Otherwise known as nevi, moles are common, typically harmless skin growths that develop during childhood or adolescence due to the overgrowth of melanocytes (pigment-producing cells)

The majority of moles that a person has typically appears during their first 25 years, and it’s perfectly normal to have anywhere between 10-40 moles upon reaching adulthood.

However, as we get older, we might notice some of our moles changing in appearance, while others may not change at all or slowly fade away over time.

You can even develop new moles as a result of melanocytes in your skin proliferating, causing the characteristics that give moles its distinctive colour and shape.

The majority of moles on our body are known as common moles, which possess a round, symmetrical appearance with a smooth surface and defined borders. They are relatively small in diameter (less than 5mm) and are usually harmless.

Problems start to arise; however, when certain types of moles signify a serious health issue such as melanoma—an aggressive form of skin cancer that can be fatal.

What is the link between moles and skin cancer?

Although it isn’t sure why we develop benign moles, cancerous moles that are seen in skin cancer usually develop as a result of genetic mutations.

Some possible causes as to why we develop new moles include genetics, exposure to the sun, having fair skin that is susceptible to sunburns and having a weak immune system. You may even notice new moles or existing moles darkening or changing in appearance as your hormone levels fluctuate such as during puberty or pregnancy.

However, certain moles are associated with skin cancer—otherwise known as an atypical mole or dysplastic nevi, these moles tend to develop anywhere on the body and usually appear larger than common moles with a different colour, texture and uneven borders.

The three most common types of skin cancer are:

Basal Cell Carcinoma (BCC): usually develops as a small and raised white or flesh-coloured bump, reddish patches or sores that grows slowly and may bleed.

Squamous Cell Carcinoma (SCC): typically identified by a red, firm and raised, bump or lesion that feels rough and scaly and bleeds easily.

Melanoma: normally appears as a light brown or black, irregularly-shaped blemish that can appear anywhere on the body. This is the most dangerous type of skin cancer that has a high risk of metastasizing.

85% of skin cancer cases are diagnosed as BCC, with SCC being the second most common type and melanoma being the rarest. However, despite making up only 1% of cases, melanoma accounts for the majority of skin cancer deaths.

Pertinent to the successful treatment of any type of skin cancer is being aware of the changes in your moles and seeking a professional evaluation as soon as you notice any red flags. And since they can be tricky to spot especially to the untrained eye, it is important that you know what to watch out for.

What are the warning signs of skin cancer?

Unfortunately, certain people have a higher risk of having moles that develop into skin cancer. This includes people with more than 50 common moles, have a family history of atypical moles or skin cancer, or those who have been excessively exposed to ultraviolet rays from the sun or radiation therapy.

Remember: the key to spotting cancerous moles is when it changes.

This is often referred to by doctors as the “ugly duckling” mole—a mole that is distinctly different in appearance or texture from the rest of your moles. You might also notice a consistent itch, bleeding or discomfort that is caused by the mole. For example, SCC moles tend to be tender to touch and bleed easily with relatively little trauma or zero explanation.

The simplest and most common way to identify a suspicious mole at home is to use the ABCDE method, which is highly recommended by doctors worldwide for people to assess their moles at home to spot potential melanomas:

A: Asymmetry–half of the mole does not match the other half.

B: Border–the mole has uneven, irregular, blurred or jagged edges.

C: Colour–the mole contains a mixture of different colours (multiple shades of black or brown with areas of red, pink, white or blue is cause for concern)

D: Diameter–the mole is bigger than 6mm (bigger than a pencil eraser) in diameter.

E: Evolving–the shape, size or colour of the mole is changing.

It might be worthwhile to add an additional E and F:

E: External surface–is the mole raised, lumpy, firm, swollen, rough to the touch, scaly, ulcerated or bleeding?

F: Feel–is the mole itchy, tingly or tender?

It is recommended that you conduct self-examinations every 6 months, or even 3 months if you fall under a high-risk category.

A 2017 review found that 70.9% of melanoma cases arose from a new mole, and moles that develop over the age of 40 are more likely to develop into skin cancer than those that you had as a child.

However, it is important to note that not all melanomas fit the ABCDE rule or are new moles—if you notice anything amiss, do not hesitate to visit a doctor as soon as possible.

How is skin cancer diagnosed?

The problem with moles is that you can never fully determine whether or not it is benign or cancerous, or at least, not by yourself.

Both doctors and dermatologists are well-trained to use tools such as a dermatoscope to identify changes in moles over time.

At our clinic, we use a dermatoscope to help identify the patterns of a mole and determine the risks of skin cancer. We first conduct a full physical skin examination and decide if a biopsy is necessary.

Conducting a biopsy is the only way to accurately diagnose melanoma or skin cancer—it involves shaving or cutting out the entire mole so that it can be further evaluated for cancer under the microscope. It is a relatively painless and straightforward procedure that can be done in as little as 15 minutes.

