The mole that changed: when to have it looked at

Skin cancer is the commonest cancer in humans and also the most curable, on one condition: that it is treated in time. In Peru people come late, and in the consultation the same two reasons come up again and again.

The two beliefs that make people late

The first: that dark skin does not develop skin cancer. It is false. It develops less often, but it is diagnosed later precisely because of that belief, and so it arrives in worse shape.

There is an important nuance: in darker skin, melanoma appears relatively often in areas with little sun exposure — the soles of the feet, the palms and under the nails — which are the ones nobody looks at. Those areas need checking too.

The second: not taking the radiation into account. Lima, the highlands and the jungle have very high ultraviolet indices, and the accumulated exposure of a working life outdoors is a real factor, even without memorable sunburn.

Which changes justify a consultation

• A mole that changes in size, shape, colour, or whose borders become irregular.
• A lesion that bleeds, ulcerates or does not heal within a month. This is the most underestimated: it gets put down to a knock, a shave or a spot, and half a year goes by.
• A new lesion in an adult, especially if it is growing. New moles after forty deserve a look.
• A mole that itches or hurts for no reason.
• The one that does not look like the others. If all your moles resemble each other and there is one that is different, that is the one to look at.

A lesion that does not close within a month deserves a consultation, even if it does not hurt and even if it is small. Especially if it is small: that is when it is dealt with by minimal surgery.

Everything removed is examined

Without exception, and even when the lesion looks clearly benign. It is the only way to have a certain diagnosis and to confirm the margins came back clear.

Hence something worth knowing before agreeing to it anywhere: a suspicious lesion is not removed with laser or cautery. Those methods destroy the tissue and make pathology impossible, so the diagnosis is lost and there is no way of knowing whether anything was left behind. For benign lesions already identified there is more latitude; where there is any doubt, it is excised and examined.

What the surgery is like

The lesion is removed with a margin of healthy skin around it, the width depending on the tumour type, and the defect is closed: directly, with a graft or with a flap, according to size and site. Thirty to a hundred and twenty minutes, local anaesthesia, as a day case, normal life in two to seven days.

On the face, where most of these tumours occur, the reconstruction matters: it is possible to remove the tumour well and leave an avoidable deformity. The order, though, is never reversed: first the margin the tumour demands, then the scar.

What is not promised

It is not promised that no scar will be left: removing a tumour always leaves a mark, and on the face it is planned to disguise it, not to avoid it. Nor that no others will appear: anyone who has had one is at higher risk, which is why there is follow-up.

If something is worrying you, the consultation is quick and often reassuring. You leave knowing what it is.