Dermoscopic mole check in Belgrade

The ABCDE rule is used for self-examination: A – asymmetry (the halves of the mole differ), B - irregular, blurred or indistinct edges, C – multiple colours or shades in the same change, D - diameter greater than 6 mm and E – evolution, that is change over time. In practice, the last letter is the most important: a mole that is changing speaks more than a mole that simply looks unusual.

The “ugly duckling” sign is also useful. A person's moles usually resemble one another, so the one that stands out from the rest in colour, shape or size deserves attention, even when it does not meet the ABCDE criteria.

An urgent examination is needed if a mole bleeds, oozes, itches or is inflamed. Self-examination helps to notice a change in time, but it does not replace a dermoscopic examination.

Benign mole

• symmetrical, regular in shape (oval, round or oblong)
• neat, regular edges
• light brown or dark brown in colour (red moles are also mostly harmless)

High-risk mole

• irregular in shape, ‘notched’, frayed edges
• uneven colours, either very dark (almost black) or other unusual colours
• larger than 6 mm with noticeable changes
• if there is inflammation, weeping, bleeding, itching (it is essential to consult a doctor)

Between annual check-ups, it is useful to occasionally, every few months, check your skin yourself. Self-examination takes a few minutes and is easiest with a large mirror and daylight, in this order:

1. face, neck, chest and stomach;
2. with arms raised – hips, armpits, both sides of the arms and palms;
3. in a sitting position – legs front and back, soles of the feet, the space between the toes and around the nails;
4. with a smaller mirror or someone else's help – back, bottom and back of the head;
5. scalp, by parting the hair section by section.

People with many moles can occasionally photograph them with their phone, always under the same light and from the same angle, because comparing the photographs makes it easier to notice any changes.

Yes, when necessary. Melanoma does not only occur on sun-exposed skin – it can also develop on the soles of the feet, palms, under the nail and on mucous membranes. That is why those areas are also examined during a full-body check, and a dark streak that has appeared under the nail always warrants an examination.

Yes. Children are born with few moles, and most develop during childhood and puberty, so the appearance of new ones is not in itself a cause for concern. An examination is advised for congenital moles, especially larger ones, for changes that grow rapidly, for pink or reddish changes that are enlarging, and for children with many moles and fair skin prone to burning. Children are examined in the presence of a parent or guardian.

During pregnancy, existing moles may darken slightly or enlarge, and new ones may appear, which in itself is not a sign of danger. However, a mole that changes shape, acquires multiple colours, itches or bleeds should not be attributed to pregnancy without a dermatologist's assessment. A dermoscopic examination is safe at all stages of pregnancy, as the skin is merely observed under magnification.

• Change in an existing mole (inflammation, bleeding, change in shape/colour)
• Increased exposure to UV rays
• Heredity and skin type

Before the advent of dermoscopy as a diagnostic method, every skin lesion suspicious of cancer (especially malignant melanoma) was referred for surgical removal with mandatory histopathological analysis. The use of the dermatoscope has enabled:

• Increasing diagnostic accuracy by a large percentage
• Increase in the number of tumours detected at an early stage
• Reduction in the number of unnecessary surgical interventions
• Easier differentiation of pigmented skin lesions from melanoma

A 2018 Cochrane review showed that dermoscopy, alongside clinical examination, is significantly more accurate at detecting melanoma than examination with the naked eye and reduces the number of unnecessary removals. Sources are listed at the bottom of the page.

This examination is very important, therefore it should by no means be forgotten or skipped, because a dermoscopic examination can detect:

• Difference between benign and malignant skin lesions
• Early diagnosis of melanoma
• Type of skin tumour – basal cell carcinoma, squamous cell carcinoma, seborrhoeic keratoses, dermatofibroma...
• Fungal skin infections
• A clear distinction as to whether they are warts or other skin lesions

Using a dermatoscope, even the smallest change, invisible to the naked eye, can be spotted and treated in time. Given that a growing number of skin tumours are being recorded worldwide, doctors recommend that a dermoscopic examination of moles is carried out at least once a year, and more frequently for high-risk groups.

Dr Marina Ćirović explains how moles develop and when they should be removed in the article Everything you need to know about moles.

Dermoscopy reveals structures in the superficial layers of the skin, down to the papillary dermis, so deeper changes cannot be assessed with it. It does not provide a definitive diagnosis, but helps to decide whether a lesion is harmless, whether it should be monitored or if tissue analysis is required. No dermoscopic finding is completely certain, which is why a suspicious lesion is removed and sent for histopathological analysis, while a borderline one is monitored over time.

When tissue examination is required for a diagnosis, the doctor determines the appropriate sampling method. More about the procedure and analysis can be found on the page skin biopsy.

Moles are removed for two reasons. Medically, when a dermoscopic finding shows a change that needs to be analysed – then removal is a diagnostic step. Aesthetically or practically, when a mole is harmless, but bothersome: it is located in an area of friction, catches on clothing or is injured during shaving.

Depending on the findings, we perform surgical removal of a mole or radiowave removal, and the removed tissue is sent for histopathological analysis in both cases. The results are usually ready in a few working days up to two weeks. Moles should not be removed in beauty salons, with acids or over-the-counter products, as this destroys the tissue and it can no longer be analysed.

A photograph can serve as a rough guide, but it does not replace a dermoscopic examination. The structures that a dermatologist assesses are located beneath the skin's surface and cannot be seen in a photo taken with a phone.