This mole had been growing and changing for a few years, and there was no other mole on the patient’s skin. This should have sounded warning bells, but she wasn’t worried because it didn’t itch. And itching is an important feature of skin cancer, isn’t it? NO IT ISN’T. I have been working in this field for 20 years and learned from many of the world’s best experts, attending their lectures, reading their books, even sitting in on some of their clinics. Melanomas DO NOT as a rule itch. It’s what they look like that worries us, not what they feel like. Many people also assume that skin cancers are painful. They aren’t (with the exception of a proportion of some squamous cell cancers, but they are easy to diagnose as they grow so fast).

Here is the ‘mole’ as presented to the doctor, several years after it…

During a routine skin check, a mole was noticed that was larger and darker than the person’s other moles.

It’s not dramatic, but it stands out, so it needs a closer look.

Dark, slightly irregular. Needs a closer look.

Dermoscopy reveals no chaos, clues to benignity, no melanoma clues.

This mole is dark brown with two patterns arranged concentrically (featureless centre, reticular lines in the periphery which fade out evenly all round. We also see several small pale areas which represents perifollicular hypo pigmentation. This is of no significance. The overall appearance is highly symmetrical, a slight irregularity of shape means nothing.

Lesion was not excised. The beginner with Dermoscopy should get a book, attend courses and use the web, but should then apply the dermoscope to hundreds and thousands of lesions to ‘train your brain’ to recognize the range of normal naevi…