Melanoma Awareness, Skin Cancer
The ABCDEFG rules are a handy guide when checking for signs of melanoma. In this feature, we'll cover each of these rules, starting with the letter 'A' for Asymmetry.
These guidelines are endorsed by many non-profit skin cancer authorities around the world, including Melanoma New Zealand. When checking your skin, or the skin of your loved ones, look out for the following:
A is for Asymmetry
So what does ‘asymmetry’ mean, and what does it look like?
An asymmetric mole is one that's irregular-shaped, uneven or lop-sided - you can try drawing an imaginary line in any direction through the middle of a mole and then look for moles where one half does not match the other.
In general, normal moles are evenly-coloured in brown, tan or black, and either flat or raised on the skin. They’re usually fairly symmetrical too.
Image: normal moles are often oval-shaped, evenly coloured, and create either raised or flat surfaces on the skin
If you notice any mole on your skin that is irregular in shape, it would pay to get it checked - it could be an early warning sign of melanoma.
Image: to an untrained eye, melanoma can look much like any other spot. At MoleMap, our Melanographers use special 'dermatoscopes' and other high resolution imaging equipment to look deep inside a mole’s structure. For medium-to-high risk patients, our skin-mapping technology is used to track changes over time.
B is for Borders
In normal moles, the borders or ‘edges’ of are fairly round and evenly formed. If you notice that the edges are becoming ragged, vary from sharp to fuzzy, or are notched, scalloped or blurred - get a professional skin check straight away.
Image: these moles with unusual borders were diagnosed as melanoma
Also, the pigment might start to spread into the skin outside the mole - that’s not so normal! It could be an early warning sign of melanoma, so it’s a good idea to get it checked as soon as possible.
C is for Colour
Moles can be all sorts of different colours – that’s quite normal. Most commonly, they’re an evenly coloured spot on the skin, either flat or raised, round or oval. They can be flesh coloured, tan, brown or even black – and they can also darken over time or from exposure to the sun.
Image: these moles with unusual colouring were diagnosed as melanoma
Once a mole has developed, it will usually stay the same size, shape, and color for many years. However ... if a mole is changing in colour rapidly or suddenly, is uneven in colour and/or has multiple colours in it (including differing shades of brown, tan or black, or patches of pink, red, white or blue) it may be of concern and you should get it checked out straight away.
You should also watch out for:
If you have any of the above symptoms, it doesn’t mean they are melanoma, but it would pay to have them checked by skin cancer detection experts as soon as possible to make sure.
Which skin colour is most at risk of skin cancer?
As most of us know, people with fair or very pale skin (particularly those who have a lot of moles and freckles), are most at risk of skin cancer. If you have olive or dark skin, your risk is reduced – but remember that low risk doesn’t mean NO risk. People with darker skin can still get melanoma – in fact, the famous Jamaican musician Bob Marley died as a result of an untreated melanoma on his toenail!
What’s more, darker skinned people often aren’t as vigilant about wearing sunscreen and other sun safety precautions as those with paler, frecklier skins, so their skin can end up with a lot more harmful sun damage over time.
D is for Diameter
When it comes to moles and other spots, size does matter – especially a change in size. The general rule is that if a mole is bigger than 6mm (i.e. the size of a pea or the eraser on a pencil), it can be a warning sign of melanoma. The earlier melanoma is detected, the better, so don’t wait for a suspicious-looking mole to grow to 6mm in size.
Dangerous moles commonly tend become bigger in size over weeks or months – although conversely, they can become smaller as well. Both changes are a cause for concern. One important thing to note is that dangerous moles also tend to grow unevenly and have ragged or uneven borders.
D also stands for ‘dark’. No matter what the size of a spot, if it’s dark - or growing darker - it can be sign of melanoma. A tiny but very dark spot can be very dangerous, so if you notice a spot like this, it’s important to get it checked out as soon as possible
Image: these moles were larger than 6mm and diagnosed as melanoma.
I have a large mole – does it mean it’s melanoma?
No, not necessarily. Many people have large moles which are completely innocuous – these are often raised, clear or light brown or pink in colour. It’s when a larger mole is changing, growing, unusual-looking or showing any other of the other signs of skin cancer, that you need to be concerned and get it checked out.
Image: sunspots are often a sign of overexposure to the sun
What about sun spots – are they dangerous?
Lots of people (especially older people) have large ‘sun spots’ (solar lentigines) on parts of their body that have been exposed to the sun. Sun spots, also known as ‘age spots’ or ‘liver spots’, are not necessarily dangerous in themselves, but they can be a warning sign that you’ve had too much sun exposure and therefore have a higher risk of melanoma.
E is for Evolving (or Elevated)
As we age, our skin is constantly changing. It’s all just a normal part of getting older, but, when it comes to moles and other spots, change isn’t always a good thing.
Moles usually emerge in childhood and adolescence, and change in size and colour as you grow. New moles can also appear at times when your hormone levels change, such as during pregnancy. They can appear anywhere on your body, alone or in groups.
The appearance of a new mole or spot, or a change in an existing freckle or mole, can be an early sign of a melanoma.1 The change may be in asymmetry, borders, colour or size (see A,B,C,D above) and normally occurs over several weeks or months. Other changes to watch for include itching, bleeding, oozing or crusting – these are the most concerning of all the melanoma warning signs.2
Image: this 'before and after' image shows melanoma developing in between skin checks - this illustrates the benefit of a skin-mapping service like MoleMap, which tracks changes to your skin over time
Should I be worried if a mole is elevated?
