Image Source: Getty / Grady Reese
Anyone who knows me personally also knows that I wax lyrical (read: go on, and on) about the importance of daily SPF use and avoiding long stints in the sun. So, you can imagine my shock when I moved to the UK in 2018 and discovered the sunbed industry is not only alive and well, but thriving. See, I grew up in Australia, where we were regularly schooled on sun safety, with slogans like "Slip, Slop, Slap", and "No Hat, No Play" being drilled into us by school teachers almost daily. Fast forward to 2019, and there are grassroots initiatives like Call Time on Melanoma that are highlighting the importance of regular skin checks from a young age, and serving 20-somethings the hard truths that if you think you're too young to get on top of your skin health, well, you're wrong.
But I'll admit that even with all the sun safety messaging being pushed on me since birth, skin checks have always been a relative blind spot, let alone mole mapping. Mole mapping is a term that is increasingly popping up as the awareness of skin cancers rises, but I had never heard of the procedure before this year. That's why I sat down with Dr. Catherine Borysiewicz, consultant dermatologist at the Cadogan Clinic in London, to get the lowdown on exactly what this emerging skin cancer detection tool is. Keep on reading to find out how mole mapping is different from a regular skin check and whether everyone should make an appointment to have it done ASAP.
What Is Mole Mapping?
Simply put, mole mapping is a process designed to detect very early skin cancers by monitoring atypical moles and tracking them for changes over time. In practical terms, that means a dermatologist, usually with the help of a nurse, will take digital photographs of your entire body, documenting every single one of your moles, to compare with your previous mole mapping images.
Should Everyone Have Their Moles Mapped?
According to Dr. Borysiewicz, mole mapping is most useful for anyone who has many moles on their body, moles in hard-to-see areas, multiple moles that all look different from one another, or someone who is considered at a high risk of developing skin cancer (that is, anyone who had significant sun exposure in childhood; has fair skin, freckling, and light or red hair; a family history of melanoma; use of sunbeds; or anyone with irregular moles in varying pigmentation that are more than five millimetres in diameter). "In those patients, mole mapping is invaluable," she said. "[Without mole mapping] each time you saw a dermatologist because you were worried about a mole's changing appearance, the sensible and the safe thing [for the doctor] to do would be to remove it." Instead, this type of skin check helps to save patients from unnecessary surgery because the dermatologist is able to compare the mole with previous images and confirm whether a mole is harmless, even if it looks a little unusual in isolation.
On the flip side, considering the highly specialised nature of mole mapping skin checks, Dr. Borysiewicz told POPSUGAR that anyone who has "three or four scattered moles on the arms, stomach and legs would be able to keep an eye on those at home between regular skin checks. Even with the digital photos you can take on your phone."
What Will Happen During My Mole Mapping Appointment?
A typical mole mapping appointment is a two-stage process that takes roughly 40 minutes all up, but will be shorter for follow-up appointments. The first half involves a consultation with a dermatologist — to identify a family history of skin cancer, risk factors, and any skin concerns you may have — followed by a thorough skin check. During the skin check, the dermatologist inspects every single mole and freckle on your body with the dermatoscope, making a note of any specific moles that require mapping. A dermatoscope is a small, hand-held (and non-invasive) device that is basically a high-tech magnifying glass designed specifically to inspect moles. The device, which has a daylight bulb and a 20-times magnification, allows the specialist to "zoom in and out through the first layers of the skin to see the incredibly detailed structure," Dr. Borysiewicz said.
Image Source: Getty / zoranm
The second half of the appointment is usually performed by a nurse, who will first take photographs of your entire body from all angles to ensure every inch of your skin has been recorded. Next, they'll use a more detailed imaging device to take microscopic photos of any moles the dermatologist has determined to be atypical, and map them with the full-body images. Rest assured, the entire process is completely painless.
How Is Mole Mapping Different From a Standard Skin Check?
A standard skin check at either your GP or dermatology clinic is generally a quick process that takes only 10 minutes to complete. Specifically, you will be asked to remove your clothes and put on a medical exam gown, then the dermatologist looks at every inch of your body to inspect your moles. At this point, you would point out any moles that have caught your eye, or you feel are concerning for the doctor to have an even closer look at.
