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February 5, 2018 / molehunter

Bad information on moles and melanoma

I get a regular Google update on melanoma related news, this morning I found this article from Essex (the county where I was born).

A 20 year old model, Ella Ravenscroft, with a history of sun bed use was worried that 4 of her moles had changed. She has now had 4 moles cut out. I assume we would have been told if any of them were malignant, so I’m sure they were all harmless. Was it really necessary for them to be cut out?

essex girl


The young lady said, and I quote, ‘I realised if I didn’t have them taken off I could end up with skin cancer’. This amounts to an assertion that these moles were known to be pre-malignant. No evidence is provided to support this statement, and I am concerned that it may lead to needless fear. I am seeing patients in my NHS clinic who have become terrified witless about trivial moles after something they have seen on line.

According to the latest research, which I have blogged about before here, there is probably no such thing as an identifiable ‘pre-malignant mole’.  So, with respect to Miss Ravenscroft, she appears to have picked up a populist idea which is scientifically established to be wrong. The idea that funny looking moles need to be cut out to stop them developing into cancer is mistaken, and can lead to needless fear and surgical scars.

From the photo she has shared, it looks like the 2 moles removed from Ella’s abdomen (replaced with a scar) were round and even in colour. I must be careful how I put this, and am not in a position to comment on the clinical judgment of whoever advised surgery, but the following facts are very well established:-

1) melanoma in 20 year olds is quite rare, even if they have used sun beds.

2) dermoscopy by a trained user can almost always give reassurance that a mole is harmless, avoiding the need for excision biopsy.

3) doubtful flat moles can usually be safely managed by photography and monitoring.

I am also concerned at the advice in the article that itching is a major sign of skin cancer. It is not. I am saying that from the position of an experienced NHS skin cancer doctor who has learned from the best international teachers and sees several hundred new cases of skin cancer every year. Hardly any skin cancers present with itch, hardly anything that presents with itch is a skin cancer. Change in shape, size and colour are much better guides-also bear in mind that 80% of melanomas come out of clear skin, only 20% from pre-existing naevi.

Fair play to the young lady for sharing her experience and warning again the dangers of sun beds. But it sounds as if, just possibly, dermoscopy and mole mapping might have allowed her to avoid some surgical scars. I don’t mean to cause offence or ridicule, but what is know is known, and this story, or at least the way it has been reported, appears to carry some misleading messages which I feel as a skin cancer diagnostician and educator a professional obligation to respond to.

There are 2 reasons I teach dermoscopy for skin lesion recognition, 1) earlier detection of skin cancers, and 2) to avoid the surgical removal of harmless moles.



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