When Should a Mole Be Checked? A Clinician-Led Guide to Changing Moles and Skin Lesions

Most moles are harmless. Even so, knowing what is normal for your skin makes it easier to notice a new or changing mark that deserves professional assessment. Melanoma can arise in an existing mole, but it can also appear on skin that previously looked normal. Other skin cancers may look more like a persistent scab, sore, lump or scaly patch than a familiar mole. [1] [2]

This guide explains the changes to look for, what the ABCDE rule can—and cannot—tell you, and what may happen during an in-person skin cancer check with a suitably trained clinician.

Important: Photographs and checklists cannot diagnose skin cancer. If you are worried about a new, changing or unusual lesion, contact your GP or an appropriately qualified clinician. Do not delay an urgent NHS assessment while waiting for a private appointment.

The most important sign is change

The appearance of healthy moles varies considerably from person to person. A useful starting point is therefore not whether a mark looks exactly like a photograph online, but whether it is new, changing or noticeably different from your other moles.

Changes that should prompt an assessment include a lesion that:

• changes in size, shape or colour
• develops an irregular or blurred edge
• contains several colours or becomes much darker than your other moles
• bleeds, crusts, oozes or does not heal
• becomes inflamed, itchy, painful or otherwise feels different
• appears as a new lump, patch or mark that persists for more than a few weeks

A lesion does not need to be painful to be important. Many melanomas do not itch or hurt, while some non-cancerous lesions do. Symptoms are clues for assessment—not proof of a diagnosis. [1]

The ABCDE guide to checking a mole

The ABCDE framework is a memorable way to recognise some features associated with melanoma:

• A — Asymmetry: one half of the mole or patch looks unlike the other half.
• B — Border: the edge is irregular, blurred, jagged or notched rather than smooth.
• C — Colour: the colour is uneven or includes different shades, such as brown, black, pink or red.
• D — Diameter: many melanomas are more than 6 mm across, but an early melanoma can be smaller. Size alone cannot rule cancer in or out.
• E — Evolving: the lesion is changing in size, shape, colour, surface or sensation—or has started bleeding, itching or crusting.

ABCDE is a prompt to seek advice, not a home diagnostic test. A melanoma may not display every feature. A mark that looks like an ‘ugly duckling’—meaning it stands out from your other moles—should also be checked, even if it does not fit the full ABCDE pattern. [1]

Skin cancer does not always look like a dark mole

Melanoma can occur on any skin tone and anywhere on the body. In brown or black skin, it may be harder to recognise and may appear on a palm, the sole of a foot or beneath a nail. Some melanomas are pink or relatively symmetrical rather than dark and obviously irregular. [1] [2]

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) can also have a wide range of appearances. A BCC may resemble a pearly lump, a red flat patch, or a scab that repeatedly bleeds and does not completely heal. An SCC may appear as a scaly or crusted raised area, a tender lump or an ulcer.

For a self-check, look beyond the areas that receive the most sun. Include the scalp, behind the ears, back, under the breasts, groin, palms, soles, between the toes and beneath the nails. A mirror—or help from someone you trust—can make difficult-to-see areas easier to examine.

What happens during a professional mole or lesion check?

At The Medical Skin Clinic in Newmarket, a skin lesion consultation begins with a clinical history and an examination. The clinician may ask when you first noticed the lesion, how it has changed, whether it has bled or caused symptoms, and whether you have personal or family risk factors.

Where clinically appropriate, the lesion is then examined using dermoscopy. A dermatoscope is a handheld magnifying instrument with a specialised light source. It allows a trained clinician to see structures and colour patterns beneath the skin surface that cannot be assessed reliably with the naked eye alone.

NICE states that dermoscopy performed by suitably trained specialists can improve the distinction between benign and malignant lesions, reduce the risk of missing melanoma and reduce unnecessary surgery for benign lesions. However, dermoscopy does not replace tissue diagnosis when a lesion needs biopsy or removal. [3]

Dermoscopy, biopsy and histology: what is the difference?

• Dermoscopy: a non-invasive, magnified-light examination of a lesion while it remains on the skin.
• Biopsy: removal of all or part of a lesion so tissue can be examined. The method depends on the clinical question, lesion and location.
• Histology: laboratory examination of the removed tissue under a microscope by a pathologist. This can establish the tissue diagnosis and help guide further care.

If a lesion appears benign, the clinician may advise reassurance, monitoring or elective removal if it is symptomatic or unwanted. If tissue diagnosis is required, the plan may involve biopsy or excision with histology. A consultation is not a guarantee of same-day removal: assessment and treatment are planned according to clinical priority, location, complexity and the safest pathway.

