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See also melanomas; cancers
of the mouth and skin; benign lesions
of the skin
What are freckles and skin moles?
Freckles are small usually pale brown areas of skin, which are
often temporary and are usually caused by exposure to the sun.
Moles are areas of darker pigmented (brown or brown/black) on
the skin, they are long-lasting and are only indirectly associated
with exposure to the sun.
Both freckles and moles are very common in all peoples of the
world but they are more obvious in people who have lighter coloured
skin. There are rare types of freckles (usually clustered around
the mouth) that are part of a genetic syndrome called Peutz Jegher's
Syndrome. These are quite easy for a doctor or dentist to diagnose
in a person or family.
Why do we have pigment in our skin?
The colouration in our skin (partially) protects us from ultraviolet
(UV) light in the sun. Some people have dark skin all the time
and others only when they are exposed to UV light (tanning). Even
people with normally dark skin usually go darker in the sun.
How to stay safe in the sun
What causes pigmentation of the skin?
Skin is a particular colour because of the production of types
of melanin by a specialised skin cell called the melanocyte. If
these are infrequent, evenly spaced and produce low levels of
melanin you will have pale skin. If you have more of the cells
and they produce higher amounts of melanin you will have darker
(or even black) skin. If the melanocytes cluster together and
produce melanin, you can develop freckles or moles, which depends
on how many of the cells are clustered and how much melanin they
make.
What causes skin moles and are they 'normal'?
Moles are very common and therefore 'normal' for most people:
the average adult has between ten to forty at any time. Moles
are collections of melanocytes that are producing melanin to give
a concentrated 'patch' of colour in the skin.
Some people are born with a few or many moles and some families
have more moles than others. We think others develop moles as
a response to sun exposure. The type of moles that doctors are
most interested in are those that can become a type of skin cancer
(melanoma).
You can have any number of moles, and most never become cancerous.
How common are unusual/atypical moles?
Moles that are considered unusual or 'atypical' occur in around
10% of the population. Only one in ten thousand of these people
will have a malignant (cancerous) mole.
Do moles last for ever?
Some moles do last for your lifetime, others come and go but
usually over years.
Quite often a mole begins as a small, flat spot and over time,
becomes raised. It might then flatten again, become paler and
even disappear altogether.
Some moles develop and change their appearance quickly - these
are the ones to be most concerned about.
How can I keep an eye on my moles?
Doctors encourage people to be aware of what is 'normal for
me' and to look out for changes in the appearance and feel of
their bodies. This is also true for your moles.
When you wash in the bath or shower, you will become aware of
where your moles are and what they look like; if one or more changes
its appearance towards a suspicious mole (see below), let your
general practitioner (GP) know.
What changes in moles can mean they need medical attention?
Doctors encourage people to keep an eye on their moles and ask
them for advice when a mole:
If you find a mole that has any of these changes, do go to see
your general practitioner soon. They will be able to check it
out for you and refer you to a dermatologist or oral and maxillofacial
surgeon (if it is on your head, neck, face or is in your mouth).
If my moles change appearance does it mean I have cancer?
Moles commonly change appearance and most of these changes will
not be cancers (see above). It is best for your health to know
so you either won't worry unnecessarily or might catch an early
cancer when it can be successfully and easily treated.
How can doctors tell if a mole is a cancer or just atypical?
Patients are good at detecting changes in their visible moles.
Doctors are good at telling which moles are probably normal and
which look as if they might be atypical or unusual (or even cancers).
To tell if a mole is an early cancer, the doctor will usually
need to look at some cells from the mole under a microscope. These
cells are obtained after a biopsy, which (depending on the size
and location of the mole) usually removes part or the whole of
the mole and/or a little tissue around it.
Some specialist clinics (eg at Addenbrooke's
Dermatology) have equipment that detects the most atypical
(suspicious) moles without the need for biopsy.
How are moles removed?
If a biopsy of a mole indicates the presence of atypical or
already cancerous cells, removal of the mole will probably be
recommended. The removal of the mole usually includes the removal
of a normal margin of tissue around the mole. This is to ensure
that no cancer cells remain around the site of the mole.
There are different techniques for mole removal according to
where they are on your body. Those on the face are treated very
carefully to minimise any scarring.
Your doctor will carefully explain what is involved for you and
support you throughout the process.
Can I have moles removed within the NHS?
Your general practitioner is the best person to advise you about
the removal of moles within the NHS. For example, it might not
be a health priority of the NHS for moles to be removed for purely
cosmetic reasons.
If the mole seems suspicious to them, it will be a priority to
know if it is a skin cancer and they will advise you of how to
proceed.
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