As radio presenter Chris Evans announces he has been diagnosed with skin cancer, our writer Ingeborg van Lotringen shares what happened to her when an odd-looking new mole turned out to be dodgy and why regular mole checks are vital
This week presenter Chris Evans announced live on his radio show that he had been diagnosed with skin cancer. Thankfully his malignant melanoma had been caught early and he is due to start treatment in a few weeks' time, but it's a timely reminder for everyone to check their moles regularly.
Mole checks feel like yet another thing on a never-ending list of health checks to book in for but they're worth it, as I found a couple of years ago during a post-holiday mole check. I returned from Ibiza with a small pinkish spot on my arm that had appeared out of nowhere and seemed to be growing, peeling and itching,
I took myself for a mole check with skin cancer specialist Dr. Marko Lens. “You’ll be here every year,” he declared. My mole was a basal cell carcinoma – a very slow-growing skin cancer that can turn dangerous if left untreated. With my pale skin type and sunbathing history, I would always have to keep looking out for similar patches, he cautioned, as he excised the offender. With age, and even if I were to keep out of the sun entirely, they were bound to pop up more often.
Cases of melanoma (the deadliest form of skin cancer) remain on the up. “Sixteen thousand cases are diagnosed every year in the UK, making this the fifth most common cancer in the UK,” says Laura Harker, lead nurse at The Mole Clinic.
Melanoma is a type of cancer where early diagnosis makes all the difference to your chances of beating it, and because it initially develops right on top of your skin (or your scalp) it’s also the one cancer that gives you a fair chance of spotting something untoward yourself.
I had a slower-growing skin cancer called basal cell carcinoma (squamous cell carcinoma is another). These carcinomas are far more common than melanoma and will also be picked up by a mole check. All three are mainly related to exposure to UV light from the sun and from tanning beds, through cumulative exposure as much as through burning.
As a child of the 70s and 80s, I’ve had my fair share of rays. Back then, skin cancer awareness was non-existent; sun protection was for wimps. Even if you did use ‘sun tan lotion’ as we called it then, SPF4 was considered high. Summer holidays were one long tanning competition with no regard for whether your natural skin tone was lily white or mocha brown. As the years went by and education (and SPF factors) increased, I learned to slather my pale limbs in the best high-factor body sunscreen I could find and stay under a parasol. But the moles and brown spots still kept coming: a sure sign of sun exposure indiscretions in the distant or recent past slowly coming to the surface.
MORE GLOSS: Best skincare for pigmentation
Although they may be unsightly and ‘ageing’, the good news is that brown spots on the whole are harmless. However, because they are all the result of sun-induced damage to our DNA, they can be, or turn, nasty.
As Dr. Lens predicted, in subsequent years I had another basal cell carcinoma removed from the bridge of my nose, alongside two brown scaly lesions called actinic keratoses, which are mostly innocuous but can turn out to be pre-cancerous, as mine did.
It’s made me hyper-aware of how important mole checks are - and not just for me as a white-skinned person. Dark skin does offer more natural protection against skin cancer, but because of this reassuring thought, dangerous moles too often go unrecognised and are spotted too late, which is why black people have a higher risk of dying from melanoma.
Astonishingly, 11% of Brits don’t ever protect their skin in the sun at all while over a third don't put on SPF while out and about in the UK in summer (are we back in the ‘80s?!), according to recent research by Dermalogica. Meanwhile, all-year-round SPF is still an anathema to most of us, no matter how much we bang on about its importance.
So from very pale to very dark, we’re should all be vigilant. Here’s how to check for a bad mole what to look out for and what to expect to pay. But first a caveat…
If you think you have a bad mole, don’t get it removed without a doctor
Whichever one of the available mole checks you choose, your mole must be checked by a dermatologist or plastic surgeon who knows what (s)he’s removing, not a cosmetic doctor and certainly not an aesthetician, even if you want yours gone just for aesthetic reasons. This can be done with laser, as you’ll see advertised by many cosmetic clinics, but only if the mole is 100 per cent benign is this safe to do so. Only dermatologists can determine this properly.
I once had a scaly lesion on my face treated with laser in order to get rid of it, but instead it started growing and going red. It turned out that the laser had activated what was a pre-cancerous actinic keratosis and turned it into a cancerous basal cell carcinoma. Let that be your warning!
How to do a mole check at home
How do you know if your mole or brown spot is worrying? There are some initial checks you can do at home, says Harker.
- Look for the ‘ugly duckling’
Everyone’s skin and mole pattern is individual. As a nurse, Harker looks for the ugly duckling, one that looks different to all the others. “What you want to see in the moles all over your body as a whole is uniformity,” says Harker. You want them to be roughly of the same pattern and colour – and any that stand out as quite different warrant a closer look.”
- Keep an eye on brand-new moles
These should also attract your eagle eye, particularly if they appear from aged 45 onwards.
