By M.D., Ph.D Saroj Suvanasuthi, M.D. at Samitivej Sukhumvit Hospital
Do not take moles lightly; they might indicate melanoma and the sooner they are detected the better
Mr X found a new mole on his arm. He felt it was unsightly and came in to the hospital for a removal. Under magnification, we found that the mole was abnormal in shape. This is often a marker for cancerous moles. It was just 2 mm in size and we could cut it out quickly. A pathologist confirmed that it was malignant. If he had delayed seeking medical attention even a little, maybe by just 6 months, he would have needed additional investigation and treatment, including sampling his lymph nodes, chemotherapy, radiation, and, of course, plastic surgery to cover the surgical scar.
Among most people, moles change all through their life, from birth till death. They grow darker or lighter, they get bigger, and they disappear. Some moles simply mature over a lifetime, while others are attacked by the body’s immune system. A few others can mutate to become cancerous. It is not possible to pinpoint one specific reason for this change since many factors contribute to it. These include genetic predisposition, environment, hormones, exposure to sunlight, oxidative stress, metabolism, and pollution.
It is, therefore, important to keep track of your moles and find out which ones are new, which ones are growing, and which ones are a cause for concern. The best way to find out if any mole could be problematic is with a regular body scan. The good thing about this is that it is to be done at home. Make a monthly home scan part of your schedule. Use a mirror and study each part of your body. Keep track of the moles all over your body as much as is possible. Ask a friend or family member to help you check your back and even the back of your head. If you find any moles anywhere on your body, schedule an annual total body mapping and mole analysis at the hospital.
How does total body mapping work? During the body mapping at the hospital, we take 20 pictures of your entire body from head to toe. Each section is then checked for atypical moles with a dermoscope. This is recorded and crosschecked every year during the annual body mapping exercise. With this, we not only track new moles, but also existing ones that are changing in shape, size, or color. This is especially important if you have many moles, photoaging, or a history of melanoma. People with more than 100 moles have seven times higher risk of developing melanoma than people with fewer moles.
It is recommended that you follow the ABCDE rule of moles. In this rule, A stands for asymmetry. A symmetrical mole is usually safe; however, if your mole is asymmetrical, please see a doctor immediately. B is for border. If the border of the mole is clear, then you need not worry. A jagged or wavy border, however, spells trouble. C is for color. The color of your mole should be uniform. A mole with two or more colors needs a doctor’s attention. D is for diameter. Any mole larger than 6 mm in diameter needs to be checked by a skin specialist. E is for evolution. Any new mole or any changing mole is a sign of possible danger. If you have any moles that are flaking, oozing, itching, bleeding, or leaking, then rush to a doctor immediately.
As with all cancers, the earlier we detect a melanoma, the easier it is to treat it. The best time to detect a melanoma is when it is small and doesn’t go beyond the epidermis. With a high magnification Polarized camera, it is possible for doctors to see the structure of the mole under the first layer of the dermis.
Not all moles are melanomas and not all melanomas are moles. However, considering that melanoma is responsible for the greatest number of deaths related to skin cancer, we recommend that you stay safe with regular checkups.
Melanomas are a malignant version of the melanocyte cells. Melanocytes are found in the top-most layer of your skin, and they produce melanin which normally protects your skin from the sun’s harmful rays. Sometimes, however, these melanocytes mutate and that is when they become dangerous. While we cannot stop this process entirely, it is possible to ensure that such melanocytes do not become cancerous.
First of all, protect yourself from the sun. Cover your body with light clothes to protect your skin from direct sunlight. Use sunscreen with sun-protection factor (SPF) to shield your face and hands. Schedule and attend monthly checkups diligently so that you can diagnose the problem early. Ensure that you report for your annual mole mapping so that the doctor can catch any new developments. If the screening raises any red flags, opt for a biopsy. The pathologist will tell you if the cells are malignant.
Melanomas are classified in stages 0 to 4. A stage 0 melanoma is easy to treat and to remove. A melanoma is classified as stage 4 if it has spread to other parts of the body, usually through the lymph nodes. In this case, an oncologist will recommend a program of radiation therapy or chemotherapy. A melanoma is usually removed along with some healthy skin around it. If the doctor removes a large mole, he or she will often schedule plastic surgery to ensure that the removal will leave the most beautiful scar.
An old Asian saying claims that our moles decide our fortune. There may just be an element of truth in this superstition.
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M.D., Ph.D Saroj Suvanasuthi, M.D.
The First Class Honors M.D., Faculty of Medicine, Siriraj Hospital, Mahidol University, 2002 Mahidol University , 2002
Doctor of Philosophy in Medical Science (Gene Therapy), Osaka University, 2007. OSAKA University , 2007
Diploma in Clinical Science in Internal Medicine, Mahidol University, 2009.
Diploma of Thai Board of Dermatology, The Medical Council of Thailand, 2012.
Fellowship of Hair Disorder and Hair Transplantation, Siriraj Hospital, Mahidol University, 2013
Certificate of Dermoscopy, Skin cancer College, Sydney, Australia, May 2013.
American Board of Hair Restoration Surgery. , 2017