Mole Check & Mole Mapping

What is Mole Check?
Mole check is the main way to screen all kind of skin cancers. This may be for merely one or multiple lesions that has caught your attention due to any changes, bleeding, growth or pain.
The best and recommended mole check, however, is a thorough inspection of skin from scalp to toes by proper instruments. This is the only way to assure no lesion is missed. For all Australians above 16 years of age every 6 to 12 monthly check is necessary based on the national guidelines.
Why should I have frequent mole check even if I haven't noticed any new or suspicious lesion?
Worldwide in an optimistic view only up to 50% of Melanomas are found by patients. In our experience this is even by far less. Majority of skin cancers are found in general skin checks or when the patient has come to check another lesion. Generally speaking, skin cancers may be exactly those that look very innocent to the patient.
Moreover, many of the skin cancers evolve in a previously benign lesion i.e. sun spots and moles. This is discussed in more details in "Mole Mapping".
These lesions and spots been on my face ,arms and body for a while. Should I still worry about them?
Growth rate of skin cancers, including melanoma, may be either very slow or fast. Some of these , e.g. Superficial BCC, Morphaeic BCC and Lentigo Maligna, grow insidiously within years and are symptomless. People generally consider them a harmless natural age related freckles, dry skin or even dermatitis. The least consequence is a larger cancer, however the main one is gradual invasion into the deeper tissues and simultaneously progressing to a more aggressive trait capable of rapid growth and spreading through blood vessels and lymphatics.
This is not limited to skin cancers. Colorectal, Breast and Prostate cancers are all slow growing tumors needing years to grow big and invasive. It is therefore obvious that slow growing doesn't essentially mean unaggressive behaviour and keep all of these cancers on the top List of killing cancers in human.
On the other hand some other tumours can evolve initially invasive and fast growing e.g. Nodular Melanoma and some SCCs. Therefore they may reach to a life-threatening stage in just few weeks. The higher the stage of tumour, the worse prognosis is expected. it is albeit essential to understand that the tumour stage is not necessarily proportionate to its clinical size. In particular Melanoma can reach a high stage while is clinically less than 5mm.
Differentiating these cancers in early stages are merely possible by appropriate equipment and digital technology used by a skilled specialist.
What is digital follow up?
If a lesion is considered suspicious but doesn't reach the threshold for excision your doctor may take a digital photo of the lesion and then will review in 3,6 or 12 months based on the lesion type. They will then look for likely new changes to take the proper action, i.e. excision, reassurance or further follow up.
What is Mole Mapping?
Mole mapping is the most advanced surveillance programme assisting in detecting melanoma in its earliest stage in those considered high risk to develop melanoma.
This programme involves taking high quality digital images from the whole body in standardized positions. The lesions of concern are then accurately localised using sophisticated computer programs capable of differentiating the smallest moles within multiple compact moles in a small area. Taking a macro and Dermoscopic image ( microscopic view) is the next step.
This method enables recognizing any new moles evolving on the patient's body. Moreover it enables to identify any changes in pre-existing moles. This is the best method to diagnose malignant changes toward melanoma in earliest stage - stage I - which treatment has an excellent prognosis.
For melanoma to be distinguishable by a skilled operator using Dermoscoy they should generally be in higher stages - at least stage II. This impacts directly the final prognosis. This would be worse if melanoma reaches the stages which are recognizable clinically with naked eyes- generally III-IV.
Who needs mole mapping?
Mole mapping is a time consuming and technology dependent procedure that incurs more costs. It is currently recommended for those who have high risk of developing melanoma like:
  1) Those with many moles, in particular above 50-100 moles on the body
  2) People with atypical moles
  3) Previous melanoma or multiple non-melanoma skin cancers
  4) Melanoma in one or more first degree family members
  5) Moles on the back which are difficult to keep an eye on
  6) Moles on those with very fair skin ( skin type I)
  7) Those with concerning freckles especially large ones e.g. 2cm