“Moles, both raised and flat, are perfectly natural – some babies are born with them and some can grow slowly over time,” says Harker. “New ones will appear throughout life, but we advise that you pay particular attention to ones that appear after the age of 45 and ideally have them professionally checked out.”
This is, says consultant dermatologist Dr Derrick Phillips “not because new benign moles don’t appear after this age – they do. But most instances of melanoma are found after age 45 [this is because of cumulative sun exposure – 85 per cent of melanomas are caused by UV rays]. And because they’re often perceived as ‘just another mole’, it’s good to be on the safe side.”
That said, if the mole doesn’t look ‘out of line’ compared to your other ones and doesn’t display any of the ‘alphabet’ warning signs outlined below, there’s no need to be alarmed.
- Asymmetry - The mole’s sides are not identical or have different shapes
- Border - The outside edges of the mole or area may be blurred, show notches or look ‘ragged’
- Colour - The colour is patchy or irregular and new colours are developing; there may be various shades of black, brown, pink or purple. Any itching, stinging or weeping is a red flag, too.
- Diameter - Your mole or mark grows larger, fast – meaning over a period of weeks or months
- Expert – if any mole or pigmented blotch, old or new, does look different, it’s time to visit to your GP or dermatologist
How often should I do an at-home mole check?
Harker advises to do a quick check every three months, and if you feel any moles may be changing, to take a close-up picture of them against a ruler or piece of tape. “Only that way you can determine for sure if there’s any change in size the next time you check,” she says.
What are the best mole checks to book in for?
Here are the options below in order of price
- Mole check on the NHS via your GP (free)
- High Street Mole Scanning at Boots (from £35)
- Mole checks at clinics such as The Mole Clinic, from £50 for a single mole to £145 for full body check and £295 for mole mapping, where the whole body is photographed to track moles over time.
- Private dermatologist, from £200 depending on who you see and where you live
- The superfast Vectra WB360 whole body 3D imaging system, from £495.
Apart from the free NHS service there are various add-on charges if any moles need investigating, which we’ll explain below.
How to get a mole check from your GP on the NHS
If you have a worrying mole, your GP will generally check just the one that’s worrying you rather than doing a full body check.
“GPs are trained to detect to spot suspicious lesions on the body, and skin cancer is given priority on the NHS,” says Dr Phillips. “If you ask your GP to look at a mole that worries you and she or he suspects melanoma, the form of skin cancer that can quickly turn deadly, the aim is to get you referred to a dermatologist within two weeks. On the whole, this target is still being hit,” he says.
But he admits that the pressures on the NHS can cause some delays in getting your results (tissue is sent to a lab for analysis, and can get stuck in a backlog) and treatment. Usually, though, the NHS acts fast and reliably if your mole is a cause for real worry.
If a lesion is thought to be possibly a slower-moving form of skin cancer (basal cell carcinoma or squamous cell carcinoma, which should be removed before they become dangerous over time), referral times may take longer. Also, elaborate all-over body checks on the NHS such as mole mapping are generally reserved for those patients deemed high risk.
You can also have a mole checked by an NHS dermatologist online – this involves sending digital pictures for assessment after registering with nhsgp.net.
If you need faster peace of mind or want a professional to track your moles, you should opt for private treatment.
How to get a Boots mole check
An accessible alternative to your GP is Boots’ Mole Scanning Service. You can book an appointment online at selected Boots branches, for a 20-minute in-person consultation with a Boots pharmacy team member for up to four moles of concern. It costs £35 for the first one, and £15 per mole for any additional ones during that same appointment. Your mole is examined and photographed using a dermatoscope, which takes a detailed picture beneath the surface of the mole to show features invisible to the naked eye, and allows for diagnosis of the very earliest skin cancers.
The images are sent off to specialists for signs of malignant melanoma. A report will be sent to you in one week, and if there is a problem, a ScreenCancer dermatology nurse will contact you discuss further steps. You’ll likely be advised to see you GP for referral to an NHS or private dermatologist for removal. You need to be 18; some areas can’t be checked, including tattoos and intimate areas.
Mole checks and mole mapping at a mole clinic
Mole clinics are one good way of getting your moles tracked professionally, and getting quick treatment if you need it. At The Mole Clinic, (which is one national chain) you can either get individual moles checked, have a 45-minute full-body skin check, or book in for a one-hour full-body ‘mole mapping’, where pictures are taken of your moles so they can be tracked for changes by means of regular (e.g. yearly) appointments.
- Individual mole check: “Your individual or full-body mole check will be done by a screening nurse such as myself,” says Harker. “For an individual mole report, I’ll use a ‘dermoscopic’ lens (see above) to take a detailed image. This, alongside other images to show the location and context of the mole, gets sent off for evaluation by a ‘skin doctor’ who’ll issue a mole diagnostic report, with advice, within three days.
