The mole check process: choosing the suspicious lesion(s) for medical assessment

At this point, you understand the importance of selecting the appropriate lesions to eventually upload for medical assessment. We know from everyday practice that the suspicious lesions patients bring to a mole check are often not the ones that dermatologists eventually identify as causes for concern. With self-mole checks, it is your responsibility to do your best to identify the lesions that truly need to be examined by a doctor. In this section, we will provide thorough guidance on how to conduct a self-mole check and how to potentially identify the right lesions for medical analysis.

PLEASE NOTE: This section is educational only, preparing you for your mole check. There is a dedicated section later when we guide you through the process.

Are You a High-Risk Patient with Numerous Moles?

A special note for high-risk patients with a large mole count: for those with a high number of moles, such as those with Atypical Mole Syndrome (AMS), selecting suspicious moles can be incredibly challenging, simply because many may appear suspicious. In our opinion and experience, on-the-spot medical knowledge, using a handheld dermatoscope, or even mole mapping with comparative analysis is crucial during their examination. This case study demonstrates how mole mapping led to the diagnosis of an early-stage melanoma undetectable by the naked eye.

We strongly encourage high-risk patients to seek a dermatologist-led mole check or, even better, a mole mapping check.

Despite this, if you can identify a changing mole, you may submit it here, but please be aware of the limitations detailed above.

Can You Conduct a Mole Check Alone?

Are you ready to perform a self-mole check? But wait a moment – can you do it alone? As it’s called a “self” mole check, you might assume you should be able to, right?

Based on our experience, we believe that the best results come from involving someone else (a trusted family member or friend) in the mole check process. We recommend proceeding with this “assisted self-mole check” setup and have formulated our guidance accordingly.

Why do we believe this is the better approach? There are two main reasons:

#1 “Four eyes see more than two”: Engaging someone else in the skin examination process provides an extra pair of eyes, increasing the chances of spotting something suspicious, particularly in hard-to-examine locations. Additionally, you can discuss specific moles to determine whether they should be submitted for medical assessment. Before conducting the mole check, ask your helper to review the same learning materials on this website to ensure both of you possess the same knowledge and understanding.

#2 Taking images: We believe that it’s nearly impossible to capture dermatoscopic images of one’s own moles, especially in hard-to-reach locations such as the back, regardless of the method used. Having a helper is essential for taking high-quality images.

How to conduct an ‘assisted self-mole check’?

The first two most important aspects of a mole check process are to check the whole body and identify the suspicious moles. In the case of an ‘assisted self-mole check’, this is your and your helper’s responsibility.

The order of examination:

Always follow the same steps:

Print out the Mole check: Order of examination manual

Print out the What to look for and helping questions manual

Step	‘Patient’	‘Helper’	Comment
1	Sits on a chair	Checks the scalp for any unusual pigmented or shiny reddish lesions	Check the ears, behind the ears
2	Check the face and neck from the front with a hand held mirror	Checks the same areas with the patient and they discuss what they see
3	Check the chest the same way		Check beneath the female breasts as well.
4	Check the abdominal area together		Check the navel
5	Check the sides of the torso + armpit together		Disregard the possible, skin coloured hanging skin tags here.
6	Check the right arm together	Examine the triceps region	Any pigmentation on any of the fingernails?
7	Chek the left arm together	Examine the triceps region	Any pigmentation on any of the fingernails?
8	Check the lateral aspect of the left leg together
9	Check the medial aspect of the left leg together
10	Check the medial aspect of the right leg together
11	Check the lateral aspect of the right leg together
12	Is there anything among the toes?		Any pigmentation on any of the toenails?
13		Checks the upper and lower back
14		Checks the buttocks
15		Checks the back of the thighs
16		Checks the calves
17		Checks the soles of the feet
18		Asks the patient about hidden areas (genitalia) whether there are any moles.	If yes, find the best way to take images and discuss whether to submit or not.

What Should You Look For?

– Look for the outlier mole that stands out from the rest: the “ugly duckling.”

– Look for moles that exhibit the ABCDE characteristics:

Asymmetry: The two halves of the mole do not match.

Border: The edges are irregular, scalloped, or poorly defined.

Colour: The mole has various shades of brown, black, or other colours.

Diameter: The mole is larger than 5mm (about the size of a pencil eraser). However, this is a weak point, as there are melanomas smaller than 5mm.

Evolving: The mole changes in size, shape, or colour over time.

– Look for anything reddish and shiny, particularly with shiny edges (stretch the skin when examining shiny lesions).

– Look for non-healing skin lesions that bleed or ooze intermittently. (If there is bleeding or oozing, your helper should wear gloves during the examination, and the area should be covered with a bandage afterwards.)

– Review these images of benign skin lesions.

– Examine these images of potentially concerning lesions.

How to Decide Whether to Submit a Particular Lesion for Medical Assessment?

Consider the following questions to decide whether to submit a skin lesion for medical assessment or not:

– How long has that lesion remained unchanged? If your answer is “a long time for sure” or “as long as I can remember” it is likely to be a benign mole.

– Is the lesion growing or changing? If that particular mole hasn’t changed in any way for a long time and you are sure of it, it might be benign. Change (E from the ABCDE rule) is a sign of suspicion.

– Is the lesion flat or raised? This doesn’t matter: skin cancer and benign lesions can be flat or raised, so it is not a determining factor.

– Evolving, asymmetrical, odd lesions should be submitted for medical assessment.

Later, in the photography section, we will provide more sophisticated methods to help determine whether a lesion should be submitted or probably not.

Use your dermatoscope camera adapter to assess moles

As you can see in this video, examining a mole with the naked eye and using a dermatoscope can give different results. It’s best to use your dermatoscope camera adapter to check the ABCD characteristics of a skin lesion and decide if it needs further medical assessment.

Case studies

These case studies link to short videos on my TikTok channel. They’re made to help you learn certain parts of the mole-checking process to identify suspicious skin lesions that could be a problem.

How to spot an odd (ugly duckling) mole?

A beautiful case for the ugly duckling sign.

Dr Bela explains the ABCDE principle.

The difficulty of spotting a changing mole.

A beautiful case for the ugly duckling sign.

Melanoma: she didn’t see the change.

Is melanoma flat or raised?

In conclusion

By now, you understand how to perform an “assisted self-mole check” and what to look for. Discuss each identified lesion with your helper, considering whether to submit it for further assessment. When you decide to submit a mole, place a numbered sticker close to it or mark the mole with an eyeliner.

The next step is the most critical, as it determines whether a doctor can provide an opinion on the mole. Additionally, we will offer more advanced criteria to help you decide whether a specific mole requires further medical attention.

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