Your concern
Moles that change
What to look for in a mole, what looking is not enough for, and when to have it checked.
Most moles stay the same for a lifetime, and most of those that change do so for entirely ordinary reasons. But change is the only signal the skin gives in advance, and that is why it deserves attention: not because every mole that changes is a problem, but because it is the information that arrives before all the others.
The best known rule is ABCDE: Asymmetry between the two halves, irregular or blurred Borders, uneven Colour, increasing Diameter, Evolution over time. Of the five, the letter that matters most is the last. A mole unchanged for twenty years says something; the same mole altering within a few months says something else.
The limits of this rule must be known too, because this is where self-surveillance at home can let you down. Some lesions escape ABCDE: they are symmetrical, uniform in colour, even small — passed by every letter — but they are raised, firm to the touch and grow quickly. A lesion that protrudes, feels hard and grows over a matter of weeks should be examined even if it passes ABCDE. That «even if» is the whole reason for this page.
The second useful criterion is the ugly duckling sign: one person's moles tend to resemble one another, like members of a family. The one that stands out — different in shape, colour or size from all the others — deserves a look, regardless of how it behaves against the five letters.
Our role here is one, and it is stated plainly: to look early, with the right instrument. A visit with dermatoscopic examination allows structures to be seen beneath the surface that do not exist to the naked eye, and lesions that look alike from outside to be told apart. If a picture requires a path beyond dermatological assessment, we say so and indicate where to continue: that is not an evasive answer, it is the difference between a centre that knows what it does and one that promises everything.
ABCDE does not see everything: if it is raised, firm and growing, it gets checked anyway
It is the least known and most useful piece of information. The five letters work well on flat lesions that spread, and were devised for them. They do not intercept as well the forms that grow in height: these can be symmetrical, of a single colour and only a few millimetres across, so they appear «regular» at every check at home, while changing within weeks. If a lesion protrudes, feels hard under the finger and grows quickly, passing ABCDE is not reassuring: this is the case in which that rule is not the right instrument.
How it shows
- A mole changing in shape, colour or size over a matter of months
- Borders becoming irregular or fading into the surrounding skin
- Several colours within the same lesion, or an area that has darkened
- A raised lesion, firm to the touch, growing rapidly — even if regular and uniform in colour
- A mole different from all the others on the same person
- Persistent itching, spontaneous bleeding, or a small scab that does not heal
How we proceed
- 1Dermatological visit with dermatoscopic examination of the lesion of concern
- 2Assessment of the whole skin surface, not only the mole reported
- 3Comparison with the person's other moles: the ugly duckling criterion
- 4Mapping and scheduled follow-up for those with many moles or risk factors
- 5If the picture requires it, explicit indication of the path to follow and where
Available treatments
- Dermatology visit
- Dermatoscopic diagnosis
- Mole mapping
- Mole check
- Scheduled follow-up
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Frequently asked questions
How often should I have my moles checked?+
There is no single interval valid for everyone, and this is one of the things decided at the visit. Number of moles, skin type, sunburns in childhood, family history and current therapies all weigh in: two people can leave the same visit with very different schedules, both correct. What holds for anyone is that a change does not wait for the appointment in the diary: it gets looked at when it happens.
Is a mole that itches or has bled a cause for concern?+
These are signs that deserve to be looked at, not interpreted at home. A mole can itch from friction with clothing and can bleed because it was knocked or rubbed: these are frequent, entirely ordinary explanations. They become different information when it recurs without an obvious reason, or is accompanied by a change in appearance. The difference is seen at a visit, not in the mirror.
I have a great many moles: is that in itself a problem?+
Having many moles is not a diagnosis and not a sentence: it is an element in the risk assessment, and it changes above all the frequency of surveillance, not its outcome. In practice it means that comparison over time becomes the main instrument — it is harder to remember the appearance of a hundred lesions — and that mapping serves exactly this purpose: to have an objective reference to compare at the next check.
If a mole needs removing, do you remove it?+
Removing a skin lesion is an outpatient procedure we carry out at both locations, and whatever is removed always goes for histological examination: it is histology that gives the answer, not appearance. If instead the assessment indicates an oncological pathway, that is not our field: we say so clearly and indicate where to continue. We would rather be precise about where our role ends than keep a patient where it does not serve them.
What is the difference between looking at a mole with the naked eye and dermatoscopy?+
Dermatoscopy illuminates and magnifies the lesion so as to make visible the structures below the most superficial layer: networks, vessels, pigment distribution. These are elements that simply do not exist to the naked eye, and they are often the ones that distinguish lesions which look alike from outside — a mole and a seborrhoeic keratosis, for example. It is why a check made with the instrument and one made by looking are not the same thing.
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