- Full body scan and mole mapping: In a full body scan, I’ll assess which moles, if any, are of possible concern, and will send pictures of all of these to the doctor,” says Harker. With mole mapping, I’ll do the same but will also take pictures of the entire body which can be compared against previous or future images to detect changes.” Again, a report will be issued within three days.
In all cases, the doctor comes back with one of three recommendations. “Either, no further action is required, or they will advise another dermoscopy check in three months to be sure an a-typical mole is not problematic, or they will advise possible removal,” says Harker.
For removal, your will be referred to a private consultant dermatologist within a few days. They will clinically assess the mole (a ‘biopsy consultation’) and tell you whether it has to indeed be removed. This can be in the form of a ‘shave biopsy’ or ‘excision biopsy’ which can then happen immediately.
Alternatively, you can choose to take this referral to your GP and get them to refer you to an NHS dermatologist, but you would have to wait at least two weeks to be seen.
Is a mole clinic expensive?
The obvious pros of the Mole Clinic are that there’s no waiting around, and that a diagnostic report for a single mole is reasonably priced at £50. The thing to keep in mind, though, is that the pricing adds up as you move further through the process. A full-body mole check is £175 and Mole Mapping £295, with, in these cases, diagnostic reports for each ‘suspicious’ mole charged at £30. If you are referred for possible removal, the consultation to assess if this is indeed necessary is £195, and the actual biopsy, including a histopathology report (a lab report telling you if the mole was cancerous and whether further treatment may be required) is £495 for shaving and £675 for excision, with additional moles removed for £145 if during the same appointment. So the price for removal of a single mole starts at £740, or £895 if it was identified via a full-body mole check.
What does a mole check by a private dermatologist cost?
Another option is to see a private dermatologist to have your suspicious mole(s) checked out; to find one in your area, check nhs.uk or doctify.com. They will do your consultation (with full sun exposure and family history check), mole assessment and, if necessary, removal, for you; this may take two appointments. There are often three or four separate fees (consultation, biopsy/removal, histology, and facility fee) that may be charged here, so make sure you get an upfront picture of the total cost. Expect to pay no less than £1000 from consultation to removal. Recently the facility or clinic fees in particular, which cover the use of a medical facility and nurse support, have shot through the roof. It's why dermatologists like Dr Mary Sommerlad hesitate to take on patients without private health insurance: "many people are not prepared for the cost picture," she says.
To give you two central London examples (prices outside of the capital and the South-East will be lower) Sommerlad charges £250 for the consultation which includes a full-body mole check, and £700 to excise a suspect mole that is not obviously melanoma, including histology. Dermatology professor Firas Al-Niaimi will charge £375 for a single mole check and £500 for its excision. His clinic fees for this include histology and nurse support and start at £600.
If a consultant spots an obvious melanoma, prices will go up as the excision becomes more complicated and requires further investigation as to whether the cancer has spread.
What is the latest mole mapping procedure?
The Vectra WB360 whole body 3D imaging system is brand new and captures your entire skin surface in super high-res 3D in about five seconds. It’s just like standing in an airport security scanner (only with just your pants on) and much faster than having lots of individual pictures taken. One Welbeck, a health clinic and private outpatient hospital in central London, is the first place in the UK to offer it.
After a short wait, you meet directly with a consultant dermatologist who goes through your history and zooms in on every mole and pigmented lesion. I had 89, but some people have 8000 (?!) while others might have 10. Any moles worth a detailed look are captured with a dermoscope, analysed and discussed with you. A week later, you get a report confirming the derm’s findings and recommendations.
My derm singled out seven lesions for dermoscopy. They were fine apart from one he advised I have rechecked in three months, just to be sure. The big advantage here is that it’s a dermatologist, not a nurse, who decides which moles require dermoscopy. The same consultant will perform any biopsies at the earliest opportunity, if required.
You’re sent home with a memory stick containing your dermoscopic images as well as your futuristic full-body scan image and the software to view the scan image; very helpful for keeping an eye on changes yourself (unfortunately, the software requires a very high-resolution computer screen, which neither my MacBook Air nor my husband’s MacBook Pro appear to measure up to).
One Welbeck Mole Mapping costs £495, follow-up assessments £220 to £320. Individual mole checks without the mole mapping service are between £250 and £350. Mole removal starts at £500 for the procedure plus from £750 for the facility fee plus histology. So you could be looking upwards of £1750 with mole mapping, and £1500 without.
Is it worth paying for a mole check?
Luckily we have the NHS and if you have private health insurance, you will generally be covered for private mole checks and treatment. But if you do discover a worrying mole and the only way to have it removed, fast, is to stump up the money, don’t hesitate if you can. “It’s always surprising to me how people are happy to pay very large sums of money for cosmetic treatment, but not for checking and removing moles that could be very dangerous,” says Professor Al-Niaimi. “Not everyone takes skin cancer very seriously in the UK, I fear.”
Certainly, £1000 or more is a bum-clenching amount of money at any time, and definitely right now. But for a procedure that could save your life, it may not seem quite so extortionate.