What if the lesion may be skin cancer?

The next step depends on what is suspected. The Medical Skin Clinic can diagnose and surgically manage selected skin cancers within its scope, including selected BCCs and SCCs. Tissue removed at the clinic is sent for histology when indicated, and the result is reviewed with the patient.

Some findings require onward referral rather than treatment at the clinic. If melanoma, a higher-risk skin cancer or care requiring a hospital skin cancer multidisciplinary team is suspected, the clinician will explain the concern and arrange or recommend referral through the appropriate local hospital or NHS pathway. UK guidance supports urgent specialist referral for lesions that meet suspected-cancer criteria, including where dermoscopy suggests melanoma. [3] [4]

Choosing a private assessment does not remove your right to NHS care. If an urgent hospital pathway is the safest next step, that should take priority.

Can a lesion be removed if the NHS considers it cosmetic?

Yes, following an appropriate assessment. Some benign lesions are not routinely removed by the NHS when treatment is considered cosmetic or of limited clinical value. The Medical Skin Clinic offers self-funded removal of suitable benign lesions, including lesions that are unwanted, repeatedly irritated or affecting confidence.

The clinician must assess the lesion before recommending a technique. If there is diagnostic uncertainty, histology may be advised even when the original reason for seeking removal was cosmetic.

When should I arrange an appointment?

Arrange an assessment if you notice a new, changing or unusual lesion, or if something about a mark worries you. You do not need to wait until it meets every ABCDE feature. A persistent sore, unexplained nail streak, bleeding area, changing lump or lesion that looks very different from the rest of your skin also deserves attention.

If you already have an urgent NHS referral, keep that appointment. If your GP or clinician advises a suspected-cancer pathway, do not postpone it to seek cosmetic removal elsewhere.

For patients in Newmarket, Cambridge, Bury St Edmunds and the surrounding Suffolk area, The Medical Skin Clinic offers in-person skin cancer checks with dermoscopy where clinically appropriate. Appointments are available with a GP with a Special Interest in Dermatology or a Dermatology Clinical Nurse Specialist. If consultant or hospital assessment is needed, our team can advise on an appropriate referral pathway.

Frequently asked questions

Does every changing mole mean melanoma?

No. Benign moles and other non-cancerous lesions can change or become irritated. Because appearance alone is not always reliable, a new or changing lesion should be assessed rather than self-diagnosed.

Can dermoscopy confirm that a mole is cancerous?

Dermoscopy gives a trained clinician a more detailed view and can improve diagnostic assessment, but it is not the same as histology. If a definite tissue diagnosis is needed, biopsy or excision may be recommended.

Will my mole be removed at the first appointment?

Not necessarily. The first priority is an accurate assessment and a safe plan. Removal may be arranged separately depending on the diagnosis, procedure required, consent, location and complexity.

What happens to a lesion after it is removed?

Where histology is indicated, the specimen is sent to a pathology laboratory for microscopic examination. The clinic reviews the report and explains whether any follow-up or further treatment is required.

Will I be referred to hospital if the lesion looks suspicious?

Yes, when hospital assessment or multidisciplinary skin cancer care is the appropriate pathway. The clinic can provide clinical information and facilitate or recommend onward referral. Suspected melanoma and certain higher-risk cancers should follow an urgent specialist pathway.

Can private health insurance cover a skin cancer check?

Cover depends on the insurer, policy, referral requirements and whether care is considered medically necessary. Contact your insurer before booking and obtain any required authorisation. Cosmetic lesion removal is normally self-funded.

A calm, medically led next step

Finding a changing lesion can be worrying, but online images cannot tell you what it is. An in-person assessment provides a safer next step: the lesion can be examined in context, dermoscopy can be used where appropriate, and you can receive a clear plan for reassurance, monitoring, biopsy, surgery or onward referral.

If you are concerned about a mole or persistent skin lesion, contact your GP or book a skin cancer check at The Medical Skin Clinic. If you have already been given an urgent NHS referral, please keep that appointment.

References

1. 1. Cancer Research UK — Symptoms of melanoma skin cancer (reviewed 2 January 2025)
2. 2. British Association of Dermatologists SkinHealthInfo — Skin cancer
3. 3. NICE Quality Standard 130 — Quality statement 3: Dermoscopy (updated 2024)
4. 4. Cancer Research UK — Referral to a melanoma skin cancer specialist