Mole assessment at Tunbridge Wells Hospital

Why might I need one?

You might have a mole assessed if it's changed, or if you're worried about it. Reasons to get a mole checked include if it:

• has changed size, shape or colour
• is painful or itchy
• is inflamed, bleeding or crusty
• is a new or unusual mark that hasn't gone away after a few weeks

Skin cancer is now one of the most common cancers in the UK, and rates of melanoma (a type of skin cancer that can develop in a mole) have risen by 31% in Britain over the last decade. You may be more likely to need regular checks if you have a personal or family history of skin cancer, have many moles or atypical moles, have fair skin that burns easily, have had significant sun exposure, or use or have used sunbeds.

What are the benefits of having it?

A mole assessment is quick and doesn't involve any cuts or discomfort. Finding a melanoma early makes a real difference to treatment: almost everyone diagnosed with stage 1 melanoma survives for 5 years or more afterwards.

If nothing concerning is found, an assessment can also give you peace of mind and help you get to know your own skin better.

Are there different types of the test?

There are two main approaches:

• a self-check, where you examine your own skin at home to get to know your moles and spot any changes early
• a professional assessment, where a doctor, nurse or specialist examines a mole you're concerned about, sometimes using a dermatoscope to see it in more detail, or a device that photographs the mole so a specialist can review the image

The two work well together: self-checks help you notice changes between appointments, while a professional assessment gives you an expert opinion on anything you're worried about.

How do I prepare for the test?

There's not usually much you need to do to prepare. It helps to think about:

• how long you've had the mole and whether you've noticed it changing
• whether you, or a close family member, have a personal or family history of skin cancer
• any photos you've taken of the mole over time, which can help show how it's changed

You may be asked to fill in a short questionnaire about your skin and risk factors, and to give your consent before the assessment goes ahead.

What happens during the test?

1. You'll be asked about the mole or moles you're concerned about, including how long you've had them and any changes you've noticed.
2. You'll fill in a short questionnaire about your skin type, sun exposure, and any personal or family history of skin cancer, and give your consent.
3. The person carrying out the assessment will look closely at the mole with the naked eye.
4. They may use a dermatoscope to view the mole at around 10 times its normal size, to look more closely at it.
5. They may take a photograph or image of the mole to keep on record, or to send to a specialist for review.

A mole assessment consultation often takes around 20 minutes. The assessment checks the mole against the ABCDE signs:

• Asymmetry: normal moles are symmetrical, with both halves looking the same; melanomas tend to be irregular or asymmetrical
• Border: normal moles have a smooth, well-defined edge; melanomas often have blurred, ragged or uneven edges
• Colour: normal moles are usually one shade; melanomas often show more than one colour, sometimes shades of brown, red, pink, blue, black or white
• Diameter: normal moles are usually no bigger than the blunt end of a pencil; melanomas are often bigger than 6mm
• Evolving: any mole that's changing, for example getting bigger, darker, oozing, itching, bleeding or becoming crusty, should be reviewed

What happens after the test?

If the assessment doesn't raise any concerns, you'll usually be reassured and advised to keep checking your moles regularly, since moles and skin are always changing.

If something needs a closer look, you'll be referred on for a more detailed assessment. Sources describe this differently depending on the service: some private scanning services send a written report within about a week, while in the NHS, if a GP is concerned about a mole, you should get a specialist appointment within 2 weeks.

If a mole turns out to be, or might be, a melanoma, the main treatment is surgery to remove it.

What are the risks or side effects?

A mole assessment itself carries almost no physical risk, since it doesn't involve any cuts, injections or discomfort.

There are some limitations to be aware of, though. A visual assessment or scan doesn't provide a formal diagnosis of skin cancer on its own; if something looks concerning, further tests, such as a biopsy (taking a small sample of the mole to examine under a microscope), are needed to confirm this. Moles and skin are always changing, so a mole that's been checked and found not to be of concern isn't guaranteed to stay that way, which is why regular checking matters. Melanoma can also be harder to spot on black and brown skin because of a masking effect, so it's worth paying particular attention to changes on the nails, palms and soles, where it's more likely to appear in these skin tones.