Changes in moles and skin cancer: an interview with Dr Anjali Mahto, Consultant Dermatologist & British Skin Foundation Spokesperson

Dr. Anjali MahtoTHOUGHT LEADERS SERIES...insight from the world’s leading experts

How frequently should people check their skin for changes and how thorough should they be?

Most dermatologists recommend skin self-exam on a monthly basis.  The purpose of this is to detect unusual growths or changes early.  The ideal time is probably after a bath or shower and should be carried out in a well-lit room with the aid of a full length mirror.

It is important to look closely at the entire body including the scalp, buttocks and genitalia, palms and soles including the spaces between the fingers and toes.  It may be helpful to seek assistance from a trusted individual to examine the hard-to-see areas.

What types of change should people be particularly aware of with regards to moles?

The acronym ABCDE can be extremely helpful in evaluating moles.  If a mole shows any of these features, it warrants review by a dermatologist to exclude melanoma, the most serious type of skin cancer.

  • Asymmetry: one half of the mole is different to the other
  • Border: irregular, scalloped or poorly defined edge
  • Colour: uneven colour or variable colours within a mole
  • Diameter: the mole is bigger than 6mm in size
  • Evolving: the mole is changing in its size, shape or colour

Other signs to look out for include any new moles, a mole that looks significantly different to the others (known as the ugly duckling sign), or any skin lesion that bleeds or fails to heal.

Are these changes in moles always a sign of skin cancer?

No, changing moles do not always equate to skin cancer and most moles are usually harmless.  It can be normal for moles to change in number and appearance; some can also disappear over time.  

For example, hormonal changes during puberty and pregnancy can cause moles to increase in number and become darker.  This is why seeing a skin specialist is vital.

A dermatologist will be able to assess individual risk factors and review the mole with an instrument known as a dermatoscope to aid diagnosis.

What should someone do if they notice a change to a mole or patch of skin?

The most important thing is to seek medical advice early.  Any concerns should prompt a visit to a dermatologist who will perform a full skin examination and may go on to either excise a mole or take a sample or biopsy of any unusual growths or patches on the skin.

How important is early detection in the treatment of skin cancer?

There is no doubt that finding skin cancer early saves lives.  Skin cancers detected and removed early are almost always curable.  If caught late, there is a higher chance of potential spread, particularly with melanoma.  This is why performing skin self-exam is key in improving survival rates.

It has been reported that the rates of malignant melanoma are rising faster than any other type of common cancer. What do you think are the main reasons for this?  

Melanoma is the 5th most common cancer in the UK and its incidence is continuing to increase since the mid-1970s.  Cancer Research UK reports that its rates have increased more rapidly than any of the current ten most common cancers in males and females.

Whilst some of this may be attributed to better surveillance and earlier detection, the real problem lies with sun-seeking behaviour and exposure to ultraviolet (UV) radiation.

There has been an increase over time in sunny holidays abroad and a failure to protect the skin, in addition to the use of tanning beds.  These factors have resulted in the rising rates of melanoma.

There are several mobile apps that claim to be able to detect malignant melanoma. What are your thoughts on these?

My feeling is that these apps need to be treated with caution.  Many have not been validated by rigorous scientific studies showing their benefit and current data suggests performance is highly variable.

It would be a disaster if an individual was falsely reassured regarding a mole and therefore chose not to receive specialist advice, when in fact, the lesion was skin cancer.

That said, the mobile applications can have a role as an adjunctive tool where photographs can be used to monitor changes over a period of time.  There is no substitute, however, for a full skin examination by an experienced dermatologist.

What do you think the future holds for the detection of skin cancer?

There needs to be a big drive to educate people on reducing the risk of skin cancer with appropriate measures, skin examination by a professional, and self-examination by the individual.

Skin is the largest organ of the body and any changes are overtly visible.  We just need to make sure people understand the risks of sunburn and also remain vigilant for any changes within their skin.

Where can readers find more information?

There are some excellent online resources available on how to perform a self-exam on the American Academy of Dermatology and The Skin Cancer Foundation websites.  General information on skin cancers can be found on the British Association of Dermatology and British Skin Foundation websites.

About Dr Anjali Mahto

Dr Anjali Mahto is a UK-trained Consultant Dermatologist. Her medical training took place in South Wales, where she also intercalated in Clinical Pharmacology. She completed higher specialist training in dermatology in a competitive London rotation. During this time, she gained experience in some of the UK’s leading teaching hospitals including Imperial College Healthcare and the Royal Free Hospital, Hampstead.

Dr Mahto has been actively involved in medical education and training.  She has presented extensively at both national and international conferences. She was awarded a British Society of Paediatric Dermatology (BSPD) case prize during her training and has published original reports in scientific literature.

Dr Mahto works as a consultant dermatologist in North West London Hospitals NHS Trust where she is also the lead for paediatric dermatology services. She is happy to consult both adults and children with skin, hair and nail disorders and she is qualified to manage all skin conditions in adults and children.

April Cashin-Garbutt

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April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.

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