of early detection of melanoma. The Skin Cancer Foundation website offers an easy, step-by-step guide to performing a skin examination.

Follow the ABCDE method when analyzing moles and notify your doctor if you discover any abnormalities. Look for the following criteria:
  (A)  ASYMMETRY: Both halves of the mole should be symmetrical; asymmetry may indicate the presence of melanoma.

  (B)  BORDERS: Are the borders of the mole uneven? A normal mole typically has smooth, round edges, while a melanoma does not.

  (C)  COLOR: A mole that has multiple colors—or that has changed colors—can be indicative of melanoma.

  (D)  DIAMETER: A melanoma is typically larger in size than the eraser on the top of a pencil (about ¼ inch).

  (E)  EVOLUTION: In the case of moles, change isn’t good. Look for any differences in moles’ size, shape, color or elevation, or obvious changes like bleeding or itching.
   
It’s important to remember that at-home skin exams should only supplement—not replace—the annual mole checks performed by your dermatologist, physician or skin care provider. The lessons amassed through years of clinical observation allow us to diagnose based on experience, instinct and medical knowledge, thereby increasing the diagnosis of early, noninvasive melanomas that are curable after a simple surgery.

When in doubt, a biopsy is the only clinical way to determine if a mole is melanoma. Over the years, I have lowered my threshold for mole biopsy. There is very little risk to biopsy; however, there is mortality associated with disseminated melanoma. The benefits of mole biopsy greatly outweigh the risk of missing a melanoma.

Partner with your dermatologist to develop a schedule for mole checks that is consistent with your risk factors and family history. And the necessity of sunscreen bears repeating: Though not a replacement for routine exams by an experienced doctor, it’s an irrefutable way to reduce your skin cancer risk.