Managing Your Moles
Getting under the skin of beauty spots and unsightly blemishes.
Naevi is the medical term for the cosmetic curiosities commonly referred to as moles. Pigment-producing cells known as melanocytes clump together and form growths that, on some people, become a defining characteristic (think mid-1990s Mr Enrique Iglesias or the late great Lemmy from Motörhead) and, on others, an unfortunate distraction.
Almost every adult will have a mole somewhere. They can be congenital, but most appear during childhood and as we age. “Sun damage from childhood sets the pathway in motion for the cells of the skin to become disordered in later years,” says aesthetic doctor Dr David Jack. “And so it becomes more likely for pigment cells to develop into moles as we age.”
While most moles are harmless, their sudden sun-induced appearance (or, indeed, mutation) at the end of summer can trigger a moment of internal hysteria. After all, one person’s healthy tan is another person’s malignant melanoma. It is worth noting that, while the odds are stacked in your favour, there are roughly 15,000 new cases of melanoma each year in the UK (quintuple the amount in the 1970s) and the American Cancer Society estimates there will be 87,110 new cases in the US by the end of 2017.
The good news is that survival rates for melanoma are reassuringly high, provided you catch it in its early stages. But how do you spot the warning signs? When is it appropriate to consult a doctor? And what do you do if that harmless growth is simply a cosmetic nuisance that detracts from your expertly crafted look?
There are a number of variables that predispose a person to skin cancer, including fair skin that burns easily and a history of sunburn. In a disconcerting study published in the British Journal Of Dermatology, researchers found that an individual’s risk for melanoma doubles if they have been sunburnt more than five times, a statistic that, for all intents and purposes, includes anyone who has ever been on a beach holiday.
You’re also at risk if you’ve been unlucky enough to inherit a faulty gene. “CDKN2A is one of two genes [the other being CDK4] that have a link to malignant melanoma,” says Dr Jack. “If someone has two or more first-degree relatives with melanoma, then it [CDKN2A] would be worth testing for.”
Of all the variables, it is the number of existing moles on your body that is the greatest determinant of whether or not you’re at risk. The more naevi there are, the more cautious you need to be.
The Skin Cancer Foundation suggests that those with more than 100 moles are seven times more likely to develop skin cancer. But before you – or a doctor with whom you are exceptionally comfortable – start exploring every nook and cranny for microscopic lesions, know that there is a quicker (and numerically less taxing) way of determining the total count.
A study published in the British Journal Of Dermatology revealed the number of moles on a person’s right arm was predictive of the total number of lesions on their body. Researchers found those with 11 or more moles on their right arm were more likely to have more than 100 moles elsewhere on their body.
Benign moles can turn cancerous, so it’s important to keep checking your collection of naevi and monitor any change in their shape or size. The ABCDE guide is a simple self-assessment tool that will reveal whether or not your mole requires medical attention. If any of the following diagnostics rings true, then it’s worth making a visit to your doctor.
A stands for asymmetry: your mole has an irregular shape or is not the same on both sides.
B is for border: the edges of your mole are jagged or blurred.
C is for colour: there has been a change in hue or different colours are present.
D is for diameter: there has been an increase in size (especially if the mole measures more than 6mm across).
E is for elevation: this is when the mole is raised from the surface of the skin in an irregular or uneven way.
As with any kind of medical misfortune, early diagnosis is conducive to successful treatment. It is highly important, therefore, to do your ABC(DE)s regularly or, better yet, get yourself checked by a medical professional once a year.
For benign naevi, the most suitable method of removal hinges on several variables such as the mole’s exact location, the type of lesion and whether or not there is a risk of scarring. The decision whether to lob the top off with a scalpel (known as a shave excision) or blast it with a laser requires an in-depth conversation with a specialist.
The word excision may sound overly dramatic for such a quick and, theoretically, simple procedure. And yet the precision required for successful removal is paramount, according to Mr Apul Parikh, resident mole expert at the PHI Clinic in London. “The incisions must be very accurately placed to ensure the scars heal as well as possible,” he says. This becomes doubly important on an area as cosmetically sensitive as the face, where a scar can end up looking far worse than a mole.
If scalpels aren’t your thing, Intense Pulsed Light or ablative heat-based techniques such as CO2 laser treatment may be a viable alternative. “The CO2 laser can be used for benign raised moles, while IPL is best suited to benign smooth moles,” says Mr Parikh. With IPL, the light seeks out the pigment that constitutes the mole and destroys it, thus rendering the lesion invisible. The pigment is then flushed away by the body’s natural healing mechanisms, a scab forms and, by the time it falls off, the mole is but a distant memory. With CO2 lasers, the beam chips away at the raised surface until it becomes flat.
As futuristic and high tech as these alternatives might first appear, there is a critical catch to using them. “Both of these non-invasive treatments need several cycles to remove the lesions, and there is a chance of recurrence,” says Mr Parikh. Furthermore, there’s a risk of hypo- or hyperpigmentation to the skin as well as a build-up of scar tissue. So, while shave excisions might seem a little old school, they’re still the best option for moles on the face because the procedure is far less traumatic to skin tissue.
However, neither method is suitable if the mole looks suspicious. “Surgical removal of moles is usually performed if there is any hint of pre-malignancy or malignancy itself,” says Mr Parikh. In surgical excisions, the entire-depth mole, plus some surrounding skin, is excavated with a scalpel and the wound is then stitched up. “The suturing technique, length of scar and type of suture all play a significant role in the final wound,” he says. Provided the handiwork is top notch, and aftercare instructions are followed to the letter, there should be little chance of scarring or, indeed, recurrence.
Protection and prevention
If you’ve read our guide on how to tan like a pro, you’ll understand why a broad-spectrum sunscreen is a staple in any skincare arsenal. But the necessity for sun protection becomes doubly important when you consider that it is UV radiation that damages the DNA in melanocytes (pigment-producing cells), causing them to grow out of control and manifest as moles. The US Environmental Protection Agency estimates that sun damage causes 90 per cent of all non-melanoma skin cancers. In other words, slather yourself in a sunblock every time you go outdoors.
Sunglasses are just as essential, and not because of the fashion points a pair of tortoiseshell D-frames will win you. Melanomas can, somewhat creepily, occur at the back of the eyes as well as on the skin, so it’s of the utmost importance to protect your eyes from UV exposure as well.
All these measures, while helpful, are by no means bulletproof. Your after-sun routine is equally important in offsetting any cellular damage that your skin may have suffered. A good-quality vitamin E cream, such as Malin+Goetz Vitamin E Face Moisturizer, will help reduce inflammation and assist cells in recovering from the onslaught of UV exposure. “Once inflammation has settled down, vitamin E combined with vitamin C (L-ascorbic acid) will have a synergistic effect,” says Dr Jack. “Both are potent antioxidants so they’ll help limit and reverse damage.”
Illustrations by Mr Andrea Mongia