Dr Shefali Rajpopat, Consultant Dermatologist Answers Your Frequently Asked Questions on Melanoma

Melanoma is an uncommon but potentially life threatening type of skin cancer. It is the fifth most common cancer overall in the UK and the second most common in adults under the age of 50. Early detection and treatment is key to ensuring a good outlook.

In our latest Ask the Expert article (published in The West Essex Life Magazine), Dr Shefali Rajpopat, Consultant Dermatologist answers your frequently asked questions on melanoma

What causes melanoma?
Excessive exposure to ultraviolet light is the main cause of melanoma. Tanning and especially sunburn damages the genetic material inside skin cells. The body has machinery to repair this but the process is not always perfect and so with repeated sunburn and increasing age, there is a higher chance that something will go wrong. Melanoma arises when the damaged DNA is not removed and this prompts the cell to multiply uncontrollably in a malignant fashion.
Who is at risk of melanoma?
The following increase the risk of developing melanoma:
  • excessive sun exposure
  • sunbed use
  • sunburn
  • older age – melanoma is very rare in children
  • fair skin that burns easily, especially with fair or red hair
  • having lots of moles – especially if they are large and have odd shapes
  • having a parent or sibling with melanoma
  • having had a previous skin cancer
  • conditions or drugs that lower your immunity
  • Parkinson’s disease.
What are the signs and symptoms of melanoma?
The most common sign is the appearance of a new mole or change in an existing mole. Melanomas can arise anywhere on the skin, not just on a sun-exposed site. Rarely melanoma can affect the eyes, lips, mouth and genitals. There are often no symptoms but any mole that is persistently itchy, sore, crusty or bleeding should be checked. Melanomas begin as flat moles that change shape, size, colour and sometimes texture and elevation.
What is the ABCDE of moles?
This is a checklist that can help to distinguish between a normal mole and a melanoma:
  • Asymmetrical – when you compare two halves of an abnormal mole they will look different
  • Border irregularity – melanomas have irregular or notched borders while normal moles have a smooth outline
  • Colour variation – moles with three or more colours may be abnormal
  • Diameter over 6mm – this may be an abnormal sign if all the other moles are small
  • Evolving – melanomas change appearance with time.
Visit to see a slide show on the ABCDE.
What is the ugly duckling sign?
This is the concept that an individual’s moles resemble each other and so the abnormal one is the mole that looks different to the rest. For example, in a person with lots of moles that are large and dark, the ‘ugly duckling’ would be a small or light mole.
What are the types of melanoma?
  • Superficial spreading melanoma is the most common type and accounts for 70% of all cases. This is a flat asymmetrical mole with an irregular outline and lots of colour variation that will change with time.
  • Nodular melanoma is a lumpy mole that can grow and spread more rapidly. They are often black or dark red. Bleeding, crusting an oozing are common symptoms.
  • Lentigo maligna melanoma affects the elderly, evolves slowly over many years and affects sun exposured sites, such as the face. Suspect this if there is a large ‘sun spot’ that is growing, changing shape or colour.
  • Acral lentiginous melanoma arises on the palms and soles. It is the most common type of melanoma in pigmented skin.
  • Subungual melanoma grows under the nail. Suspect this if there is a new dark band on a nail.
  • Amelanotic melanoma is rare. It lacks colour and doesn’t look like a typical mole. Suspect this when there is an unusual red or pink spot on the skin.
How is melanoma diagnosed?
A skin specialist will check a suspicious mole with a dermatoscope. This is a specialised magnifying glass that allows the mole to be reviewed in greater detail. The examination is painless and can be performed on the spot. If the mole looks abnormal then it is removed under local anaesthetic and sent for testing to check if it is cancerous.
How is melanoma treated?
If melanoma is confirmed, then a second surgical procedure is performed called a wide local excision. This involves removing a larger area of skin to ensure that no cancerous cells are left behind.  For most people diagnosed at an early stage, no further treatment is needed and the outlook is very good.
If there is concern that the melanoma has spread to other organs then additional tests may be needed such as a lymph node biopsy and a PET scan. A cancer specialist would also be involved and in the last few years there have been major advances in the treatment of advanced melanoma with several new therapies now available.
How can I prevent melanoma?
Be sensible in the sun and use a combination of techniques to avoid burning:
  • Seek shade under trees, umbrellas or parasols.
  • Sunscreen – use at least SPF 30 for UVB protection and look for a high star rating or ‘UVA’ in a circle, which indicates that it meets the EU standard. Apply it liberally, re-apply frequently and check the expiry date before use. Remember sunscreen doesn’t offer 100% protection and you can still burn.
  • Clothing – wear lose fitting clothes made from material with a tight weave. Wide brimmed hats provide great protection as do good quality sunglasses.
  • Sunbeds are best avoided but cosmetic tanning products are a great alternative.

Self-monitoring is really important. Know your skin and if you see a new or changing mole that looks different to the rest, get it checked immediately.

Dr Rajpopat has clinics at The Holly Private Hospital on Wednesday evenings. To make an appointment call our friendly appointments team on 020 8936 1201. 

Date: 30/07/2018