During the standard skin check, the doctor follows the very strict NICE guidelines, set by the British Association of Dermatologists (BAD), which, simply put, are the ABCDE guidelines, Dr. Borysiewicz said. That is, they'll be evaluating the asymmetry, border irregularity, colour, diameter, and evolution (aka changes over time) of your moles.
What Happens After My Mole Mapping Appointment?
What happens immediately following your mole mapping appointment depends on the outcome of the exam. When I asked Dr. Borysiewicz whether she would alert a patient during their mole mapping appointment if she identified a mole that's worrying, she confirmed that she would discuss it immediately. Currently, the best practice following mole mapping is to remove any mole that the dermatologist feels is worrying, and send it for further testing.
Logistically, it's important that the doctor discusses any concerns with the patient at the mole mapping appointment, in order to organise a timely follow up. She also thinks it's a great opportunity to teach the patient how to spot an atypical mole in the future, "particularly in terms of helping people learn what to look out for when self-checking at home." She said, "the beauty of the mole mapping is that when I take the photographs, I can actually show you, visually, what I'm looking at, and what I'm worried about," so you'll know what to look out for in the future.
If the dermatologist doesn't identify any concerning moles while performing your mole mapping, then they will likely tell you on the spot too, before creating a more thorough report which will be sent to yourself and your GP. As for how often you should have mole mapping done, Dr. Borysiewicz said, "For people where everything looks normal and stable, it would be a 12-monthly appointment." As for people who have slightly unusual-looking moles, it may be a six-month follow-up instead, but your doctor will recommend what is best for you.
Can I Map My Moles Myself at Home?
In short, yes. But that doesn't mean you should delay seeking medical advice if you notice a mole that worries you. According to Dr. Borysiewicz, one of the most useful tools you have to monitor your moles at home over time is the camera on your phone. This is also helpful if you've seen your GP about a specific mole, have been assured it is harmless, but have a niggling feeling that something isn't quite right. "If you're worried about a mole, take a picture of it regularly over a couple of weeks, so you can prove change over time [to your GP]," she said. "That is immensely helpful if you're trying to persuade a GP [to refer you to a dermatologist] if you feel that they're not understanding what you're saying."
When it comes to full-body skin checks at home, Dr. Borysiewicz suggests you become very comfortable looking at yourself naked in a full-length mirror to learn what your skin's version of normal looks like. "Every patient should be looking at their skin at least every three months . . . literally just when they come out the shower, have a good look," she says. "You want to look in a mirror, front and back, and, not in any huge amount of detail, focus on a few hidden places on your feet, between your toes, and your fingers." It's important to do these at-home skin checks regularly, she says, to notice when a new mole appears, or something that looks a bit off. "The big advice I give patients over all the years I've done melanoma work is called the Ugly Duckling sign. This is literally when you look in the mirror, it is the one thing that your eye goes straight for." The NHS also has a helpful self-assessment tool on their website if you don't know where to start.
Is Mole Mapping Covered by the NHS?
In short: yes. The longer answer is a little bit more complex, though. The highly specialised mole mapping process outlined above will not be offered to every patient through the NHS since it's reserved for very high-risk patients. If you are considered to be at a high risk of developing skin cancer, and have been through the process of a regular skin check with a dermatologist who has referred you for mole mapping at a public clinic, it will be fully covered.
According to the British Association of Dermatologists, one in six people in the UK are not aware that a mole can be checked for free by a GP. Furthermore — there are no long waiting lists for patients seeking a skin check through the NHS. "Most GPs are very, very good at assessing [moles] and making a decision," Dr Borysiewicz said. "If they're worried that the mole is changing, or if it has features that also make them worried, you will be referred to see a specialist dermatologist within two weeks." She also notes that full-body skin checks by your doctor are very important as it is "very difficult to assess moles in isolation." That means, if you are concerned about any mole (or feel that you're simply due for a skin check), you should seek advice from your GP as soon as possible, and request a referral to a dermatologist if you feel that you require a more thorough examination.