There are many reasons why moles can be raised. The main one is that it’s a healthy, benign mole (usually genetic) mole that you’ve had for a while and feels soft and sometimes wobbly to touch. These benign moles can lose colour or get darker with age and should be monitored for any drastic change, but generally aren't cause for concern.
However, moles that change and become raised could be an indication of melanoma - in this case, we recommend seeking advice from skin cancer detection specialists.
F is for Firm
Nodular melanoma accounts for about 15% of melanoma in Australia and New Zealand5. This type of melanoma can affect anyone, but is generally much more common in men over 50 and those with fair skin6.
The frightening thing about nodular melanoma is that because it grows fast, it can penetrate deep within the skin very quickly (within a few months of appearance), which is why it’s so dangerous and needs early diagnosis and removal.
Image: examples of nodular melanoma
What are the early signs of nodular melanoma?
Nodular melanoma usually presents as a rapidly enlarging lump (over several weeks to months). It may arise as a new lump or within an existing mole anywhere on the body, although it’s most commonly found on exposed areas of the head and neck.
Nodular melanoma isn’t necessarily dark or coloured, but the key giveaway is that it's raised, often symmetrical, firm to touch, and is changing or growing. In the early stages, this change might just be a sense of change rather than visible – perhaps the mole is itchy, or just feels funny. The signs of nodular melanoma include:
How can you tell if a mole is firmer than usual?
Normal (benign) moles are usually soft to the touch. They might feel ‘spongy’ or ‘wobbly’ when you press on them. But if a mole feels firm, scaly or rough – or if you can feel a hard lump – it can be a cause for concern. What’s more, a lump doesn’t have to be big for the growth to be dangerous.
If you notice any unusual mole or lump that feels firm, or has any of the above features, we recommend having a Skin Check or Full Body MoleMap as soon as possible.
How to check for a changing mole?
When self-checking your skin (you can download our Melanoma Self-Check Guide here), look for any changes in size, shape, colour or elevation of a mole, including itching, tenderness, bleeding, oozing or crusting. Also look for a sore or spot that doesn’t heal, redness or a new swelling beyond the border of a mole, or the appearance of a lump or bump.
The best way to monitor changes to skin is to take photographs and compare them at a later date to identify any changes - put simply, this is what a Full Body MoleMap is.
What causes a new mole to appear?
A new mole appears when melanocytes (the pigment-producing cells in your skin) proliferate, or duplicate. Possible causes of a new mole include: exposure to the sun, having fair skin, a genetic predisposition to moles and freckles, or a weakened immune system.3
Almost all moles are benign (non-cancerous), while cancerous moles, including melanomas, usually develop as a result of genetic mutations. The exact cause of benign moles remains unknown.
However, new moles in an adult are more likely to become cancerous than old moles - around 70% of melanoma cases occur in people aged 50 years and older.4 So if you’re older and notice a new mole, or if an existing mole changes in appearance, it would pay to get it professionally checked to make sure it’s not cancerous.
The ‘ugly duckling’ rule
Another useful method for spoting melanoma is to look for the ‘ugly duckling’. If any mole stands out or looks different from that of nearby moles, it is the ugly duckling, and we advise you to see your GP or a skin cancer detection service such as MoleMap to get an expert opinion as soon as possible.
It can be a bit scary having a suspicious-looking mole checked in case it really does turn out to be melanoma. Melanoma is fast-growing and if left untreated, it can spread very quickly below the surface and through your body.
However, on a more positive note, melanoma that’s detected early can almost always be treated successfully. In most cases, this involves surgical removal of the mole and possibly some skin around it to ensure any melanoma hasn’t spread. To ensure our service is unbiased, we don’t remove moles here at MoleMap, but we can recommend Dermatologists who can.
If a mole looks suspicious, but doesn’t have any immediately concerning features of skin cancer, we’ll ask you to come back in a few months so we can monitor any changes. Our Full Body MoleMap includes unlimited free spot checks, so we encourage our patients to take advantage of these if you notice any changing moles between appointments.
Image: if you're unsure what sort of skin check is right for you, you can book a free online chat with a MoleMap Melanographer
In many cases, a suspicious-looking mole doesn’t turn out to be melanoma, but the only way to know for sure is to get it professionally checked.
If you’re not sure whether you need an expert check – or what type of skin check to book – you could start by requesting a SpotChat online consultation. Spotchat is MoleMap’s free online skin cancer advisory service, so you can talk to a Melanographer (trained skin cancer nurse) from the comfort of your own home.
You can also upload photos of the mole (or moles) of concern through My MoleMap (our personal patient app). The Melanographer will check the images – and she may ask you to show her a close-up of the mole using your phone camera. Then she’ll advise you on whether it needs further checking in one of our clinics or whether you should keep monitoring it yourself for any further changes.
A SpotChat is easy, free and confidential, so it’s a great way to ensure your mole is professionally checked straight away – and to offer you peace of mind.
No matter what type of check you need, it pays to shop around and ensure you’re getting the most comprehensive service possible. For complete reassurance, look for a head-to-toe skin check by trained experts that includes a skin surveillance program as well as dermatologist diagnosis - such as a Full Body MoleMap. Check out our range of MoleMap services here, or click the link below to make a booking.
Sources: 1,4. Melanoma.org.nz: https://www.melanoma.org.nz/be-informed/understanding 2,3. Healthline: https://www.healthline.com/health/new-mole 5,6. https://dermnetnz.org/topics/nodular-melanoma/
Note: This quick questionnaire is designed to give you an idea of your personal skin cancer risk factors.
It isn’t intended to be a substitute for medical advice or diagnosis – please contact us if you have any questions about your skin cancer risk.
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