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February 20, 2017 / molehunter

Selfies for melanoma detection

This sounds interesting.

A US based study using self photographes and Apple software is trying to see if this can be used to detect melanoma early. A paper in the British Journal of Dermatology by Peter Soyer et al showed that selfies of patient- identified suspicious moles with a cheap smartphone dermoscope was feasible.

In the end though, what really matters is people looking out for new and funny moles and easy access to a trained, capable dermoscopist. I am currently working on a presentation about mole monitoring and will post a summary here. Based on what I have been able to learn, there is a lot to be said for selfie mole mapping and 3 monthly review by a friend or relative, with easy access to an expert opinion in the event of a new or changing mole.

more later.


February 4, 2017 / molehunter

2 ugly moles on men’s backs

These 2 cases were seen on the same day and had similar stories-a suspicious mole noticed on a middle aged white man’s back. Both are ‘ugly ducklings’, that is to say your eye is drawn to them as the most outstanding mole on the person’s skin.


Are you worried about 1, 2 or both? Perhaps you may agree its not so easy to be sure.

Dermoscopy changes everything.


This is the dermoscopy of the first lesion. It shows an even reticular network, several shades of brown but no additional colours, an overall well balanced structure, and was flat on palpation. Diagnosis: benign junctional naevus which just happens to be the man’s largest naevus.  No concerns, advised to self photograph and report any significant change.

Lesion 2 is different.


Multiple colours, multiple structures= chaos. The main colour is light to medium brown, but there is also a black blotch to right of centre and a bluish structureless area. As far as structure is concerned, there are multiple dots and globules of varying sizes and irregular distribution. Diagnosis=probable superficial spreading melanoma. (histology awaited)

PS melanoma confirmed 0.45mm Breslow, should be cured.


Dermoscopy makes a difference to the diagnosis of a solitary questionable mole.


December 23, 2016 / molehunter

Checking your partner’s moles can save their life

New research shows the benefit of education about how to check someone’s skin for  abnormal moles can greatly increase the pick up rate of skin  ancers at an early, therefore more curable, stage. I have been convinced of this for years and try to always to educate my patients, using on line images of melanoma.

More needs to be done by health care providers and others to educate the public. Earlier diagnosis saves more lives than drugs like nivolumab and vemurafenib, and saves them cheaper.


November 30, 2016 / molehunter

Scary looking mole, but harmless

A middle aged white person presented with a story of a mole on an arm that had been changing and growing over 6 months. In the absence of a photograph, we have no objective way of being certain whether, and how much, a lesion has changed, so have to go on people’s stories. Here is the plain view.


And a close up


Not that worrying, but there is the history to consider and it is the largest mole. Dermoscopy.


Irregular globules can be seen, varying in size and mainly a greyish-blue in colour. Given the history of change, this was considered to be adequate grounds for excision.  Note also the pale circles associated with hair shafts, these are of no concern and are termed perifollicular hypopigmentation.

Histology was of a benign dermal naevus.

On reflection, did this mole really need excising? I showed the picture to colleagues, some said yes, others said that photography and monitoring would be acceptable. This is a debate that will continue-we must not miss melanomas but should avoid excising excessive numbers of benign lesions. Sharing images like this where histology has been obtained should perhaps over time help us to be more confident in deciding to monitor-but many experts say, if there is doubt about a changing/suspicious solitary lesion then remove the doubt by getting histology. I am sure we will get to know better as time goes on PROVIDED that we photograph lesions before surgery and then learn from the photos when the histology report comes back. And we all need to audit our ‘hit rate’.

November 14, 2016 / molehunter

Another melanoma detection app

Just heard of yet another mobile phone based app for early detection of skin cancer. This one depends on sending an image of suspicious moles to a trained dermatologist.



I have heard of something similar being trialed in Britain.

One issue with apps like this is the whole skin isn’t evaluated, another is that an on line dermatologist is likely to be very anxious about saying ‘Yeah, nothing to worry about’ (and risk getting sued if it works out bad) on the basis of an imperfectly focused or badly lit image, so will say ‘better come along to make sure’.

I’m not against this sort of thing, but it seems to me to just say that our regular health care professionals aren’t well enough trained. If we find a suspicious, new or changing mole, we ought to be able to have easy access to a Primary Care clinician who can adequately triage the mole or spot as harmless or suspicious, and then quickly move the suspicious on to a specialist..

This ought to be routine, then we wouldn’t need short cuts and technological gimmicks.





October 29, 2016 / molehunter

2017 dermoscopy course

Just to say that while the 2017 course is booking steadily, there are plenty of places available. I have had several enquiries from GPs, consultants and nurses asking if there are still places before they book.  There are. Once the course is fully booked, I will place an announcement here to say so, until then , there are spaces. Fully electronic on line booking not available, but you can download and complete the form (see box in top right of this page) email it to me and pay by BACS as an alternative to printing it and posting with a cheque.

PS a survey of dermoscopy by French GPs and an editorial in the October 2017 British Journal of Dermatology further underline the need for courses like ours. Please consider getting dermoscopy training, health care professionals wherever you are.

October 15, 2016 / molehunter

Tattoos may conceal skin cancers

More and more  men and women are getting tattoos, sometimes very large and dark ones. There is no evidence, or reason to suppose, that tattoos increase the risk of a skin cancer (although there have been reports of infections) but if people are unlucky enough to get a skin cancer under a tattoo, it may make diagnosis more difficult.


This image shows part of a large tattoo, something was noted at the edge of it. This picture is not very well focused, but shows an area of slightly abnormal skin that presented as it was scabbing slightly. A skin lesion that scabs and never heals over 3 weeks or more may be a basal cell cancer (BCC). The lesion is indistinct, let’s get the dermoscope on it to see if we can discover any more detail.


The area blanches under pressure from the glass plate of the dermoscope, revealing a quite different texture to the surrounding normal skin. A few compressed blood vessels near the centre of the image can just be seen. but the most striking features are the blue-grey clods (or globules) in the bottom left, which vary considerably in size and shape. These are also known as blue grey ovoid nests, and are very typical of BCC. To the right, we see a micro ulcer, the well defined irregular red clod. This is ample to diagnose a BCC, which was confirmed on histology after the lesion was removed.

The blue-grey colour at the top of the picture is tattoo ink, which happens to be a very similar colour to the blue-grey clods seen in BCC. Once again, the dermoscope takes a rather nondescript skin lesion and enables us to make a positive diagnosis by revealing detail the naked eye cannot see.

The moral of the story is, tattoos can make skin cancers more difficult to diagnose. In this case it didn’t matter but if you had a melanoma come up under a dense black area of tattoo ink, it might grow for longer than it might otherwise have done before being spotted. I have seen a melanoma come up in a gap in a dark tattoo-lucky it came up in the gap and was caught early.

Just saying.