Should your biopsy results point towards a benign mole, no further action is required. If it’s malignant, your doctor will then advise you on mole removal options and recommend an appropriate treatment plan for you.

What mole removal options are there?

There are several ways to remove your moles such as dermabrasion, chemical peels or laser therapy. However, the best way to effectively remove cancerous cells is still surgery.

The goal of surgery is to remove the cancerous cells while leaving as much nearby skin intact and minimizing scarring.

We offer two key surgical mole removal methods:

• Shave excision: the procedure is done by removing the top part of the mole by carefully shaving it down with a scalpel. It doesn’t require any sutures and is a great option for moles that are raised and stick out. A scab or tiny pink mark is left which takes about 1-2 weeks to fully heal.

• Surgical excision: after applying local anaesthesia, the doctor proceeds to cut out the entire mole and below the subcutaneous fat layer where deeper moles are found. A margin of normal skin around the edge of the mole is removed as well. It is slightly more invasive than a shave excision and stitches are required to close up the wound. The stitches are then removed after about 10-14 days (or less for facial moles)

The best treatment option for you depends on the location, depth and characteristics of your mole. Surgical excision is best utilized for malignant moles that have grown beneath the epidermis and is ideal for diagnosing aggressive and late-stage skin cancer cases.

The biggest concern that patients have is that both these procedures leave some form of scarring. The recurrence rates of both treatments also differ—shave excision tends to have a higher recurrence rate since it only removes the protruding surface of the mole, thus allowing mole cells beneath to grow back.

If you wish to remove your moles for cosmetic reasons, laser therapy might be a better option for you, although they can also be used to treat early-stage BCC cases.

Lasers such as the Vbeam Perfecta laser is well-known as an acne scar treatment that also treats vascular or pigmentation lesions. It essentially targets the haemoglobin in the blood to effectively destroy the pigmentation from the inside out.

At our clinic, we also utilize the Q-switch and fractional CO2 laser to vaporize a thin, precise layer on top of the mole that removes any unwanted bumps and pigmentation without harming the surrounding skin. We often utilize lasers for moles that do not require any further evaluation or for removing moles in hard-to-reach areas on the face, including the nose and throat.

It will require at least 1-3 sessions to see results, but laser therapy is by far the least invasive method that doesn’t require any downtime and also minimizes scarring!

However, laser treatments come with its limitations—it is not as effective in removing nodular, wart-like and raised growths as compared to excision removal.

Achieve your best and most healthy skin yet

Melanoma may be the deadliest form of skin cancer; however, early detection and treatment can significantly improve your long-term outcomes. In fact, experts estimate that patients with early-stage melanoma have a 5-year survival rate of 98% once treated, with the 10-year survival rate being 93%!

As you get older, other types of pigmentation and skin growths such as seborrheic keratosis, sunspots and skin tags can make it more confused to self-assess a malignant mole. According to a 2000 study, self-checks can also often miss changes in moles, making it even more important that you seek help from a professional and experienced doctor to advise you further.

Our doctors have years of experience dealing with all types of skin cancer cases, and we also boast a multi-disciplinary team that ensures you get access to the best treatment, care and attention. Together with the pathology labs at Singapore General Hospital, we can help you to detect, assess and diagnose skin cancer in its early stages so that you can start treatment as soon as possible.

It all starts with being a little more observant of the changes in your moles. Regardless of whether you want to get your mole removed for medical or cosmetic reasons, our doctors will help you to achieve your best and most healthy skin yet—contact us to book your consultation today!

FAQ

• Do cancerous moles only appear on parts of the skin that has been exposed to the sun?

This is a common misconception that is NOT TRUE! Skin cancer can develop anywhere on the body, including the buttocks, nails and even under the soles of your feet.

• Is it possible to get skin cancer twice?

Unfortunately, the answer is yes.

The best way to prevent skin cancer is to apply a broad-spectrum sunscreen of at least SPF 30+ that protects against both UVA and UVB rays, not forgetting to apply on commonly-missed sites such as the ears, back and neck.

When used correctly, this can help prevent up to 97.9% of rays—so make sure you are applying it liberally even on a cloudy day.

Patients who have had melanoma are more likely to be diagnosed with skin cancer again as compared to those who have never been diagnosed and treated for the condition. This is why it is important for those who have had skin cancer to be screened more regularly and protect their skin from the sun!

• Can I still get my mole removed for cosmetic reasons?

Absolutely!

We do see patients coming into our clinic for removing their moles due to cosmetic reasons or in the case where their moles are causing great discomfort due to friction or rubbing when wearing certain clothing.

We also help our patients resolve other pigmentation issues such as acne scar removal and offer one of the best acne spot treatment in Singapore—making us a one-stop aesthetic clinic for all your skin, eyes, body, hair and face needs!