Most people have a mole or two on their bodies. They are normal and even constitute beauty spots when you consider celebrities such as Cindy Crawford, Madonna and the late Marilyn Monroe. So what are they, and how can they cause health problems?

What is a mole?

A mole is an area of pigmentation made from melanin, which is a substance made from melanocytes, cells within the basal layer of the skin. People from tropical countries have many more melanocytes in their skin, which are producing melanin all the time, so their skins are darker to protect them against the sunlight. In temperate countries such as Britain, where the majority of people are fair-skinned, our skin produces less melanin.

Moles, which are areas of concentrated melanin produced by the melanocyte cells, usually develop when we are young. Most people have a few moles; anywhere between 20 and 200 is the normal range, and they can develop at any time of life.

Melanomas explained

Unfortunately for us, moles and disease affecting them are a serious health issue. Skin cancer is the fastest growing type of cancer in Britain: “In the UK alone over 100,000 new cases of skin cancer are diagnosed annually,” says Rebecca Freeman, spokesperson for the British Association of Dermatologists. “Of these, 9,000 are melanoma, which develop from moles or look like new moles, which is the most deadly type of the disease.”

There are three types of skin cancer: basal cell carcinomas, which usually appear on the face and which affect the basal layer of cells within the skin. The second type are squamous cell cancers, which affect the squamous cells in the skin: tumours appear as tiny gritty bits just under the surface of the skin, often appearing on the back of the hands, or in areas of sun damage. Third are melanomas, which are cancers of the melanin-producing cells in the skin, and which frequently affect existing moles.

“Keeping an eye on your moles at home is vital because melanoma, which usually starts as a mole, is fatal if not spotted early,” says Megan Dawe, head nurse at The Mole Clinic, London. “Early detection will save your life. If you see any changes in a mole get it checked out professionally straight away as it is very treatable if spotted early.”

Who is at risk?

Melanoma is one of the few cancers to affect young adults and is the most common cancer among 15-34-year-olds. More women than men develop melanoma and you are at risk if you were sunburnt a lot as a child. Other risk factors include use of sunbeds – now classified by the International Agency for Research on Cancer (IARC) as a carcinogenic factor for skin cancer much the same as cigarette smoking is for lung cancer – and constant tanning, to the point of being sun-burnt.

Fair-haired, blue-eyed people, who don’t tan and burn easily, are at greatest danger, and need to take the most care of their skin, using sun blocks and sun screens liberally and avoiding heavy sun exposure.

“Getting out into fresh air and getting some sun exposure is vital for the production of vitamin D, which is essential for our skin and bone health, so nobody wants to avoid sunlight entirely,” says Dr Tom Smith, a GP from Scotland and author of Skin Cancer: Prevent and Survive (Sheldon Press, 2009), but he warns “they just need to take sensible precautions to protect their skin from harmful ultraviolet light.”

Where to go for help

If you are at all worried, then take your concerns to your GP. “Most GPs should take melanoma worries very seriously and refer you on to your consultant dermatologist at a local hospital very quickly,” says Dr Tom Smith. There are also private ‘mole clinics’ operating within the UK which offer a service to check mole health and suggest treatment options. However, many of these are unregulated, so it’s wise to question the professional credentials of the staff before paying out for any health checks.

If it’s malignant

If after seeing a specialist dermatologist, a mole has been diagnosed as malignant, a patient will be offered surgical treatment to remove the mole and to clear the affected area. If the doctors believe that the cancer has metastased and spread to other areas of the body, a CAT scan will be done to fi nd out what areas are aff ected. Removing lymph nodes close by is the next step. If all is well, patients are then given reconstructive surgery to repair the affected area.

If the cancer has spread throughout the body, the outcome isn’t quite so positive, as this type of cancer doesn’t respond that well to conventional chemotherapy intervention. Survival rates for malignant melanomas vary according to what stage the cancer is at when first diagnosed.

About 90 per cent of people who are diagnosed with Stage 1 melanoma (where the tumour shows no sign of having spread to other parts of the body) will survive for at least fi ve years.

If the tumour has spread, survival rates are much, much lower. Over 2,600 people die from skin cancer each year and most are from malignant melanoma.

“Although skin cancer, and melanoma in particular, is a serious issue, treatments are being developed all the time to improve the survival rates for this disease,” says Dr Tom Smith. “Early diagnosis and early prevention is key to a successful outcome.”

Signs to look for

GPs recommend that we all take an active interest in the state and number of moles on our skin. Some doctors even suggest you photograph any suspicious moles. However, for those who live alone or who aren’t able to see their entire body (some moles develop on the top of the head, for instance), this isn’t easy. When checking the moles on yourself or for someone else, look for the following ABCDE signs:

• Asymmetry – if the two halves of the area differ or have started to differ in shape
• Border – note if the edges of the area have become irregular or blurred or perhaps have notches
• Colour – any changes in colour, different shades of black or pink or brown?
• Diameter – most melanomas are at least 6mm in diameter.
• Elevation – is the mole suddenly elevated, or bigger or has raised edges?
  

Useful information

• www.bad.org.uk/sunawareness - British Association of Dermatologists.
• www.cancerresearchuk.org - general information about cancer
• www.skcin.org - The Karen Clifford Skin Cancer Charity
• www.themoleclinic.co.uk is based in London with branches in main Superdrug stores. It is the only clinic using trained medical staff and offering examination of moles using a deep level imaging system called Telederm. A top-to-toe Mole Check costs £115 and a single mole check £45.